CanCer-666: Esophageal cancer

Esophagus Cancer Treatment

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Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Esophagus Cancer Treatment. 
 
After the cancer is found and staged, your cancer care team will discuss treatment options with you. It is important that you take time to think about your choices. You will want to weigh the benefits of each treatment option against the possible risks and side effects. In choosing a treatment plan, 2 of the main factors to consider are your overall health and the stage (extent) of the cancer. The main options for treatment of cancer of the esophagus include: 
 
• Chemotherapy 
Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. 
 
As explained above, chemotherapy and radiation therapy are often given at the same time to treat esophageal cancer, called chemoradiotherapy. Recent studies also show that chemotherapy without radiation therapy may work as well, but more research is needed to understand any benefits of chemotherapy without radiation therapy compared with chemoradiotherapy. 
 
The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. 
 
• Cryotherapy 
This is a type of palliative treatment that uses an endoscope with a probe attached that can freeze and remove tumor tissue. It can be used to reduce the size of a tumor to help a patient swallow better. 
 
• Electrocoagulation 
This type of palliative treatment helps kill cancer cells by heating them with an electric current. This is sometimes used to help relieve symptoms by removing a blockage caused by the tumor. 
 
• Photodynamic therapy 
Photodynamic therapy is a palliative or supportive option used to make swallowing easier, especially for people who cannot or choose not to have surgery, radiation therapy, or chemotherapy. In photodynamic therapy, a light-sensitive substance is injected into the tumor and stays longer in cancer cells than in healthy cells. A laser is then aimed at the tumor, destroying the cancer cells. Although photodynamic therapy may relieve swallowing problems for a short period of time, it does not cure esophageal cancer. Esophagus Cancer Treatment. 
 
• Radiation therapy 
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation treatment is given directly inside the body, it is called internal radiation therapy or brachytherapy. For esophageal cancer, this involves temporarily inserting a radioactive wire into the esophagus using an endoscope. 
 
Side effects from radiation therapy may include fatigue, mild skin reactions, soreness in the throat and esophagus, difficulty or pain with swallowing, upset stomach, nausea, and loose bowel movements. Most side effects go away soon after treatment is finished. 
 
• Surgery 
Surgery is the removal of the tumor and surrounding tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Surgery has traditionally been the most common treatment for esophageal cancer. However, currently, surgery is used as the primary (first) treatment only for patients with early-stage esophageal cancer. 
 
For patients with locally-advanced esophageal cancer, a combination of chemotherapy and radiation therapy, or only chemotherapy in some situations, may be used before surgery to shrink the tumor. For people who cannot have surgery, the best treatment option is often a combination of chemotherapy and radiation therapy. 
 
The most common surgery to treat esophageal cancer is called an esophagectomy, where the doctor removes the esophagus and then connects the remaining healthy part of the esophagus to the stomach so that the patient can swallow normally. The stomach or part of the intestine may sometimes be used to make the connection. The surgeon also removes lymph nodes around the esophagus. 
 
• Targeted therapy 
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to normal cells. 
 
Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. As a result, doctors can better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. 
 
Some of these treatments can also be used as palliative treatment when all the cancer cannot be removed. Palliative treatment is meant to relieve symptoms, such as pain and trouble swallowing, but it is not expected to cure the cancer. 
 
Depending on the stage of the cancer and your general health, different treatment options may be used alone or in combination. Based on these options, you might have different types of doctors on your treatment team. These doctors could include: 
<ul>
<li>A gastroenterologist: a doctor who specializes in treatment of diseases of the digestive system</li>
<li>A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy</li>
<li>A radiation oncologist: a doctor who treats cancer with radiation therapy</li>
<li>A thoracic surgeon: a doctor who treats diseases of the chest with surgery</li>
</ul>
Many other specialists might be part of your treatment team as well, including physician assistants, nurse practitioners, nurses, nutrition specialists, social workers, and other health professionals. Esophagus Cancer Treatment.</div>
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Esophagus Cancer Treatment

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the ...

Esophagus Cancer Causes

ancorez Esophageal cancer 12:50 PM

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Esophagus cancer occurs when cells in your esophagus develop errors (mutations) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells form a tumor in the esophagus that can grow to invade nearby structures and spread to other parts of the body. Esophagus Cancer Causes. 
 
Scientists believe that some risk factors, such as the use of tobacco or alcohol, may cause esophageal cancer by damaging the DNA in cells that line the inside of the esophagus. Long-term irritation of the lining of the esophagus, as happens with reflux, Barrett’s esophagus, achalasia, Plummer-Vinson syndrome, or scarring from swallowing lye, may also lead to DNA damage. Esophagus Cancer Causes. 
 
The DNA of esophageal cancer cells often shows changes in many different genes. However, it’s not clear if there are specific gene changes that can be found in all (or most) esophageal cancers. Some people inherit DNA changes (mutations) from their parents that increase their risk for developing certain cancers. But esophageal cancer does not seem to run in families, and inherited gene mutations are not thought to be a major cause of this disease. 
 
Essence, the main cause of esophagus cancer is not known with certainty. However, there are certain risk factors that make getting esophageal cancer more likely. Esophagus Cancer Causes.</div>
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Esophagus Cancer Causes

Esophagus cancer occurs when cells in your esophagus develop errors (mutations) in their DNA. The errors make cells grow and divide out ...

The Risk Factors for Esophagus Cancer

ancorez Esophageal cancer 4:08 PM

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A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices. The Risk Factors for Esophagus Cancer. 
 
Scientists have found several factors that affect your risk of cancer of the esophagus. Some are more likely to increase the risk for adenocarcinoma of the esophagus and others for squamous cell carcinoma of the esophagus. But having a risk factor, or even several, does not mean that you will get the disease. Many people with risk factors never develop esophagus cancer, while others with this disease may have few or no known risk factors. 
 
• Achalasia 
In this condition, the muscle at the lower end of the esophagus (the lower esophageal sphincter) does not relax properly. Food and liquid that are swallowed have trouble passing into the stomach and tend to collect in the esophagus, which becomes stretched out (dilated) over time. The cells lining the esophagus can become irritated from being exposed to foods for longer than normal amounts of time. People with achalasia have a risk of esophageal cancer that is many times normal. On average, the cancers are found about 15 to 20 years after the achalasia is diagnosed. 
 
• Age 
The chance of getting esophageal cancer is low at younger ages and increases with age. Less than 15% of cases are found in people younger than age 55. 
 
• Barrett’s Esophagus 
If reflux of stomach acid into the lower esophagus goes on for a long time, it can damage the inner lining of the esophagus. This causes the squamous cells that normally line the esophagus to be replaced with gland cells. These gland cells usually look like the cells that line the stomach and the small intestine, and are more resistant to stomach acid. This condition is known as Barrett’s (or Barrett) esophagus. The longer someone has reflux, the more likely it is that they will develop Barrett’s esophagus. Most people with Barrett’s esophagus have had symptoms of heartburn, but many have no symptoms at all. 
 
The gland cells in Barrett’s esophagus can become more abnormal over time. This can result in dysplasia, a pre-cancerous condition. Dysplasia is graded by how abnormal the cells look under the microscope. Low-grade dysplasia looks more like normal cells, while high-grade dysplasia is more abnormal and is linked to the highest risk of cancer. People with Barrett’s esophagus are much more likely than people without this condition to develop adenocarcinoma of the esophagus. Still, most people with Barrett’s esophagus do not get esophageal cancer. The risk of cancer is highest if dysplasia is present or if other people in your family also have or have had Barrett’s. 
 
• Diet 
Certain substances in the diet may increase esophageal cancer risk. For example, there have been suggestions, as yet not well proven, that a diet high in processed meat may increase the chance of developing esophageal cancer. This may help explain the high rate of this cancer in certain parts of the world. 
 
On the other hand, a diet high in fruits and vegetables is linked to a lower risk of esophageal cancer. The exact reasons for this are not clear, but fruits and vegetables have a number of vitamins and minerals that may help prevent cancer. Drinking very hot liquids frequently may increase the risk for the squamous cell type of esophageal cancer. This might be the result of long-term damage the liquids do to the cells lining the esophagus. Overeating, which leads to obesity, increases the risk of the adenocarcinoma of the esophagus. 
 
• Gastroesophageal Reflux Disease 
The stomach normally makes strong acid and enzymes to help digest food. In some people, acid can escape from the stomach into the lower part of the esophagus. The medical term for this is gastroesophageal reflux disease (GERD), or just reflux. In many people, reflux causes symptoms such as heartburn or pain that seem to come from the middle of the chest. In some, though, reflux doesn’t cause any symptoms at all. 
 
People with GERD have a slightly higher risk of getting adenocarcinoma of the esophagus. This risk seems to be higher in people who have more frequent symptoms. But GERD is very common, and the vast majority of people who have it do not go on to develop esophageal cancer. 
 
• Gender 
Esophageal cancer is more common in men than in women, but the gender gap is narrowing. 
 
• History of Certain Other Cancers 
People who have had certain other cancers, such as lung cancer, mouth cancer, and throat cancer have a high risk of getting squamous cell carcinoma of the esophagus as well. This may be because all of these cancers can be caused by smoking. The Risk Factors for Esophagus Cancer. 
 
• Human Papilloma Virus (HPV) Infection 
HPV is a group of more than 100 related viruses. They are called papilloma viruses because some of them cause a type of growth called a papilloma (or wart). Infection with certain types of HPV is linked to a number of cancers, including throat cancer, anal cancer, and cervical cancer. 
 
Signs of HPV infection have been found in up to one-third of esophagus cancers from patients in parts of Asia and South Africa. But signs of HPV infection have not been found in esophagus cancers from patients in the other areas, including the US. 
 
• Injury to the Esophagus 
Lye is a chemical found in strong industrial and household cleaners such as drain cleaners. Lye is a corrosive agent that can burn and destroy cells. Accidentally drinking from a lye-based cleaner bottle can cause a severe chemical burn in the esophagus. As the injury heals, the scar tissue can cause an area of the esophagus to become very narrow (called a stricture). People with these strictures have an increased risk of squamous cell esophageal cancer, which often occurs many years (even decades) later. 
 
• Lye 
Accidental ingestion of cleaning liquids containing lye may increase a person's chances of getting squamous cell esophageal cancer, especially if the accident occurred in childhood. 
 
• Obesity 
Being severely overweight and having too much body fat can increase a person's risk of developing esophageal adenocarcinoma. 
 
• Plummer-Vinson Syndrome 
People with this rare syndrome have webs in the upper part of the esophagus, typically along with anemia (low red blood cell counts) due to low iron levels, tongue irritation (glossitis), brittle fingernails, and sometimes a large thyroid gland or spleen. Another name for this is Paterson-Kelly syndrome. 
 
A web is a thin membrane extending out from the inner lining of the esophagus that causes an area of narrowing. Most esophageal webs do not cause any problems, but larger ones can cause food to get stuck in the esophagus, which can lead to problems swallowing. About 1 in 10 patients with this syndrome eventually develop squamous cell cancer of the esophagus or cancer in the lower part of the throat (hypopharynx). 
 
• Race 
Squamous cell cancer of the esophagus is more common among blacks than whites. Adenocarcinoma is more common in white men than men of other races. 
 
• Tobacco and Alcohol 
Use of tobacco in any form can increase your risk of developing esophageal cancer — particularly squamous cell carcinoma. The more you smoke and the longer you smoke, the greater your risk of esophageal cancer. 
 
The same is true of heavy use of alcohol over a long period of time. The combination of smoking with heavy alcohol use is the most significant risk factor for squamous cell carcinoma of the esophagus, greatly increasing your chances of developing the disease. 
 
• Tylosis 
This is a rare, inherited disease that causes excess growth of the top layer of skin on the palms of the hands and soles of the feet. People with this condition also develop small growths (papillomas) in the esophagus and have a very high risk of getting squamous cell cancer of the esophagus.bPeople with tylosis need to be watched closely to try to find esophageal cancer early. 
 
• Vitamin Deficiencies 
Some studies have linked esophageal cancer with deficiencies in beta carotene, vitamin E, selenium, or iron. 
 
• Workplace Exposures 
Exposure to chemical fumes in certain workplaces may lead to an increased risk of esophageal cancer. For example, exposure to some of the solvents used for dry cleaning might lead to a greater risk of esophageal cancer. Some studies have found that dry cleaning workers may have a higher rate of esophageal cancer, but not all studies have found this link. The Risk Factors for Esophagus Cancer.</div>
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The Risk Factors for Esophagus Cancer

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development o...

Staging and Grading Esophagus Cancer

ancorez Esophageal cancer 2:59 PM

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The diagnosed with esophageal cancer will help to determine what stage and grade your cancer is at. The stage and grade of esophageal cancer is a standard way for doctors to sum up how far the cancer has spread. The treatment and outlook for people with esophageal cancer depend, to a large extent, on the cancer’s stage. Staging for esophageal cancer can be confusing, so ask your cancer care team to explain the stage of your cancer to you in a way you understand. This can help you make informed choices about your treatment. Staging and Grading Esophagus Cancer. 
 
<h3>
Esophagus Cancer Stage Grouping</h3>
this information is combined into an overall stage of 0, I, II, III, or IV. This process is called stage grouping. Some stages are further subdivided into A, B, or C. The stages identify cancers that have a similar prognosis (outlook). Patients with lower stage numbers tend to have a better prognosis. The stage groupings for adenocarcinoma and squamous cell carcinoma are different. Cancers that have features of both squamous cell and adenocarcinoma are staged as squamous cell carcinomas. 
 
 • Adenocarcinoma Stages 
 
The location of the cancer along the esophagus does not affect the stage of adenocarcinomas. 
<ul>
<li>Stage 0: Tis, N0, M0, GX or G1: This is the earliest stage of esophageal cancer. It is also called high-grade dysplasia. The cancer cells are found only in the epithelium (the layer of cells lining of the esophagus). The cancer has not grown into the connective tissue beneath these cells (Tis). The cancer has not spread to nearby lymph nodes (N0) or other organs (M0). It is well differentiated (G1) or grade information is not available (GX).</li>
<li>Stage IA: T1, N0, M0, GX, G1, or G2: The cancer has grown from the epithelium into the layers below, such as the lamina propria, muscularis mucosa, or submucosa, but it has not grown any deeper (T1). It has not spread to nearby lymph nodes (N0) or to distant sites (M0). It is well (G1) or moderately differentiated (G2), or grade information is not available (GX).</li>
<li>Stage IB: Either of the following: 
<ol>
<li> T1, N0, M0, G3: The cancer has grown from the epithelium into the layers below, such as the lamina propria, muscularis mucosa, or submucosa, but it has not grown any deeper (T1). It has not spread to nearby lymph nodes (N0) or to distant sites (M0). It is poorly differentiated (G3).</li>
<li> T2, N0, M0, GX, G1, or G2: The cancer has grown into the muscle layer called the muscularis propria (T2). It has not spread to nearby lymph nodes (N0) or to distant sites (M0). It is well (G1) or moderately differentiated (G2), or grade information is not available (GX).</li>
</ol>
</li>
<li>Stage IIA: T2, N0, M0, G3: The cancer has grown into the muscle layer called the muscularis propria (T2). It has not spread to nearby lymph nodes (N0) or to distant sites (M0). It is poorly differentiated (G3).</li>
<li>Stage IIB: Either of the following: 
<ol>
<li> T3, N0, M0, any G: The cancer has grown through the wall of the esophagus to its outer layer, the adventitia (T3). It has not spread to nearby lymph nodes (N0) or to distant sites (M0). It can be any grade.</li>
<li> T1 or T2, N1, M0, any G: The cancer has grown into the layers below the epithelium, such as the lamina propria, muscularis mucosa, or submucosa (T1). It may also have grown into the muscularis propria (T2). It has not grown through to the outer layer of tissue covering the esophagus. It has spread to 1 or 2 lymph nodes near the esophagus (N1), but it has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade.</li>
</ol>
</li>
<li>Stage IIIA: Any of the following: 
<ol>
<li> T1 or T2, N2, M0, any G: The cancer has grown into the layers below the epithelium, such as the lamina propria, muscularis mucosa, or submucosa (T1). It may also have grown into the muscularis propria (T2). It has not grown through to the outer layer of tissue covering the esophagus. It has spread to 3 to 6 lymph nodes near the esophagus (N2) but it has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade (G).</li>
<li> T3, N1, M0, any G: The cancer has grown through the wall of the esophagus to its outer layer, the adventitia (T3). It has spread to 1 or 2 lymph nodes near the esophagus (N1), but it has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade (G).</li>
<li> T4a, N0, M0, any G: The cancer has grown all the way through the esophagus and into nearby organs or tissues (T4a) but still can be removed. It has not spread to nearby lymph nodes (N0) or to distant sites (M0). It can be any grade (G).</li>
</ol>
</li>
<li>Stage IIIB: T3, N2, M0, any G: The cancer has grown through the wall of the esophagus to its outer layer, the adventitia (T3). It has spread to 3 to 6 lymph nodes near the esophagus (N2), but it has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade (G).</li>
<li>Stage IIIC: Any of the following: 
<ol>
<li> T4a, N1 or N2, M0, any G: The cancer has grown all the way through the esophagus and into nearby organs or tissues (T4a) but still can be removed. It has spread to 1 to 6 lymph nodes near the esophagus (N1 or N2), but it has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade (G).</li>
<li> T4b, any N, M0, any G: The cancer cannot be removed with surgery because it has grown into the trachea (windpipe), the aorta (the large blood vessel coming from the heart), the spine, or other crucial structures (T4b). It may or may not have spread to nearby lymph nodes (any N), but it has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade (G).</li>
<li> Any T, N3, M0, any G: The cancer has spread to 7 or more nearby lymph nodes (N3), but it has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade (G).</li>
</ol>
</li>
<li>Stage IV: Any T, any N, M1, any G: The cancer has spread to distant lymph nodes or other sites (M1). It can be any grade (G).</li>
</ul>
• Squamous Cell Carcinoma Stages 
<ul>
<li>Stage 0: Tis, N0, M0, GX or G1; any location: This is the earliest stage of esophageal cancer. It is also called high-grade dysplasia. The cancer cells are found only in the epithelium (the layer of cells lining the esophagus). The cancer has not grown into the connective tissue beneath these cells (Tis). The cancer has not spread to nearby lymph nodes (N0) or other organs (M0). The tumor is well differentiated (G1) or grade information is not available (GX), and it can be anywhere along the esophagus.</li>
<li>Stage IA: T1, N0, M0, GX or G1; any location: The cancer has grown from the epithelium into the layers below, such as the lamina propria, muscularis mucosa, or submucosa, but it has not grown any deeper (T1). It has not spread to nearby lymph nodes (N0) or to distant sites (M0). The tumor is well differentiated (G1) or grade information is not available (GX). It can be anywhere along the esophagus.</li>
<li>Stage IB: Either of the following: 
<ol>
<li> T1, N0, M0, G2 or G3; any location: The cancer has grown from the epithelium into the layers below, such as the lamina propria, muscularis mucosa, or submucosa, but it has not grown any deeper (T1). It has not spread to nearby lymph nodes (N0) or to distant sites (M0). It is moderately (G2) or poorly differentiated (G3). The tumor can be anywhere in the esophagus.</li>
<li> T2 or T3, N0, M0, GX or G1; location lower: The cancer has grown into the muscle layer called the muscularis propria (T2). It may also have grown through the muscle layer into the adventitia, the connective tissue covering the outside of the esophagus (T3). The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0). It is well differentiated (G1) or grade information is not available (GX). Its highest point is in the lower part of the esophagus.</li>
</ol>
</li>
<li>Stage IIA: Either of the following: 
<ol>
<li> T2 or T3, N0, M0, GX or G1; location upper or middle: The cancer has grown into the muscle layer called the muscularis propria (T2). It may also have grown through the muscle layer into the adventitia, the connective tissue covering the outside of the esophagus (T3). The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0).The cancer is in the upper or middle part of the esophagus and is well differentiated (G1) or grade information is not available (GX).</li>
<li> T2 or T3, N0, M0, G2 or G3; location lower: The cancer has grown into the muscle layer called the muscularis propria (T2). It may also have grown through the muscle layer into the adventitia, the connective tissue covering the outside of the esophagus (T3). The cancer has not spread to lymph nodes (N0) or to distant sites (M0).The cancer is in the lower part of the esophagus and is moderately (G2) or poorly differentiated (G3). Staging and Grading Esophagus Cancer.</li>
</ol>
</li>
<li>Stage IIB: Either of the following: 
<ol>
<li> T2 or T3, N0, M0, G2 or G3; location upper or middle: The cancer has grown into the muscle layer called the muscularis propria (T2). It may also have grown through the muscle layer into the adventitia, the connective tissue covering the outside of the esophagus (T3). The cancer has not spread to nearby lymph nodes (N0) or to distant sites (M0). It is in the upper or middle part of the esophagus and is moderately (G2) or poorly differentiated (G3).</li>
<li> T1 or T2, N1, M0, any G; any location: The cancer has grown into the layers below the epithelium, such as the lamina propria, muscularis mucosa, or submucosa (T1). It may also have grown into the muscularis propria (T2). It has not grown through to the outer layer of tissue covering the esophagus. It has spread to 1 or 2 lymph nodes near the esophagus (N1) but has not spread to lymph nodes further away from the esophagus or to distant sites (M0). It can be any grade (G) and can be anywhere along the esophagus.</li>
</ol>
</li>
<li>Stage IIIA: Any of the following: 
<ol>
<li> T1 or T2, N2, M0, any G; any location: The cancer has grown into the layers below the epithelium, such as the lamina propria, muscularis mucosa, or submucosa (T1). It may also have grown into the muscularis propria (T2). It has not grown through to the outer layer of tissue covering the esophagus. It has spread to 3 to 6 lymph nodes near the esophagus (N2) but it has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade (G) and can be anywhere along the esophagus.</li>
<li> T3, N1, M0, any G; any location: The cancer has grown through the wall of the esophagus to its outer layer, the adventitia (T3). It has spread to 1 or 2 lymph nodes near the esophagus (N1), but it has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade (G) and can be anywhere along the esophagus.</li>
<li> T4a, N0, M0, any G; any location: The cancer has grown all the way through the esophagus and into nearby organs or tissues (T4a) but still can be removed. It has not spread to nearby lymph nodes (N0) or to distant sites (M0). It can be any grade (G) and can be anywhere along the esophagus.</li>
</ol>
</li>
<li>Stage IIIB: T3, N2, M0, any G; any location: The cancer has grown through the wall of the esophagus to its outer layer, the adventitia (T3). It has spread to 3 to 6 lymph nodes near the esophagus (N2), but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade (G) and can be anywhere along the esophagus.</li>
<li>Stage IIIC: Any of the following: 
<ol>
<li> T4a, N1 or N2, M0, any G; any location: The cancer has grown all the way through the esophagus and into nearby organs or tissues (T4a) but still can be removed. It has spread to 1 to 6 lymph nodes near the esophagus (N1 or N2), but it has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade (G) and can be anywhere along the esophagus.</li>
<li> T4b, any N, M0, any G; any location: The cancer cannot be removed with surgery because it has grown into the trachea (windpipe), the aorta (the large blood vessel coming from the heart), the spine, or other crucial structures (T4b). It may or may not have spread to nearby lymph nodes (any N), but it has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade (G) and can be anywhere along the esophagus.</li>
<li> Any T, N3, M0, any G; any location: The cancer has spread to 7 or more nearby lymph nodes (N3), but it has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade and can be anywhere along the esophagus.</li>
</ol>
</li>
<li>Stage IV: Any T, any N, M1, any G; any location: The cancer has spread to distant lymph nodes or other sites (M1). It can be any grade (G) and can be anywhere along the esophagus.</li>
</ul>
<hr />
<h3>
TNM Staging System</h3>
Some doctors may prefer to describe the stages of cancer using the more complex TNM staging system. The three categories are used to create a more detailed classification: 
<ul>
<li>T refers to how far the primary tumor has grown into the wall of the esophagus and into nearby organs.</li>
<li>N refers to cancer spread to nearby lymph nodes.</li>
<li>M indicates whether the cancer has metastasized (spread to distant organs).</li>
<li>G describes the grade of the cancer, which is based on how the patterns of cancer cells look under a microscope.</li>
</ul>
• T categories 
<ul>
<li>TX: The primary tumor can’t be assessed.</li>
<li>T0: There is no evidence of a primary tumor.</li>
<li>Tis: The cancer is only in the epithelium (the top layer of cells lining the inside of the esophagus). It has not started growing into the deeper layers. This stage is also known as high-grade dysplasia. In the past it was called carcinoma in situ.</li>
<li>T1: The cancer is growing into the tissue under the epithelium, such as the lamina propria, muscularis mucosa, or submucosa. 
<ol>
<li> T1a: The cancer is growing into the lamina propria or muscularis mucosa</li>
<li> T1b: The cancer has grown through the other layers and into the submucosa</li>
</ol>
</li>
<li>T2: The cancer is growing into the thick muscle layer (muscularis propria).</li>
<li>T3: The cancer is growing into the outer layer of the esophagus (the adventitia).</li>
<li>T4: The cancer is growing into nearby structures. 
<ol>
<li> T4a: The cancer is growing into the pleura (the thin layer of tissue covering the lungs), the pericardium (the thin sac surrounding the heart), or the diaphragm (the thin sheet of muscle below the lungs that separates the chest from the abdomen). The cancer can be removed with surgery.</li>
<li> T4b: The cancer cannot be removed with surgery because it has grown into the trachea (windpipe), the aorta (the large blood vessel coming from the heart), the spine, or other crucial structures.</li>
</ol>
</li>
</ul>
• N categories 
<ul>
<li>NX: Nearby lymph nodes can’t be assessed.</li>
<li>N0: The cancer has not spread to nearby lymph nodes.</li>
<li>N1: The cancer has spread to 1 or 2 nearby lymph nodes.</li>
<li>N2: The cancer has spread to 3 to 6 nearby lymph nodes.</li>
<li>N3: The cancer has spread to 7 or more nearby lymph nodes.</li>
</ul>
• M categories 
<ul>
<li>M0: The cancer has not spread (metastasized) to distant organs or lymph nodes.</li>
<li>M1: The cancer has spread to distant lymph nodes and/or other organs. (Common sites of spread include the liver and lungs.)</li>
</ul>
• Grade 
<ul>
<li>GX: The grade cannot be assessed (treated in stage grouping as G1).</li>
<li>G1: The cells are well-differentiated.</li>
<li>G2: The cells are moderately differentiated</li>
<li>G3: The cells are poorly differentiated</li>
<li>G4: The cells are undifferentiated</li>
</ul>
Staging and Grading Esophagus Cancer. 
<ul></ul>
</div>
</div>

Staging and Grading Esophagus Cancer

The diagnosed with esophageal cancer will help to determine what stage and grade your cancer is at. The stage and grade of esophageal ca...

Esophageal Cancer Diagnosis

ancorez Esophageal cancer 2:06 PM

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Esophagus cancers are usually found because of signs or symptoms a person is having. If esophagus cancer is suspected, exams and tests will be needed to confirm the diagnosis. Tests and procedures used to diagnose esophageal cancer include: 
 
Endoscopy 
 
This is one of the first tests you will have to help confirm a diagnosis of cancer of the oesophagus. Endoscopy is a medical procedure that allows doctors to see inside the body. During this procedure a thin, flexible instrument called an endoscope is passed through your mouth and down towards your stomach. The endoscope has a light attached to the end and feeds back the images of your oesophagus to a monitor. This will allow your doctor to look for any signs of abnormal cells or tumours. 
 
Before having an endoscopy you should avoid eating for several hours, as food can obstruct the view of the endoscope. An endoscopy should not cause you any pain, although it may feel uncomfortable. Before the endoscopy takes place you will normally be given a local anaesthetic or sedative to help you relax and to help make the procedure less uncomfortable. The endoscopy itself will usually take about 15 minutes, although you should allow approximately two hours for your visit. 
 
• Bronchoscopy 
This exam may be done for cancer in the upper part of the esophagus to see if it has spread to the windpipe (trachea) or the tubes leading from the windpipe into the lungs (bronchi). For this test, a lighted, flexible fiber-optic tube (bronchoscope) is passed through your mouth or nose and down into the windpipe and bronchi. The mouth and throat are sprayed first with a numbing medicine. You may also be given medicine through an intravenous (IV) line to make you feel relaxed. If abnormal areas are seen, small instruments can be passed down the bronchoscope to take biopsy samples. 
 
• Endoscopic ultrasound 
Once cancer of the oesophagus has been diagnosed your doctor will need to assess how far the cancer has spread and how large the tumour has grown. An endoscopic ultrasound will help your doctors assess how far your oesophageal cancer has progressed. It involves having a very small ultrasound probe passed into your oesophagus using an endoscope. This test produces sound waves that can penetrate the surrounding tissues. These waves are then used to produce an image of your oesophagus so your doctor can see if the cancer has spread to the surrounding tissue. 
 
• Thoracoscopy and laparoscopy 
These exams let the doctor see lymph nodes and other organs near the esophagus inside the chest (by thoracoscopy) or the abdomen (by laparoscopy) through a hollow lighted tube. These procedures are done in an operating room while you are under general anesthesia (in a deep sleep). A small cut (incision) is made in the side of the chest wall (for thoracoscopy) or the abdomen (for laparoscopy). Sometimes more than one cut is made. The doctor then inserts a thin, lighted tube with a small video camera on the end through the incision to view the space around the esophagus. The surgeon can pass thin instruments into the space to remove lymph node and biopsy samples to see if the cancer has spread. This information is often important in deciding whether or not a person is likely to benefit from surgery. 
 
• Upper endoscopy 
This is an important test for diagnosing esophageal cancer. During an upper endoscopy, you are sedated (made sleepy) and then the doctor passes the endoscope down the throat and into the esophagus and stomach. The camera is connected to a monitor, which lets the doctor see any abnormal areas in the wall of the esophagus clearly. The doctor can use special instruments through the scope to remove (biopsy) samples from any abnormal areas. These samples are sent to the lab so that a doctor can look at them under a microscope to see if they contain cancer. 
 
If the esophageal cancer is blocking the opening (called the lumen) of the esophagus, certain instruments can be used to help enlarge the opening to help food and liquid pass. Upper endoscopy can give the doctor important information about the size and spread of the tumor, which can be used to help determine if the tumor can be removed with surgery. 
 
<hr />
Imaging tests 
 
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Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests might be done for a number of reasons both before and after a diagnosis of esophageal cancer, including: 
<ul>
<li>To help determine if the treatment has been effective</li>
<li>To help find a suspicious area that might be cancer</li>
<li>To learn if and how far cancer has spread</li>
<li>To look for possible signs of cancer coming back after treatment</li>
</ul>
• Barium swallow 
A barium swallow is a test that involves drinking a thick white liquid called barium. Once you have swallowed the barium you will undergo a series of X-rays. The barium coats the lining of your oesophagus so that it shows up on the X-ray. These X-rays are able to show your doctor whether there is an obstruction in your oesophagus, which may be an indication of a tumour. 
 
You may have to undergo this test if your cancer has already been diagnosed, as it will help your doctor to assess the size of your tumour. A barium swallow usually takes about 15 minutes to perform. After the procedure you will be able to eat and drink as normal, although you may need to drink more water to help flush the barium out of your system. Esophageal Cancer Diagnosis 
 
• Computed tomography (CT or CAT) scan 
A CT scan takes a series of X-ray images of your body and uses a computer to put them together. This then creates a very detailed picture of the inside of your body. This will help your doctor assess how advanced your cancer is. It allows them to see whether the cancerous cells have formed tumours in any other places within the body. A CT scan will also allow your doctors to work out which type of treatment will be most effective and appropriate for you. 
 
• Magnetic resonance imaging (MRI) scan 
Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. A contrast material might be injected into a vein. This contrast is different than the one used for CT scans, so being allergic to one doesn’t mean you are allergic to the other. 
 
MRI scans are very helpful in looking at the brain and spinal cord, but they are not often needed to assess spread of esophageal cancer. MRI scans take longer than CT scans – often up to an hour – and are a little more uncomfortable. You have to lie on a table that slides inside a narrow tube, which is confining and can upset people with a fear of enclosed spaces. Special, more open MRI machines can sometimes help with this if needed, although the images may not be as sharp in some cases. MRI machines make buzzing and clicking noises that you may find disturbing. Some centers provide earplugs to help block this noise out. 
 
• Positron emission tomography (PET) scan 
A positive emission tomography (PET) scan can produce a detailed, three-dimensional picture of the inside of the body. During a PET scan a substance known as a radiotracer is passed into your body. A radiotracer is a radioactive chemical that releases tiny particles called positrons. A PET scan may be used to find out whether the cancer has spread. It may also be used for follow-up examinations after treatment to check for scar tissue or any remaining cancer cells. 
 
<hr />
Lab testing of biopsy samples 
 
An area seen on endoscopy or on an imaging test may look like cancer, but the only way to know for sure is to do a biopsy. For a biopsy, the doctor removes small pieces of tissue from an abnormal area. This is most often done during an endoscopy exam. A doctor called a pathologist then looks at the tissue under a microscope to see if it contains cancer cells. If there is cancer, the pathologist will determine the type (adenocarcinoma or squamous cell) and the grade of the cancer (how abnormal the patterns of cells look under the microscope). 
 
HER2 testing: If esophageal cancer is found but is too advanced for surgery, your biopsy samples may be tested for the HER2 gene or protein. Some people with esophageal cancer have too much of the HER2 protein on the surface of their cancer cells, which helps the cells grow. A drug that targets the HER2 protein, known as trastuzumab (Herceptin®), may help treat these cancers when used along with chemotherapy. Only cancers that have too much of the HER2 gene or protein are likely to be affected by this drug, which is why doctors may test tumor samples for it. 
<hr />
Medical history and physical exam 
 
If you have symptoms that might be caused by esophageal cancer, the doctor will ask about your medical history to check for possible risk factors and to learn more about your symptoms. Your doctor will also examine you to look for possible signs of esophageal cancer and other health problems. He or she will probably pay special attention to your neck and chest areas. If the results of the exam are abnormal, your doctor probably will order tests to help find the problem. You may also be referred to a gastroenterologist (a doctor specializing in digestive system diseases) for further tests and treatment. Esophageal Cancer Diagnosis 
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</div>

Esophageal Cancer Diagnosis

Esophagus cancers are usually found because of signs or symptoms a person is having. If esophagus cancer is suspected, exams and tests wil...

Signs and Symptoms of Esophagus Cancer

ancorez Esophageal cancer 1:19 PM

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There are many signs and symptoms of esophagus cancer. If you experience any of the symptoms of esophageal cancer, consult your doctor. Unfortunately, the disease is often diagnosed when the disease has advanced, limiting treatment options. 
 
• Feeling Like Food is Stuck in Throat or Chest 
Sometimes, people complain of pain or discomfort in the middle part of their chest. Some people describe a feeling of pressure or burning in the chest. These symptoms are more often caused by problems other than cancer, such as heartburn, so they are rarely seen as a signal that a person might have cancer. 
 
Swallowing may become painful if the cancer is large enough to limit the passage of food through the esophagus. Pain may be felt a few seconds after swallowing, as food or liquid reaches the tumor and has trouble getting past it. 
 
• Heartburn 
Having heartburn often is also a symptom of esophageal cancer. Heartburn is defined as pain or burning sensation behind the breast bone. Heart burn that occurs often or increasingly warrants a consult to the doctor. 
 
• Hiccups with Pain or Difficulty Swallowing 
If you often have the hiccups and also have pain or difficulty swallowing, you need to see a doctor. These two condition when experienced together are a symptom of esophageal cancer. 
 
• Hoarseness 
If your voice is hoarse, or you feel like you have to often clear your throat, you should get checked out by a doctor. This symptom of esophageal cancer is also that of many other illnesses, so a consult is necessary. 
 
 • Pain and/or Difficulty Swallowing 
The most common symptom of esophageal cancer is a problem swallowing, with a feeling like the food is stuck in the throat or chest, or even choking on food. The medical term for trouble swallowing is dysphagia. This is often mild when it starts, and then gets worse over time as the opening inside the esophagus gets narrower. 
 
When swallowing becomes harder, people often change their diet and eating habits without realizing it. They take smaller bites and chew their food more carefully and slowly. As the cancer grows larger, the problem can get worse. People then may start eating softer foods that can pass through the esophagus more easily. They may avoid bread and meat, since these foods typically get stuck. The swallowing problem may even get bad enough that some people stop eating solid food completely and switch to a liquid diet. If the cancer keeps growing, at some point even liquids might be hard to swallow. 
 
To help pass food through the esophagus, the body makes more saliva. This causes some people to complain of bringing up lots of thick mucus or saliva. 
 
• Persistant Cough 
Having a cough that does not go away is a symptom of esophageal cancer. 
 
• Unintentional Weight Loss 
About half of people with esophageal cancer lose weight (without trying to). This happens because their swallowing problems keep them from eating enough to maintain their weight. Other factors include a decreased appetite and an increase in metabolism from the cancer. 
 
<h3>
Other Signs and Symptoms of Esophagus Cancer</h3>
 
Other possible symptoms of cancer of the esophagus can include: 
<ul>
<li>Bleeding into the esophagus. This blood then passes through the digestive tract, which may turn stools black. Over time, this blood loss can lead to anemia (low red blood cell levels), which can make a person feel tired.</li>
<li>Bone pain</li>
<li>Pneumonia</li>
<li>Vomiting</li>
</ul>
Having one or more of the symptoms above does not mean you have esophageal cancer. In fact, many of these symptoms are more likely to be caused by other conditions. Still, if you have any of these symptoms, especially trouble swallowing, it’s important to have them checked by a doctor so that the cause can be found and treated, if needed. 
 
Signs and Symptoms of Esophagus Cancer</div>
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Signs and Symptoms of Esophagus Cancer

There are many signs and symptoms of esophagus cancer . If you experience any of the symptoms of esophageal cancer, consult your doctor....

Definition and Description of Esophageal Cancer

ancorez Esophageal cancer 11:44 AM

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Definition</div>
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Esophageal cancer is a malignancy that develops in tissues of the hollow, muscular canal (esophagus) along which food and liquid travel from the throat to the stomach.</div>
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Esophageal <a href="http://cancer-666.blogspot.com/">cancer</a> is a malignant tumor of the esophagus. The risk of cancer of the esophagus is increased by long-term irritation of the esophagus, such as from smoking, heavy alcohol intake, and Barrett esophagitis. Very small tumors in the esophagus usually do not cause symptoms. As a tumor grows, the most common symptom is difficulty in swallowing. There may be a feeling of fullness, pressure, or burning as food passes down the esophagus. Cancer of the esophagus can also cause indigestion, heartburn, vomiting, and frequent choking on food. Because of these problems, weight loss is common. Esophageal cancer can be diagnosed through a barium X-ray study of the esophagus and endoscopy and biopsy of the tumor. Treatment includes chemotherapy and sometimes surgery.</div>
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Desciption</div>
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Esophageal cancer usually originates in the inner layers of the lining of the esophagus and grows outward. In time, the tumor can obstruct the passage of food and liquid, making swallowing painful and difficult. Since most patients are not diagnosed until the late stages of the disease, esophageal cancer is associated with poor quality of life and low survival rates.</div>
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Squamous cell carcinoma is the most common type of esophageal cancer, accounting for 95% of all esophageal cancers worldwide. The esophagus is normally lined with thin, flat squamous cells that resemble tiny roof shingles. Squamous cell carcinoma can develop at any point along the esophagus but is most common in the middle portion.</div>
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Adenocarcinoma has surpassed squamous cell carcinoma as the most common type of esophageal cancer in the United States. Adenocarcinoma originates in glandular tissue not normally present in the lining of the esophagus. Before adenocarcinoma can develop, glandular cells must replace a section of squamous cells. This occurs in Barrett's esophagus, a pre-cancerous condition in which chronic acid reflux from the stomach stimulates a transformation in cell type in the lower portion of the esophagus.</div>
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A very small fraction of esophageal cancers are melanomas, sarcomas, or lymphomas.</div>
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There is great variability in the incidence of esophageal cancer with regard to geography, ethnicity, and gender. The overall incidence is increasing. About 13,000 new cases of esophageal cancer are diagnosed in the United States each year. During the same 12-month period, 12,000 people die of this disease. It strikes between five and ten North Americans per 100,000. In some areas of China the cancer is endemic.</div>
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Squamous cell carcinoma usually occurs in the sixth or seventh decade of life, with a greater incidence in African-Americans than in others. Adenocarcinoma develops earlier and is much more common in white patients. In general, esophageal cancer occurs more frequently in men than in women.</div>
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There has been an alarming increase in the incidence of esophageal cancer in the United States. This has affected all segments of the population, but has most specifically affected white males 50-70 years of age. A multidisciplinary approach to the diagnosis and treatment of esophageal cancer is crucial for proper staging and therapy. The Cleveland Clinic’s team approach employs members of the department of Gastroenterology, Thoracic Surgery, Medical Oncology, Radiation Oncology, and Anatomic Pathology.</div>
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When a patient is newly diagnosed with esophageal cancer, determining precisely the stage, or extent of the tumor is crucial. Patients with esophageal cancer that is limited to the wall of the esophagus are frequently best treated with a surgical approach. Those patients with cancer that has spread through the wall are often best treated with a combination of chemotherapy, and radiation therapy, followed by surgery. This stage directed therapy has resulted in significant improvements in patient survival.</div>
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Proper staging of esophageal cancer utilizes multiple techniques, including CT scanning, PET scanning, and endoscopic ultrasound.</div>
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Patents with esophageal cancer may frequently have difficulty swallowing because of tumor obstruction of their esophagus. Relief of the swallowing difficulties may be accomplished with laser therapy, argon plasma coagulation, photodynamic therapy or the placement of an expandable metal stent. These treatments are all offered as a part of our multidisciplinary approach.</div>
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Definition and Description of Esophageal Cancer

Definition Esophageal cancer is a malignancy that develops in tissues of the hollow, muscular canal (esophagus) along which food an...

CanCer-666