What are the Risk Factors?
It is 7 times more common in men. Risk factors include black race, chronic alcohol and cigarette use, achalasia, esophageal injuries caused by caustic substances, radiation esophagitis, esophageal diverticula, advanced age, male gender, obesity, Barrett's esophagus, nutritional disorders, vitamin deficiencies, fungal toxins, anemia, These include poor oral hygiene, previous stomach surgery, and consuming very hot food and drinks for a long time.
What are the Complaints and Findings?
The most common symptom is dysphagia, that is, difficulty swallowing. % occurs in 80 cases. Although it is usually painless, pain may occur during swallowing in some cases. Difficulty in swallowing may initially occur with solid foods, but as the disease progresses, it may also develop with liquid foods. This is a late finding and indicates that more than 2/3 of the pipe is blocked. If the lumen, that is, the pipe, is completely blocked, the patient may not even be able to swallow his saliva and lung problems may occur. Serious weight loss develops. The patient may appear cachectic and weak. Patients have severe malnutrition. In advanced stages, the tumor can infiltrate neighboring tissues and cause hoarseness, bleeding and pressure complaints. Other symptoms and complaints:
Burning sensation or pain in the upper abdomen.
Weight loss, slimming.
What are the Diagnostic Methods?
The first test to be done is a medicated film. In the film, wall irregularity, filling defect, and pressure symptoms of the mass can be seen. Endoscopy should be performed in every case of difficulty swallowing, whether or not there is any doubt on the radiograph. If a lesion is detected during endoscopy, a biopsy should be taken.
With computed tomography, the size of the tumor, its relationship with the vessels, whether it has spread to the lungs and liver, and the condition of the lymph nodes are evaluated.
Magnetic Resonance examination and Positron Emission Tomography (PET) are high-level diagnostic methods that have recently come into practice. With PET, the whole body is examined in three dimensions. It is a very effective method, especially in showing distant propagations.
Esophageal cancer can be examined as early and late.
Treatment What are the treatment methods for esophageal cancer?
The main treatment methods used in the treatment of esophageal cancer are surgery, medication (chemotherapy) and radiation therapy. The most effective method for esophageal cancer is to remove the tumor by surgery.
It starts from the neck of the esophagus and continues with the stomach in the abdomen. Due to its location and close proximity to many vital organs and vessels, esophageal surgeries are more difficult to perform than many other surgeries. During surgery, the cancer must be removed with clean surgical margins, including any glands (lymph nodes) that may spread.
It is important to prepare the patient well before esophageal surgery in terms of surgical morbidity. If the patient is very thin and has poor oral intake, 2000 calories/day should be fed enterally or parenterally for 7-10 days before the operation. Anemia, protein deficiencies and vitamin deficiencies existing in the patient should be corrected. Oral and dental care should be done. Smoking should be stopped at least two weeks in advance. The patient's lung capacity should be evaluated with respiratory function tests.
1. Open Method
In tumors that are very close to the stomach, only the lower part of the esophagus is removed by entering through the abdomen or chest cavity. Following this procedure, the stomach is reconnected with the esophagus section above within the chest cavity. Sometimes it is necessary to open both the abdomen and the chest cavity for this procedure.
Removing the entire esophagus
Another type of surgery is to remove the entire esophagus. This procedure can be done using two or three separate incisions.
In some patients, it is performed through two separate incisions made on the abdomen and neck. After the esophagus is removed, a new esophagus is made from the patient's stomach or large intestine.
It is technically not possible to remove the lymph nodes around the cancer in this surgery.
This creates significant problems in the subsequent treatment of patients whose cancer has spread to the lymph nodes in this region.
Lymph nodes can be cleaned sufficiently in surgeries where three incisions are made. However, due to the three separate incisions made, the postoperative period is quite troublesome, especially in older patients with additional problems. These patients may experience very serious problems with the respiratory system.
2. Laparoscopic and thoracoscopic method
One of the important developments in esophageal treatment is that all these surgeries can be performed laparoscopically. It has been shown in recent studies that esophageal cancers can be treated safely by laparoscopic method by providing adequate oncological clearance. In this method, laparoscopic and thoracoscopic methods are used together to ensure a much better postoperative period. The procedure performed in this surgery is the same as the classical method with three incisions. The surgery is performed with the help of tubes with diameters varying between 0.5-1 cm, which are inserted through 4-5 very small incisions made in the patient's abdomen and chest cavity. The esophagus and surrounding lymph nodes are removed together. Postoperative breathing problems are much less common. Patients feel much less pain, stay in the hospital for a shorter time, and return to their normal lives in a shorter time. The cosmetic appearance is excellent. Laparoscopic-thoracoscopic esophageal cancer treatment is the newest and most effective method in this field.
IN WHICH CASES SURGERY CANNOT BE PERFORMED:
In some cases, the tumor in the esophagus cannot be removed. The main reasons for this are;
1. The general condition of the patient does not allow a major surgery,
2. It is not possible to remove the cancer by surgery and
3. Cancer spreads to distant organs.
In this way, in patients whose tumor is left in place, different treatment options such as endoscopic stent, endoscopic gastrostomy and surgical bypass are applied to nourish the patient.
HOW SHOULD THE FOLLOW-UP BE IN CASES OF ESOPHINE CANCER:
Most relapses occur in the first 2 years. A complete FM and tests should be performed every 4 months for the first year and every 6 months for the next 2 years. Complete blood count, liver function tests, chest radiography, thorax and abdominopelvic CT are among the tests to be performed. Checking with endoscopy should be done once a year.