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Ung thư và Phòng ngừa : Glossary
Esophageal Cancer
[2007-09-21 10:43] (1,051)

Outline

Esophageal cancer is the malignant tumor that typically occurs in men aged 50-70 years, comprising 2.2 ~ 2.5 % of the entire malignant tumors. It ranks seventh among the cancers that occur frequently in Korea following stomach cancer, lung cancer, liver cancer, uterine cancer, colon cancer and breast cancer. In Korea, the recent incidence rate of esophageal cancer in men is increasing gradually. Its incidence in Asian countries such as Korea, China, Japan, etc. is higher that that in the West. The esophagus has a higher degree of malignancy in terms of its anatomical nature when compared to the other internal organs and and esophageal cancer is not easily detected at early stages. For these reasons, its prognosis is poor with no significant performance status yet. Nevertheless, in case of early esophageal cancer, 70 % or more can be cured, so results can be favorable if the esophageal cancer is diagnosed early and if active treatment is pursued.

 

Synonym

 

Malignant tumor of the esophagus

 

Definition

 

Malignant tumor occurring in the esophagus

 

Symptoms

 

As the esophagus cannot be easily expanded due its nature, it barely causes any symptoms in swallowing food until the tumor blocks 75% of the esophageal lumen. For this reason, symptoms normally do not appear until this cancer has deeply spread. 

 

The most common symptom is difficulty in swallowing. At first, the trouble is with dry, solid foods, but it can become hard to swallow even liquids or spittle. When it becomes hard to take foods, weight loss, and generalized weakness follow. Other symptoms include chest pain during eating, choking, etc.

 

Cause, conditions and physiological

 

The cause of this cancer has not been clearly detected but seemed to be attributable to a variety of factors. Reportedly it depends on the regional or cultural characteristic. Cigarette smoking and excessive drinking are the important factors causing this cancer, while diseases such as caustic esophageal stricture, Barrett's esophagus, Achalasia etc. are known to result in esophageal cancer

 

Diagnosis

 

Diagnostic tests include esophagography, esophageal endoscopy, and computed tomography. Esophagography is relatively easy and is done to detect the range of cancer. Esophageal endoscopy is necessary in terms of histological diagnosis while computed tomography is necessary to stage the disease before surgery which enables the doctor to assess the progression of the cancer, whether it invaded surrounding tissues, whether it spread within mediastinum and celiac lymph node, and whether it spread within liver and adrenal gland. Also, bronchoscopic examination, abdominal ultrasonography, esophageal endoscopic ultrasonography, bone scan, etc. can be performed to further assess the spread within the other internal organ and lymph nodes.

 

Progress, Prognosis

 

Esophageal cancer rarely shows symptoms in the early stages, so once the symptoms are detected, it has already spread deeply and therefore the patient can lose the proper time to undergo the treatment. Furthermore, anatomically there is no serosa and lymph is abundantly distributed in the esophagus, which enables the frequent occurrence of local invasion and remote metastasis giving the patient a poorer prognosis compared to the other malignant tumors. Although several treatment methods have been attempted up to now, 5-year survival rate of the patients with esophageal cancer doesn’t exceed 20% in general. Nevertheless, it is reported that the cure rate is 70% or more in case of early esophageal cancer. Therefore, once the cancer is detected, the patient is required to undergo all the active treatments including operation. 

 

Complications

 

A variety of symptoms and complications appear once the esophageal cancer has progressed into the surrounding tissues, bones, liver, etc. These include aspiration pneumonia, hemoptysis, hoarse voice, chest pain and abdominal pain, etc.

 

Treatment

 

The methods to treat esophageal cancer broadly consist of surgery, radiation therapy, and chemical therapy, and are determined based on the location of tumor, invasion into the surrounding tissues, lymph metastasis, or metastasis to other internal organs. At stage I of esophageal cancer, 50% or more can be cured with surgery only, but combined therapy is necessary for more advance disease. Combined therapy consists of radiation therapy+operation, chemical therapy+operation, or radiation therapy+chemical therapy+operation. Radiation therapy and chemical therapy can be implemented before operation, after operation, or before and after operation, depending on the degree of esophageal cancer progression. In case of terminal esophageal cancer, the treatments such as radiation therapy, chemical therapy, or insertion of artificial esophagus are done for the purpose of reducing the symptoms.

The method of surgery varies depending on the location of esophageal cancer, lymph node metastasis, but the most typical surgery is
esophagogastroanastomosis. The fundamental rule of esophageal cancer operation is to cut the portion of the esophagus that includes the tumors leaving sufficient boundary (Distal portion; 5cm or more, Lower portion; abdominal part of esophagus), while completely cutting out the surrounding lymph node (chest and abdomen), lifting the stomach up to the chest or cervix, finally connecting it to the esophagus left. When the tumor is present in the central or lower part of the thoracic esophagus esophagogastroanastomosis is done in the chest. When the tumor is present in the upper part anastomosis is performed in cervical area. As remote lymph metastasis frequently occurs, the method of completely cutting out cervix lymph nodes as well as chest and abdominal lymph nodes (3 field dissections) has been reported to improve the survival rate after operation in Japan. Also, surgical methods such as interposition using colon or jejunal free flap for substituting the stomach may be necessary in some cases.

 

Consult a doctor in the following cases

 

When it becomes hard to swallow food and pain is felt, you have to suspect esophageal disease. In cases like this you are required to consult with a medical specialist immediately.

Sắc đẹp & Phong cáchUng thư và Phòng ngừaLối sống lành mạnhSức khỏe tinh thần và stressGiới tính Nam/NữChủ đề nóng bỏng
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