Introduction
Cancers continue to cause thousands of deaths and untold sufferings to individuals and their immediate families in the world. In addition, cancers have brought economic challenges to health care sectors owing to the enormity of resources required to treat the thousands of new cases diagnosed each year. Esophageal cancer contributes a sizeable proportion of the cancer burden in the United States and the world at large. An upward trend in terms of mortality and morbidity caused by the lethal forms of esophageal cancers has occurred in recent years. In fact, the United States alone reported more than 16600 new cases and 14500 deaths last year (National Cancer Institute, 2011). This essay will describe the symptoms, the common risk factors and the various diagnostic and treatment options available in the management of esophageal cancer.
Definition
Esophageal Cancer mainly refers to the growths that forms within the tissues that line the walls of the esophagus; the tube composed of muscles that aid the passage of the food from the exterior opening(throat) to the interior opening( stomach). The commonest forms of esophageal cancer are mainly squamous cell carcinoma together with adenocarcinoma remain the commonest forms of esophageal cancer (Jobe, Thomas & Hunter, 2009, p. 56). The former originates from the flat cells that line the esophagus while the latter starts within the cells that manufacture mucus and other bodily fluids. Majority of the cases in America are adenocarcinoma unlike the increasingly prevalence of squamous cell carcinoma reported in the other parts of the world (Enzinger, & Mayer, 2003, p. 351).
Risk factors
The sudden diagnosis of cancer leaves majority of the sufferers with questions of the real causative agents. In fact, doctors have failed to explain the reasons why certain people develop esophageal cancer while others don’t. Empirical evidence denotes an increasingly likelihood of the development of cancers in individuals who are exposed to certain risk factors. Elderly people who are above 65 years have a slightly high chance of developing cancer when compared to other age groups. Health records depict a dark picture with a substantial number of esophageal cancer patients diagnosed at this age group (Enzinger, & Mayer, 2003, p. 354). Gender also plays a major factor in the eventual development of this type of cancer. In fact, men have a three-fold chance of acquiring the cancer when compared with the female counterparts.
Smoking is also a contributing factor with smokers having an elevated chance of developing the cancer. Studies have also linked heavy drinking with the occurrence of the disease. In fact, drinkers who consume at least three drinks on a daily basis have a higher chance of acquiring squamous cell carcinoma when compared to non-drinkers. The risk is compounded by smoking. Although candid conclusion has not been established through research, it is believed that consumption of diet that is deficient in fruits and vegetables also elevates the risk of acquiring esophageal cancer. Obesity also elevates the chance of developing adenocarcinoma (Wu et al, 2001, p. 722). Acid reflux together with Barrett esophagus cause persistent damage to the lining of the esophagus thereby elevating the likelihood of adenocarcinoma. In addition, individuals who have an existing disorder such as esophageal webs occasioned by corrosion or abrasion during swallowing have an elevated chance of developing esophageal cancer (Jobe et al, 2009, p. 56).
Symptoms
Esophageal cancers are usually unnoticed during the early stages. Nonetheless, the sick individuals mainly start having trouble in swallowing foods of solid nature. The narrowing of the tube as the cancers grow occasions the difficulty. Subsequently, swallowing of relatively soft foods together with fluids becomes difficult in the ensuing weeks. Poor nutrition coupled with the progression of cancer contributes largely to increased weight loss in the affected individuals. In most cases, the individuals experience chest pains that are coupled with persistent and sharp back pains (Enzinger, & Mayer, 2003, p. 354). As the cancers progress, more organs and nerves are eventually invaded thereby resulting in physiological complications. Hoarseness has been recorded with studies depicting its source as the compression of the major nerve responsible for controlling the functioning and effectiveness of the vocal chords. Besides that, extreme cases of Horner’s syndrome together with bouts of hiccups accompanied by pain convulsions may eventually develop. Shortness of breath usually occurs when the cancer reach the lungs, while cases of persistent fever and swellings occur in the liver and stomach when attacked. Pain convulsions occurs when the spread affect the various bones in the proximity (Wu, Wan, & Bernstein, 2001, p. 722). Moreover, headaches coupled with elements of confusion are a common manifestation particularly when the cancer attacks the brain. Affected individuals may vomit and release stool that present traces of blood when the intestines are eventually infected. Complete blockage of the esophagus occurs especially during the late stages thereby complicating swallowing (Enzinger, & Mayer, 2003, p. 354).
Diagnosis
It is imperative for individuals to seek medical attention when they develop any of the symptoms that depict esophageal cancer. The doctor conducts a physical exam coupled with taking health history of the patient and that of the extended family. Blood tests are conducted in certain circumstances. In addition, diagnosis may occur through a process called upper GI series, whereby barium solution is used to enhance the effectiveness of x-rays in detecting tumors and obstruction. Endoscopy is the most preferred method in cases when esophageal cancer is suspected in the individuals. An endoscope is put into the mouth thus aiding in viewing the esophagus (National Cancer Institute, 2011 Biopsy removal is usually effected with the help of endoscopy. Computed Tomography (CT) together with ultrasonography scans remain the only useful tools that aid the medical practitioners to get the finer details surrounding the development and management of cancers, hence enhancing the assessment of the obstruction (Wong & Fitzgerald, 2005, p. 110).
Staging
A positive result from the biopsy occasions the doctor to undertake staging to assess the depth of the invasion on the walls, to determine whether the cancer has attacked cells in the nearby tissues and to decipher the extent of the spread, if any. The spread of the cancer is usually detected by assessing the adjoining lymph nodes, which signals invasion of other vital organs. Endoscopic ultrasound, the most preferred staging test, whereby an endoscope is used to release echoes that aid a computer to create a picture that depicts the depth of the invasion in the esophageal walls. MRI and CT scans are crucial in detection of esophageal cancers that have spread to other parts of the body through the use of certain contrast materials that make the abnormal areas visible (National Cancer Institute, 2011).
On the other hand, radioactive sugar is employed in PET scans to detect the extent of the spread. Bone scans are carried out with the aid of radioactive sugar whereby the amount of radiation depicts the extent of the spread in the bones. In addition, cancerous cells in the lymph nodes and the abdomen are checked through a process called laparoscopy. The process is usually completed once the cancerous materials and the adjoining materials are duly removed. Esophageal cancer has four stages that start with the development of the first cancerous cells to the time the cancer eventually affects other parts of the body (National Cancer Institute, 2011).
Treatment
Several treatment options are available in the management of this type of cancer. Effective management of esophageal cancer entails the combination of several options. More importantly, the selection of the treatment option is dependent on the location of the cancerous cells, the extent of the invasion in the nearby tissues and other vital organs, prevailing symptoms and the overall general health of the affected individual (Karolyn & Lise, 2010, p. 10). The fact that diagnosis only occurs after the disease has spread makes the disease fatal with less than 5 % of all cases living more than five years after diagnosis. Doctors mainly involve themselves in controlling the symptoms (National Cancer Institute, 2011). Surgery aimed at removing the cancerous material is the most preferred method since it provides relief but rarely results in cure. In fact, treatment is mainly directed at easing pain while enhancing the swallowing capacity of the patients.
Not only are the various treatment options imperative in relieving the symptoms but also improving the overall health while increasing survival time. However, the combination of radiation therapy with bout of chemotherapy during the days preceding surgery has shown to increase the level of surgical cure rate substantially (Wong & Fitzgerald, 2005, p. 110). Widening of the constricted areas of the esophagus followed by insertion of tube is usually done to ensure the pathway is open. External radiation therapy remains the commonest type whereby the treatment is effected through a machine that is located externally (Karolyn & Lise, 2010, p. 10). Brachytherapy is also practiced where a tube capable of producing radiation is put in the esophagus resulting in destruction of the cancerous cells. The nature of the radiation is usually dependent on factors such as dosage and largely on the type of radiation. Majority of the patients experience a persistent sore throat which is usually accompanied by bouts of pain in the stomach (Layke & Lopez, 2006, p. 2188). Administration of chemotherapy is done intravenously to enhance the functioning of the drugs. Side effects range from skin rash and pain convulsions to swellings, with the nature dependent on the type and the amount of the administered drugs.
Other measures include the utilization of a portion of the intestine to bypass the affected area and then exposing the tumor to laser phototherapy leading to its destruction by the high- energy beam of light (National Cancer Institute, 2011). Symptom relief is also achieved through photodynamic therapy whereby a light sensitive dye is introduced intravenously several hours before the commencement of the treatment. The cancerous cells have higher affinity for the dye than the normal body cells, thereby resulting into their destruction, when light from a laser is used to activation the dye, hence resulting in the opening up of the esophagus (Layke & Lopez, 2006, p. 2189). Destruction of the impeding cancerous materials is more rapid in photo dynamic therapy unlike in radiation and chemotherapy. In addition, it is best suited for individuals who are less tolerant to the latter methods due to their poor health.
Conclusion
It is imperative to provide adequate nutrition in order to improve the overall feasibility and tolerability of the various treatment options. Individuals experiencing difficulties when swallowing require fitting of a tube or rather intravenous feeding should occur in extreme cases (National Cancer Institute, 2011). On the other hand, people who lack difficulties during swallowing should receive concentrated nutritional supplements. The patients should be encouraged to take smaller meals, consume copious amounts of fluids and avoid foods with high levels of sugars. Follow-up care coupled with regular check-ups is imperative in identification of opportunistic infections and complications (Layke & Lopez, 2006, p. 2192). Provision of support care to the patients and their immediate families is indispensable owing to the financial and psychological problems they undergo during this period. Patients should be encouraged to form support groups where they share their experiences thereby helping themselves to cope with the pain. In fact, support groups provide the best avenue for patients to receive psychosocial assistance. More importantly, doctors, counselors and largely the clergymen should be in handy to offer psychosocial support while also providing palliative care to the patients. In addition, the health care providers should embrace professionalism when communicating with the affected families. Governments should commit adequate funds towards research studies aimed at understanding the prognosis and eventual management of the cancers.
Reference list
Enzinger, P. & Mayer, R. (2003). Esophageal Cancer. New England Journal of Medicine, 349, 2241-2252.
Jobe, B., Thomas, C. & Hunter, A. (2009). Esophageal Cancer: Principles and Practice. Pittsburgh, PA: Demos Medical Publishing.
Karolyn, A. & Lise, A. (2010). The Definitive Guide to Cancer: An Integrative Approach to Prevention, Treatment, and Healing Alternative Medicine Guides. Philadelphia: Ten Speed Press.
Layke, J. & Lopez, P. (2006). Esophageal cancer: a review and update. American Family Physician, 73 (12), 2187–94.
National Cancer Institute. (2011). What you need to know about cancer of the esophagus. Web.
Wong, A. & Fitzgerald, R. (2005). Epidemiologic risk factors for Barrett’s esophagus and associated adenocarcinoma. Clinical Journal Gastroenterology and Hepatology, 3 (1), 1–10.
Wu, A.H., Wan, P. & Bernstein, L. (2001). A multiethnic population-based study of smoking, alcohol and body size and risk of adenocarcinoma of the stomach and esophagus (United States). Cancer Causes Control, 12, 721-732.