What is it?

esophagus cancer ranks 1-2 percent of the tumors and within the digestive system, 7 percent. Different geographic areas increases the incidence and certain provinces in China, Russia and Iran. In Europe, countries with higher prevalence of esophagus cancer are: France, Switzerland, Finland and Islandia.Es more common in men and usually diagnosed between the sixth and seventh decade of life, but may appear at any age.

What types of cancer are there?

There are two types of tumors: squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma is usually localized in the middle and upper esophagus and within the predisposing factors, we must stress independently of heavy drinking and snuff, showing a synergism when the two factors together. There are other diseases that affect the incidence of cancer of the esophagus as tylosis, achalasia, caustic strictures, etc. The adenocarcinoma appears predominantly in the lower esophagus and the most important predisposing factor is the “Barrett’s Esophagus.” This is usually associated with a history of gastro-esophagus reflux and hiatal hernia of long evolution. When a patient is diagnosed with Barrett’s esophagus will need to be monitored closely in order to diagnose malignant histologic transformation before the appearance of the tumor. The incidence of adenocarcinoma has a large increase in recent years, particularly those located at the junction between the esophagus and stomach.

What are the symptoms?

The main symptom of esophagus cancer is difficulty swallowing or feeling of swallowing food detention, also known as dysphagia. This difficulty is caused by obstruction of the esophagus by the tumor. It usually starts for solid foods and is gradually expanding, becoming for liquids evolved stage of the disease. The natural history of disease, not to be remedied, lead to a complete obstruction of the esophagus with total inability to swallow. In situations with advanced disease may be associated with other symptoms such as pain with swallowing, regurgitation, excessive secretion of saliva, speech disturbances, loss of weight, etc..

How is it diagnosed?

The main method of diagnosis is the upper endoscopy. On the one hand, this exploration will direct images of the cause of esophagus obstruction, on the other hand, locate the precise point of obstruction and, finally, will provide samples to confirm the diagnosis by biopsy. With this system, diagnosed more than 95 percent of the time casos.Una confirmed the diagnosis, we must consider the extent of disease in order to assess the most suitable treatment. Within the extension studies, it is remarkable the ECO-endoscopy to assess the degree of local infiltration and computed tomography (CT) or chest and abdominal escanner for identifying distant metastases.

What is the treatment?

There are three weapons to combat esophagus cancer: surgery, radiotherapy and chemotherapy. They can be used alone or in combinación.Diversas are accepted forms of treatment. However, for healing, it will be necessary to go through surgical resection. However, persons of high surgical risk may pose other therapeutic options such as radiotherapy radical.Una form of treatment for esophagus cancer involves intensive application, first, treatment with radiotherapy and chemotherapy followed by surgery. Preoperative radio-chemotherapy shown to shrink the tumor and minimize the possibility of producing tumor implants during surgery. With this therapy is achieved completely destroy the tumor in 25-30 percent of cases.

What is surgical treatment?

Surgical treatment of esophagus cancer aims at complete tumor removal and reinstatement of the GI tract. The esophagus is communication between the mouth and stomach, through to do neck, thorax and abdomen. For this reason, surgical excision, depending on the location of the tumor, may require an approach to the abdomen, chest and neck. In certain situations the esophagus can be removed without opening the chest, as is the case of transhiatal esophagectomy.

Currently techniques are being used in laparoscopic and thoracoscopic surgery in order to reduce morbidity and mortality of surgical treatment.
Does the surgical complications?

Surgery of esophagus cancer, currently and in specialized centers, carries an operative mortality of less than 5 percent. On the other hand, postoperative complications are frequent, especially pleuro-pulmonary, reaching at times 50 percent of patients.
What other forms of palliative treatment are there?

In situations where you can not remove the tumor or in patients with high surgical risk, we can introduce various forms of palliative treatment, in order to overcome the obstacle in the esophagus and get feed enfermo.Dentro of these forms of treatment is be noted: endoscopic intubation or surgical resection trans-endoscopic palliative radiotherapy, etc.

What is the prognosis?

In general, the prognosis of patients with esophagus cancer is very bad, because, of all patients diagnosed with esophagus cancer, the five-year survival does not reach 10 percent, and the patients who were manages to remove the esophagus, expected survival is 20 to 30 percent.

Early cancers in stages 0 and I, can often be removed through an endoscope if they have not spread widely to the regions above or below the esophagus. However, the vast majority of esophageal cancers require a removal  of the esophagus

Esophageal cancer can not be cured in most patients because the diagnosis is made, usually after the cancer has spread. In addition, many patients are often too sick to undergo aggressive surgical treatment. Among the major dilemmas faced by patients with esophageal cancer is whether or not to undergo a major surgical procedure or treated with radiation therapy and chemotherapy without surgery.

There are many approaches to surgical removal of the esophagus. Important considerations include the removal of all cancer and restoration of normal continuity of the digestive system, so that patients can not feed themselves without too many complications or death is the result of the surgery. The choice of surgery depends on the location and extent of cancer, the patient’s condition, and the surgeon’s preference. Currently, there are two predominant methods: transhiatal esophagectomy and transthoracic. In an esophagectomy, the surgeon removes the portion of esophagus cancer, and reattached to the stomach to the remaining parts of the esophagus.

In a transhiatal esophagectomy, the surgeon makes two incisions, one in the cervical or neck region and the other in the upper abdomen. A third incision is made through the diaphragm, which is the breathing muscle separating the chest from the abdomen. In contrast, a transthoracic esophagectomy involves a single incision on the left side of the chest with a separation of the left side of the diaphragm.

Surgical exploration of the abdomen is performed, usually in all operations to remove esophageal cancer. The sample of lymph nodes may help determine the stage of cancer, and determine whether the goal of treatment is curative or palliative. During esophagectomy, the esophagus is removed and pulling the stomach into the neck region, and connects to the remaining end of the esophagus. Lower Esophageal cancer is easier to treat than the upper esophagus, due to the higher amount of remaining normal esophagus. The upper esophageal cancer can invade the larynx (voice box) and pharynx (throat), making it difficult to rebuild an adequate tube into the stomach.

There are many clinical studies suggest that advanced age alone should not be difficult for older patients treated with esophagectomy. These studies have evaluated and reported the results after esophagectomy in patients 70 years or older. In a clinical study, the hospital mortality rate was 18% for older patients and 14% for youngsters. In another study, survival at 5 years was 24% for elderly patients and 22% for youngsters. The patient’s condition, not age, should be the determining factor in the decision to choose an aggressive surgical approach in the treatment of esophageal cancer.
Surgery for palliation of esophageal cancer

In situations in which the cancer can not be cured, it is used often, surgery to improve patients’ ability to move food through the esophagus. In a clinical study, doctors compared the results of 39 patients with esophageal cancer at stage IV who underwent an esophagectomy for palliation, compared to the results of 49 patients with esophageal cancer at stage IV who underwent a more complete removal of the cancer. Both groups experienced significant improvement with respect to the quality and quantity of food intake and a reduction in the severity of the symptoms by eating. After 9 months, patients in the palliative group experienced more pain and worsened their quality of life, but there were no differences in sleep, activity in leisure time, and performance scores when compared with the other group. This study suggests that palliative esophagectomy relieves symptoms in most patients with inoperable esophageal cancer. One could also argue that both groups had palliative surgery because most patients who underwent surgery with curative intent, had a quick recurrence of cancer in the first or second year after surgery.

The major complications of surgery include pneumonia and digestive fluid leaks at the site where the stomach was sutured to the remaining esophagus. The mortality rate due to complications after esophagectomy varies from 0-17%, depending on the stage of cancer, the patient’s condition and experience of the surgical team. It is important that patients planning to undergo surgery receive treatment in an institution to conduct a large number of esophagectomy because the operative mortality rate is linked directly to the experience of the group of surgeons, anesthesiologists and nurses who perform operation. In a recent clinical study, we evaluated the deaths in the first 30 days after esophagectomy in more than 5,000 patients treated at several medical institutions. After esophagectomy, 17% of patients died in hospitals that performed few esophagectomy per annum compared to 3.4% in hospitals that performed esophagectomy for many years. This difference is even more relevant given that the great centers treated, often the most difficult cases. Patients must request information regarding the success and complication rates of the team performing esophagectomy at the institution where the operation is planned.

Surgery alone is the primary treatment for many patients with esophageal cancer in stages 0, I or II and the results are detailed in the General Information section of the treatment. For more information, go to stage 0 cancer, cancer in stage I, stage II cancer.

Surgery for stage III cancer is somewhat controversial and often is performed after neoadjuvant chemotherapy and radiation therapy, For more information, go to stage III cancer.
Extent of surgery

At present, there is some controversy over the extent of surgery required to remove all the cancer in patients with cancer spread outside the esophagus. Some surgeons, particularly in Japan, say that survival is improved if surgery is used extensively to remove all the lymph nodes involved. This sometimes is done with three different surgical incisions. In general, the more extensive the surgery, the greater the complications and mortality. Some surgeons claim that less extensive surgery is acceptable. However, there have been no clinical trials directly comparing these two surgeries. In the United States is more likely that patients are treated with only chemotherapy and radiation therapy or before surgery (neoadjuvant therapy), be treated with more extensive surgery. In fact, some surgeons have the esophagus removed by endoscopic techniques without a major surgical incision, minimal surgery advocate.

Surgery is an integral part of treatment for esophageal cancer, however, it is not exclusively a surgical disease, it is important that patients be treated in a medical center that can offer multiple treatment modalities, including surgeons, gastroenterologists, radio- oncologists, medical oncologists and nutritionists.

The removal of the esophagus (esophagectomy) may be used to prevent the occurrence of esophageal cancer in people at high risk for Barrett’s esophagus, as primary treatment for early stages of cancer, and as a palliative to reduce side effects or symptoms cancer patients with extensive disease. When taking a decision concerning esophagectomy, should be considered the primary goal of treatment (cure versus palliation), the experience of the group of surgeons and the patient’s age.
Barrett’s esophagus with or without low grade dysplasia

The esophagus is a more or less straight tube consisting of several concentric layers that connects the mouth to the stomach. esophagus cancer occurs when cells in the innermost layer of the wall (mucosa) multiply out of control. At first when multiplied these cells form a lump which affects the mucosa, but soon invade or infiltrate the outer layers of the esophagus wall. Then, the cancer may invade adjacent organs (lung, heart, aorta, …) and metastasize, both in lymph nodes and through blood and other organs.

We know basically two types of cancers in the esophagus. Squamous cell carcinoma or squamous cell, which is by far the most frequent (90%), and adenocarcinoma of the esophagus, which usually appears on a lesion known as Barrett’s esophagus and affects the lower third of the esophagus.

How is esophagus cancer?

As with all cancers, the ultimate cause is an alteration of genes in a cell, so that goes awry multiplication. These genes will be altered by the action of substances called carcinogens.

The incidence (number of cases in a given population in a year) varies greatly from one country to another, is very common in China, Iran, southern Russia and Normandy (France). In the rest of Europe, including Spain, the incidence is relatively low, with about 3-4 cases per 100,000 persons per year. In addition, esophagus cancer affects 1.5 to 3 men for every woman and usually occurs after age sixty.

The consumption of snuff, both smoked and chewed, the intake of alcohol, smoked or salted foods and drinks are extremely hot dietary factors most associated with esophagus cancer. The Plummer-Vinson syndrome (which is a disorder of the skin and mucous membranes, especially digestive diseases, associated with iron deficiency anemia and is often seen in women) often degenerates into an esophagus cancer.

A special situation is adenocarcinoma of the esophagus that usually (but not always) originates in the esophagus areas previously affected by an abnormality called Barrett’s esophagus. This condition occurs when stomach acid repeatedly passes over the years and into the esophagus. The lining of the esophagus, to defend against this aggression, changes shape, becoming more similar to the intestine (called metaplasia). In this situation the cells are more susceptible to the effects of carcinogens and cancer of the esophagus is frequent if not prevented.

The best way to prevent esophagus cancer is to refrain from smoking and drinking alcohol and seek medical advice if burning.

What is it?

Esophagus cancer ranks 1-2 percent of the tumors and within the digestive system, 7 percent. Different geographic areas increases the incidence and certain provinces in China, Russia and Iran. In Europe, countries with higher prevalence of Esophagus cancer are: France, Switzerland, Finland and Iceland. It is more common in men and usually diagnosed between the sixth and seventh decade of life, but may appear at any age.
What types of cancer are there?

There are two types of tumors: squamous cell carcinoma and adenocarcinoma.

Squamous cell carcinoma is usually localized in the middle and upper esophagus and within the predisposing factors, we must stress independently of heavy drinking and snuff, showing a synergism when the two factors together. There are other diseases that affect the incidence of cancer of the esophagus as tylosis, achalasia, caustic strictures, etc.

The adenocarcinoma appears predominantly in the lower esophagus and the most important predisposing factor is the “Barrett’s Esophagus.” This is usually associated with a history of gastro-Esophagus reflux and hiatal hernia of long evolution. When a patient is diagnosed with Barrett’s esophagus will need to be monitored closely in order to diagnose malignant histologic transformation before the appearance of the tumor. The incidence of adenocarcinoma has a large increase in recent years, particularly those located at the junction between the esophagus and stomach.
What are the symptoms?

The main symptom of Esophagus cancer is difficulty swallowing or feeling of swallowing food detention, also known as dysphagia. This difficulty is caused by obstruction of the esophagus by the tumor. It usually starts for solid foods and is gradually expanding, becoming for liquids evolved stage of the disease. The natural history of disease, not to be remedied, lead to a complete obstruction of the esophagus with total inability to swallow. In situations with advanced disease may be associated with other symptoms such as pain with swallowing, regurgitation, excessive secretion of saliva, speech disturbances, loss of weight, etc..
How is it diagnosed?

The main method of diagnosis is the upper endoscopy. On the one hand, this exploration will directly image the cause of Esophagus obstruction, on the other hand, locate the precise point of obstruction and, finally, will provide samples to confirm the diagnosis by biopsy. With this system, diagnosed more than 95 percent of cases.

Once the diagnosis is confirmed, we must consider the extent of disease in order to assess the most suitable treatment. Within the extension studies, it is remarkable the ECO-endoscopy to assess the degree of local infiltration and computed tomography (CT) or chest and abdominal escanner for identifying distant metastases.
What is the treatment?

There are three weapons to combat Esophagus cancer: surgery, radiotherapy and chemotherapy. Can be used alone or in combination. Various forms of treatment are accepted. However, for healing, it will be necessary to go through surgical resection. However, persons of high surgical risk may pose other therapeutic options such as radical radiotherapy.

A form of treatment for Esophagus cancer involves intensive application, first, treatment with radiotherapy and chemotherapy followed by surgery. Preoperative radio-chemotherapy shown to shrink the tumor and minimize the possibility of producing tumor implants during surgery. With this therapy is achieved completely destroy the tumor in 25-30 percent of cases. Chemotherapy and radiotherapy are also used together in some patients can not undergo surgery.

Chemotherapy drugs used to treat Esophagus cancer include 5-fluorouracil (5-FU), cisplatin, carboplatin, bleomycin, mitomycin, doxorrubina, methotrexate, paclitaxel, vinorelbine, topotecan and irinotecan. In the chemo, the drugs most frequently used 5-FU and cisplatin together.

Patients with metastatic disease may benefit from palliative radiotherapy to relieve difficulties in swallowing, and chemotherapy.

Palliative treatment should be directed at resolving the dysphagia, improve nutritional status and treat complications as tracheoEsophagus fistulas.
What is surgical treatment?

Surgical treatment of Esophagus cancer aims at complete tumor removal and reinstatement of the GI tract. The esophagus is communication between the mouth and stomach, through to do neck, thorax and abdomen. For this reason, surgical excision, depending on the location of the tumor, may require an approach to the abdomen, chest and neck. In certain situations the esophagus can be removed without opening the chest, as is the case of transhiatal esophagectomy.

Currently techniques are being used in laparoscopic and thoracoscopic surgery in order to reduce morbidity and mortality of surgical treatment.
Does the surgical complications?

Surgery of Esophagus cancer, currently and in specialized centers, carries an operative mortality of less than 5 percent. On the other hand, postoperative complications are frequent, especially pleuro-pulmonary, reaching at times 50 percent of patients.
What other forms of palliative treatment are there?

In situations where you can not remove the tumor or in patients with high surgical risk, we can introduce various forms of palliative treatment, in order to overcome the obstacle in the esophagus and get to feed the sick. Within these forms of treatment must be highlighted: endoscopic intubation or surgical resection, trans-endoscopic palliative radiation therapy, placement of stents, etc.
What is the prognosis?

In general, the prognosis of patients with Esophagus cancer is very bad, because, of all patients diagnosed with Esophagus cancer, the five-year survival does not reach 10 percent, and the patients who were manages to remove the esophagus, expected survival is 20 to 30 percent.