Esophageal cancer is quite an aggressive type of cancer. This is the most common form of malignant tumors of the gastrointestinal tract. The disease ranks the eighth place in the world among the causes of death from cancer. The previous article will discuss the characteristics of the mentioned disease, how dangerous it is and how esophageal cancer is treated abroad.
Esophageal cancer is a malignant neoplasm originating from the esophageal mucosa. The esophagus is part of the digestive tube, a long, hollow tube through which food enters the stomach. The organ is divided into three parts: cervical, thoracic and abdominal. The esophagus wall has several layers: the mucous membrane, muscle, and outer layers. A neoplasm may occur in any part of the esophagus and grow into its wall or along with the organ.
Causes of esophageal cancer
The exact cause of the development of esophageal cancer is still unknown. Healthy cells of the organ mucosa suddenly turn into cancerous cells and begin to divide rapidly, which leads to the formation of a tumor. It is considered that constant irritation of the esophageal mucosa is a decisive factor in the development of cancer.
The factors increasing the risk of disease development:
- Thermal irritation of the wall of the esophageal mucosa, i.e. frequent consumption of hot food and drinks, which can lead to burns;
- Tobacco smoking;
- Drinking alcohol;
- Age over 50 years. With age, the likelihood of development of esophagus cancer increases;
- Gender. Men suffer from the mentioned disease 3 times more often than women;
- Poor mastication, which leads to mechanical damage to the esophageal mucosa;
- Chronic inflammation of the esophagus;
- Human Papillomavirus infection.
People with Barrett’s esophagus are at risk of developing esophagus cancer. The disease refers to a pathological change in the esophageal mucosa. The likelihood of developing cancer in people with Barrett’s esophagus is 30 times higher than among those who do not suffer from this disease.
Other precancerous conditions include esophageal achalasia (impaired motility), esophageal stricture (narrowing of the esophagus), hernia and gastroesophageal reflux disease (reflux of stomach contents into the esophagus).
Papillomavirus infection can also trigger the formation of a tumor in one of the parts of the esophagus.
The first signs and symptoms of esophageal cancer
The presence of esophageal cancer may show no signs for a long time. However, swallowing disorders and the constant need to drink a large amount of liquid after eating should be alarming.
Patients with esophageal cancer have the following symptoms:
- Dysphagia - difficulty moving food through the esophagus;
- Feeling of fullness below the sternum;
- Cough (often occurs when the tumor spreads to the trachea and bronchi.);
- Regurgitation (reflux);
- Enhanced salivary secretion;
- Bad breath;
- Fatigue, tiredness;
- Weight loss;
- Low-grade fever.
Esophageal Cancer Classification
Depending on where the malignant tumor is located, the following types of esophageal cancer exist:
- Esophageal adenocarcinoma, formed from cells of mucous glands;
- Squamous cell carcinoma, which affects the deep layers of the esophagus or develops on the walls of an organ.
Adenocarcinoma and squamous cell carcinoma are the most common forms of the disease. Small cell carcinoma (undifferentiated cancer), carcinosarcoma and adenoacanthoma are diagnosed in only 1% of cases.
According to the type of neoplasm, the following types of cancer are distinguished:
- Infiltrating, which is characterized by the appearance of the growth on the mucosa;
- Ulcerative, which is characterized by the growth of a tumor in the lumen of the esophagus;
- Nodular, during which the tumor has the shape of nodules that fill the esophageal lumen.
There are several ways of cancer spread (metastasis). If metastases occur in the lymphatic system, it is called the lymphatic spread of esophageal cancer. If the disease spreads through the body through the blood vessels, this is called the hematogenous metastasis. The appearance of metastases inside the body cavities indicates implantation metastasis.
Esophageal cancer is classified according to the TNM staging system, which describes the intensity of the ingrowth of the malignant tumor, the involvement of the lymphatic system and the presence of metastases in organs distant from the esophagus.
- The first stage is characterized by the growth of the neoplasm into the submucosa, there are no metastases, the lymph nodes are not affected;
- During the second stage, the neoplasm grows into the muscle layer, lymph nodes located near the neoplasm may be affected;
- During the third stage, the neoplasm grows into the connective tissue membrane, affects several regional lymph nodes, and may produce single metastases;
- At the fourth stage, a malignant neoplasm grows into neighboring organs and produces distant metastases.
The prognosis of cure depends on the degree of spread of cancer. If a tumor was detected at the beginning of the development, the prognosis is very favorable. Deeper tumor growth, the involvement of lymph nodes and especially, metastases, significantly worsens the prognosis. During the last stage of cancer, treatment usually comes down to alleviation of patients’ condition and improvement in their quality of life.
Diagnosis of esophageal cancer abroad
Diagnostics methods include a laboratory and instrumental diagnostics. Laboratory diagnostic methods include:
- Detailed blood count;
- Tumor blood test;
Further, patients, as a rule, do a chest x-ray. Radiography allows seeing the prevalence of malignant neoplasms.
The most informative method of instrumental diagnosis is esophagogastroduodenoscopy. The method refers to an examination of the esophagus with an endoscope. If cancer is suspected, a biopsy is performed during the procedure, cells are taken to the laboratory for further examination. The treatment plan is drawn up after the biopsy results are obtained.
CT scan of the abdominal cavity and chest is an auxiliary diagnostic method, the analysis can be replaced by radiography and ultrasound.
The Caucasus Medical Center (CMC) offers patients a high-quality diagnosis of esophageal cancer and other oncological diseases. The center specializes in the diagnosis and treatment of cancer. The hospital is equipped with modern equipment, which allows carrying out a detailed and safe examination. The doctors of the center are professionals with extensive experience. Many specialists working in the Caucasus Medical Center have gained experience working abroad, in particular in German clinics.
Treatment of esophageal cancer abroad
Surgery is a radical treatment of esophageal cancer. If the surgery is not possible because of the patient’s condition, the cancer is treated with chemotherapy and radiotherapy. This method allows for achieving the best results.
The Caucasus Medical Center is located in Georgia, Tbilisi and provides medical services for local and international patients. People from all over the world are visiting the clinic. The medical center carries out unique tumor resection surgeries and applies innovative treatment methods, skillfully combining drugs with radiotherapy.
The main type of surgical intervention is a subtotal esophageal resection, which means, removal of the esophagus along with lymph nodes located nearby. After removal, the remainder of the esophagus is connected to the stomach. If the tumor has not grown outside the mucus layer, an endoscopic resection is performed.
Such operations require high-tech equipment and highly qualified doctors. Surgical intervention can be performed with minimally invasive methods, using the endoscope, which minimizes the area of intervention in the body. Operations are usually successful and lead to patient’s recovery in 80% of cases or more.
At Caucasus Medical Center surgeries are performed by experienced surgeons. All operations are carried out throughout 24 hours. After undergoing treatment at the clinic, patients receive recommendations for further action. Hospital doctors are always ready to advise patients and provide assistance even when treatment is completed.
Surgical removal of the tumor gives good results only in the initial stages of treatment. If the tumor has grown deeper into the mucosa, the effectiveness of the surgical intervention does not exceed 20%.
To achieve more effective treatment results, several methods are combined — medications and radiotherapy. Chemotherapy and radiotherapy courses can be carried out both before the operation and along with it. Radiotherapy is not used as an independent method of treatment.
Chemotherapy is usually prescribed to patients who have adenocarcinoma. Drug treatment is prescribed before and after the surgery. Chemotherapy can be an independent cancer treatment at the last stage of the disease. In this case, the treatment is intended to alleviate the symptoms of the disease.
Chemotherapy should be appropriate for patients with squamous cell carcinoma. The effectiveness of the combination treatment is individual. If doctors manage to reduce the size of the tumor, the operation is performed 1.5 months after completion of chemoradiotherapy.
In some cases, patients are prescribed only chemoradiotherapy. This occurs when the neoplasm cannot be removed surgically. The five-year survival of patients treated with chemotherapy drugs and radiation exposure does not exceed 25%.
The treatment plan for cancer patients is made individually after confirmation of the diagnosis and examination. An oncological and oncohematological day hospital functions in the Caucasus Medical Center, where patients undergo treatment. Chemotherapy drugs are infused to patients; medical staff provides round-the-clock patient care. The hospital uses radiation therapy and hormone therapy to treat various types of cancer.
After the surgery, the patient is transferred to the intensive-care unit, where they spend 1 - 2 days under the constant supervision of doctors. As a rule, immediately after surgery, the patient cannot eat on their own, so saline solutions and nutrient mixtures are infused intravenously. The rehabilitation period is strictly individual. One week after surgery, patients usually eat on their own and can fully take care of themselves.
Within six months after discharge from the hospital, it is necessary to undergo a regular examination, and if there are disturbing symptoms, consult a doctor immediately to prevent a possible relapse.
The Caucasus Medical Center is part of the largest chain of hospitals in Georgia, Evex Hospitals. The center is a multidisciplinary clinic designed according to international standards. Patients are offered modern treatment methods based on the latest medical research. The specialists of the center collaborate with well-known clinics around the world and with the Ministry of Health of Georgia. This allows us to manage complex cases and carry out rare surgeries. The pride of the center is highly qualified doctors and medical staff of the clinic.
One of the directions of the clinic is medical tourism. Employees of the Caucasus Medical Center are committed to providing world-class healthcare for everyone. Foreign patients are offered quality medical services at affordable prices.
Making an appointment with a doctor and becoming patient at the clinic is very simple. You just have to leave a request on the website. You don’t need to worry about purchasing tickets - the clinic staff will take care of administrative issues. They will provide you with an interpreter and arrange a transfer from the airport to the hotel or hospital and back. The clinic has already successfully treated 17.5 thousand international residents and more than 2 million patients from Georgia. You can read the patient’s reviews on the website of the hospital.