More men than women develop esophageal cancer in Germany. Overall, this type of cancer is comparatively rare in Germany. However, symptoms often do not appear until late. What warning signs should you see a doctor for?
As with some other types of cancer, the symptoms of esophageal cancer are initially less pronounced and non-specific. This means: They can also occur in the context of other diseases that are considered less dangerous. For example, many do not immediately think of esophageal cancer and seek medical advice late. And this often diagnoses the tumor when it is already more advanced.
The main alarm signal for esophageal cancer is difficulty swallowing. They are considered the most important sign of esophageal cancer. The reason for the difficulty in swallowing is that the tumor narrows the esophagus. Those affected first have difficulty swallowing solid food, and later also with soft, mushy or liquid food. Some people with esophageal cancer experience pain when swallowing.
The following symptoms can also indicate esophageal cancer:
If you notice any of these symptoms, always see your doctor as soon as possible. There can be harmless reasons for the symptoms, such as digestive problems, but also esophageal cancer.
Esophageal cancer is a malignant tumor that forms in the muscular tube between the mouth, throat and stomach. There are two different types of esophageal cancer, originating from different cell types:
This distinction in esophageal cancer is important because it entails, in part, a different treatment. Doctors also refer to esophageal cancer as esophageal carcinoma, esophagus is another name for esophagus.
Esophageal cancer is rare in Germany compared to other types of cancer. According to the Robert Koch Institute (RKI), 5,030 men and 1,510 women were newly diagnosed with this type of cancer in 2012. Men are therefore four to five times more likely to be affected by esophageal carcinoma than women. They are also diagnosed at an earlier age: at an average age of 67, they are about four years more likely to develop esophageal cancer than women (age: 71 years). In general, the risk of cancer increases with age.
The causes of esophageal cancer have not yet been elucidated in detail. But some factors are known to increase the risk of this type of cancer. There are different risk factors for the two types of esophageal cancer – squamous cell carcinoma and adenocarcinoma. However, one harmful influence increases the risk for both forms: smoking.
You can start with smoking, alcohol consumption and your body weight yourself – and thus eliminate important causes and risk factors for esophageal cancer.
Always consult a doctor as soon as possible at the first symptoms of esophageal cancer, for example if you have difficulty swallowing. However, because these signs usually show up late, esophageal cancer is often already at an advanced stage when it is diagnosed. The doctor will first ask you some questions about your medical history (anamnesis), including:
Your answers give the doctor a first clue as to the possible cause of your symptoms. If there is a suspicion of esophageal cancer, further examinations follow, which are usually carried out by a doctor specializing in gastrointestinal diseases (gastroenterologist).
The most important method for diagnosing esophageal cancer is an esophageal endoscopy (esophagoscopy), in which doctors examine the stomach and duodenum at the same time. The procedure has the complicated name esophago-gastro-duodenoscopy, abbreviated EGD.
The doctor carefully inserts a thin, flexible instrument – the endoscope – through the mouth into the esophagus and then into the stomach and duodenum. It is equipped with a light source and camera that delivers images from the inside onto a monitor. Doctors can use the videoscopy to assess the condition of the esophagus and identify possible changes.
Sometimes doctors also stain certain areas with dyes (chromoendoscopy) to see changes even better. At the same time, they can use tiny forceps to take tissue samples from suspicious areas (biopsy). A pathologist then examines the cells under the microscope – malignant cells are easy to identify. Pathologists can then determine whether it is squamous cell or adenocarcinoma.
If the suspicion of esophageal carcinoma has been confirmed, further examinations follow to determine the stage and extent of the tumor. This includes:
The blood values for esophageal cancer only play a role insofar as they provide information about the general physical condition. The determination of tumor markers is not recommended. If the blood values show an increased concentration of tumor markers, this can indicate cancer. However, they can also be elevated in other diseases, such as inflammation. Tumor markers as blood values are therefore neither suitable for diagnosing esophageal cancer nor for monitoring the cancer.
An X-ray examination of the chest and the so-called X-ray porridge swallow (patients swallow an X-ray contrast agent and radiologists take X-rays while swallowing) are no longer recommended in the diagnosis of esophageal cancer. These have been replaced by newer methods such as endoscopy, CT or endosonography – they deliver more precise results.
The diagnosis and treatment of esophageal cancer have improved in recent years. Nevertheless, the prognosis for esophageal cancer is still rather unfavorable because doctors often only discover the tumor at an advanced stage.
At an early stage, when the tumor is still small, esophageal cancer is curable – this applies to almost all types of cancer. Then an operation for esophageal cancer could significantly improve the life expectancy of patients. However, at the time of its discovery, the tumor was still in an early stage in only one in seven patients. Life expectancy with esophageal cancer is often low, as figures from the Robert Koch Institute show:
The treatment doctors choose for esophageal cancer depends on various factors. Most important are the type of tumor (squamous cell carcinoma or adenocarcinoma), its spread (TNM classification) and aggressiveness (grading, see explanation below). Based on the data obtained, doctors classify the disease into stages (staging). The treatment proposal depends on this “fingerprint” of the tumor. Doctors usually combine several therapies to increase their effectiveness.
In addition, the age of the patient, his general state of health and his personal wishes play a role in the therapy decision. Always talk to your doctor in detail and carefully weigh up all the advantages and disadvantages of the treatments – only then will you make a decision together with your doctor.
You also have the right to get a second opinion to gain certainty about the proposed treatment. This is stipulated by law and not an affront to your doctor. The health insurance companies and cancer advice centers often have addresses and contact persons.
Surgery is an important treatment option for esophageal cancer. The aim is to completely remove the tumor and still cure the cancer. If it has not yet spread to other organs and has not formed metastases, a cure is possible in principle. Esophageal cancer surgery is a complex and complicated procedure. Only an experienced doctor at a specialized center who has done this procedure before should perform it.
A tumor that is discovered early and is still growing superficially on the esophagus can still be operated on with a small operation using endoscopy. Doctors remove it with the help of an electric snare or knife. Doctors can still preserve the esophagus.
In most cases, however, this is not possible because the tumor has already progressed at the time of diagnosis. Doctors then remove part or all of the esophagus, along with the nearby lymph nodes. Doctors then connect the remaining esophagus to the stomach so that the food can pass through later (stomach pull-up). Doctors sometimes use a piece of the small or large intestine as an esophageal substitute. In some cases, doctors can still perform esophageal cancer surgery using minimally invasive keyhole surgery, for example through a small incision in the chest or abdomen. Another technique is “open surgery,” which means larger incisions.
After surgery, patients receive temporary feeding therapy through a tube (artificial feeding) because they cannot eat normally.
If distant metastases have already formed in other organs, the operation is of no benefit and a cure is no longer possible. Doctors then only operate to relieve symptoms or prevent complications. An example: if the tumor is so large that it prevents the passage of food. Here the operation with endoscopic procedures is possible.
Certain patients are helped by chemotherapy before esophageal cancer surgery, which they continue afterwards. For some patients, a combination of chemotherapy and radiation therapy (radiochemotherapy) is an option before surgery to shrink the tumor. This means that the subsequent intervention is less serious and the risks are reduced. Radiation therapy alone is not recommended for esophageal cancer because it is not sufficiently effective.
Combined chemo-radiation therapy is also a treatment option after surgery or as a sole measure if surgery is not possible or does not seem sensible. This supportive treatment increases the chances of success of the treatment and the chances of survival.
Both chemotherapy and radiation have some side effects. These can in turn be alleviated with supportive therapies. There are medications for pain, inflammation of the mucous membranes, nausea, vomiting, diarrhea or anemia.
Palliative care is used when esophageal cancer can no longer be cured. It is intended to slow down tumor growth, alleviate symptoms, prolong life and maintain a good quality of life for as long as possible. The following palliative treatment options are available for esophageal cancer:
Accompanying nutritional advice is also important to prevent malnutrition and weight loss. This is because many patients cannot take in sufficient food in the normal way. Many receive nutritional therapy in the form of special drinking food even before the operation – regardless of their nutritional status.
The course of esophageal cancer depends on the type, size, spread and aggressiveness of the tumor. Basically, cancer in the early stages can be treated better and is associated with greater chances of recovery. If metastases have formed in other organs, the cancer is no longer considered curable.
Doctors divide esophageal cancer into stages (“staging”) – the treatment also depends on this. The TNM classification is internationally used for the characterization of tumors:
Sometimes the tumor can only be classified more precisely according to the TNM classification after the operation.
It is also important for the course of esophageal cancer how closely the cells still resemble healthy cells (how well they are differentiated). In technical jargon, this is called “grading”. There are G1 (tumor cells are still very similar to normal cells) to G4 (cells no longer resemble healthy tissue). The pathologist obtains this information from the histological examination of the tumor cells under the microscope. He can also see whether it is squamous cell carcinoma or adenocarcinoma.
The course of esophageal cancer is often rather unfavorable. The main reason is that doctors usually only diagnose it at an advanced stage. The cancer cells spread through the blood and lymphatic system in the body. Esophageal cancer metastasizes to the lymph nodes and organs such as the lungs, liver or bones. In addition, the tumor in the esophagus enlarges and narrows it more and more. End-stage esophageal cancer means that patients often no longer eat anything in the normal way. Over time they become weaker and weaker. Treatment can often slow down the progression and gain life. Some patients experience a relapse after an initially successful treatment – then the esophageal cancer returns despite treatment.
Unlike breast or colon cancer, there are no special early detection measures for esophageal cancer. In general, the earlier doctors diagnose a tumor, the higher the chances of recovery. So watch out for the first signs of esophageal cancer yourself, such as difficulty swallowing. Take your symptoms seriously and don’t wait long, but see a doctor as soon as possible to have the symptoms clarified.
Prevention includes all measures that prevent esophageal cancer from developing in the first place. And here you can do something yourself, because an unhealthy lifestyle is a risk factor for esophageal cancer. The following measures can help to reduce the risk of esophageal carcinoma – but cancer cannot be prevented 100 percent.
Sources
This article was written by Ingrid Müller, biologist
The original of this post “Many sufferers go to the doctor late: These are warning signs of esophageal cancer” comes from FOCUS doctor search.
