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ESOPHAGEAL (food PİPE) CANCER – FAQS

  1. What is esophageal (food pipe) cancer?
  • A: “Esophageal cancer is cancer arising from the esophagus—the food pipe that runs between the throat and the stomach. Symptoms often include difficulty in swallowing and weight loss. … Squamous-cell carcinoma arises from the epithelial cells that line the esophagus”.
  1. What are the early signs of esophageal cancer?

A: Signs and symptoms of esophageal cancer include:

  • Difficulty swallowing (dysphagia)
  • Weight loss without trying.
  • Chest pain, pressure or burning.
  • Worsening indigestion or heartburn.
  • Coughing or hoarseness.
  1. What are the early symptoms of esophageal cancer?

A:

  • Difficulty and pain with swallowing, particularly when eating meat, bread, or raw vegetables. …
  • Pressure or burning in the chest.
  • Indigestion or heartburn.
  • Vomiting.
  • Frequent choking on food.
  • Unexplained weight loss.
  • Coughing or hoarseness.
  • Pain behind the breastbone or in the throat.
  1. What are the main causes of esophageal cancer?

A: “The two main types of esophagus cancer are adenocarcinoma and squamous cell carcinoma. Risk factors for both types include age 65 or older, male sex, smoking, excessive alcohol use, a diet poor in fruits and vegetables, obesity, and acid reflux (GERD) with associated transition to Barrett’s esophagus”.

  1. What were your first symptoms of esophageal cancer?

A: Symptoms of advanced GERD or the presence of Barrett’s esophagus include:

  • Frequent heartburn. A burning-type pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen.
  • Difficulty swallowing. …
  • Bleeding. …
  • Weight loss and loss of appetite.
  1. What is the average age for esophageal cancer?

A: Age: Esophageal cancer is most often diagnosed in people over age 50. Gender: Esophageal cancer is more common in men than women. Tobacco and alcohol use: Use of tobacco in any form can increase your risk of developing esophageal cancer, particularly squamous cell carcinoma”.

  1. What are the symptoms of advanced esophageal cancer?

A: You might have any of the following symptoms if your cancer has spread to the liver:

  • discomfort or pain on the right side of your tummy (abdomen)
  • feeling sick.
  • poor appetite and weight loss.
  • a swollen tummy (called ascites)
  • yellowing of the skin and whites of the eyes (jaundice)
  1. How long does it take for an inflamed esophagus to heal?

A: If allowed to continue unabated, symptoms can cause considerable physical damage. One manifestation, reflux esophagitis (RO), creates visible breaks in the distal esophageal mucosa. To heal RO, potent acid suppression for 2 to 8 weeks is needed, and in fact, healing rates improve as acid suppression increases.

  1. Esophageal Cancer: Risk Factors?

A: The following factors may raise a person’s risk of developing esophageal cancer:

Age. People between the ages of 45 and 70 have the highest risk of esophageal cancer.

Gender. Men are 3 to 4 times more likely than women to develop esophageal cancer.

Race. Black people are twice as likely as white people to develop the squamous cell type of esophageal cancer.

Tobacco. Using any form of tobacco—including cigarettes, cigars, pipes, chewing tobacco, and snuff—raises the risk of esophageal cancer, especially squamous cell carcinoma.

Alcohol. Heavy drinking over a long period of time increases the risk of squamous cell carcinoma of the esophagus, especially when combined with tobacco use.

Barrett’s esophagus. This condition can develop in some people who have chronic gastroesophageal reflux disease (GERD) or inflammation of the esophagus called esophagitis, even when a person does not have symptoms of chronic heartburn. Damage to the lining of the esophagus causes the squamous cells in the lining of the esophagus to turn into glandular tissue. People with Barrett’s esophagus are more likely to develop adenocarcinoma of the esophagus, but the risk of developing esophageal cancer is still fairly low.

Diet/nutrition. A diet that is low in fruits and vegetables and certain vitamins and minerals can increase a person’s risk of developing esophageal cancer.

Obesity. Being severely overweight and having too much body fat can increase a person’s risk of developing esophageal adenocarcinoma.

Lye. Children who have accidently swallowed lye have an increased risk of squamous cell carcinoma. Lye can be found in some cleaning products, such as drain cleaners.

Achalasia. Achalasia is a condition when the lower muscular ring of the esophagus does not relax during swallowing of food. Achalasia increases the risk of squamous cell carcinoma.

Human papillomavirus (HPV). Researchers are investigating HPV as a risk factor for esophageal cancer, but there is no clear link that squamous cell esophageal cancer is related to HPV infection. Sexual activity with someone who has HPV is the most common way someone gets HPV. There are different types of HPV, called strains. Research links some HPV strains more strongly with certain types of cancers. There are vaccines available to protect you from some HPV strains. 

  1. How curable is cancer of the esophagus?

A: In most cases, esophageal cancer is a treatable disease, but it is rarely curable.

The overall 5-year survival rate in patients amenable to definitive treatment ranges from 5% to 30%. The occasional patient with very early disease has a better chance of survival.

  1. What is the survival rate for cancer of the esophagus?

A: “Percent means how many out of 100. The 5-year survival rate for people with esophageal cancer is 19%.

**However, survival rates depend on several factors, including the stage of the cancer when it is first diagnosed. The 5-year survival rate of people with cancer located only in the esophagus is 43%”.

  1. Can you cure cancer of the esophagus?

A: “Treating stage IV cancer of the esophagus. Stage IV esophageal cancer has spread to distant lymph nodes or to other distant organs. In general, these cancers are very hard to get rid of completely, so surgery to try to cure the cancer is usually not a good option”.

  1. Is esophageal cancer curable if caught early?

A: “In general, the prognosis for people with esophageal cancer tends to be better if the cancer is caught early instead of at a later stage. … The 5-year survival rate for cancer that has reached nearby organs or lymph nodes is about 22 percent”.

  1. What is the main cause of esophageal cancer?

A: “The two main types of esophagus cancer are adenocarcinoma and squamous cell carcinoma. Risk factors for both types include age 65 or older, male sex, smoking, excessive alcohol use, a diet poor in fruits and vegetables, obesity, and acid reflux (GERD) with associated transition to Barrett’s esophagus.”

  1. Is cancer of the esophagus fatal?

A: “Because esophageal cancer usually is not diagnosed until the disease has spread, the death rate is high. … Because nearly all cases of esophageal cancer are fatal, the doctor’s main objective is to control symptoms, especially pain and difficulty swallowing, which can be very frightening to the person and loved ones”.

  1. Where does esophageal cancer metastasize to?

A: “Metastatic esophageal cancer (stage IV) is cancer that has spread (metastasized) to distant sites in the body, such as the lungs or the liver.

*Because the cancer has spread, surgery cannot remove it completely, so people with metastatic esophageal cancer typically do not have surgery as part of their treatment plan.”

  1. Can you get “esophageal cancer” from acid reflux?

A: “Heavy alcohol use. Gastroesophageal reflux disease (GERD), in which contents and acid from the stomach back up into the esophagus. Barrett’s esophagus, a condition that affects the lower part of the esophagus and can lead to esophageal cancer; Barrett’s esophagus may be caused by GERD”.

  1. Can esophageal cancer be detected by blood test?

A: “Your doctor might order certain blood tests to help determine if you have esophageal cancer. Complete blood count (CBC): This test measures the different types of cells in your blood. … Liver enzymes: You may also have a blood test to check your liver function, because esophageal cancer can spread to the liver.”

  1. How do you prevent esophageal cancer?

A: Here are five easy steps to put into action and reduce your risk of developing “esophageal cancer”:

  • Banish the booze. …
  • Toss your cigarettes. …
  • Watch your weight. …
  • Eat right. …
  • Control Gastroesophageal Reflux Disease (GERD).
  1. How can I heal my esophagus naturally?

A: Recommendations:

  • Reduce or eliminate alcohol consumption (if you take an occasional drink, make sure there is food in your stomach).
  • If you smoke, STOP.
  • Avoid coffee and decaf, both of which can be irritating. Switch to chamomile tea, which can help soothe the digestive system.
  • Avoid any food you find irritatingchocolate, peppermint, raw onions, tomatoes or citrus fruits are common culprits.
  • Don’t eat within two to three hours of bedtime.
  • Try visualization, a mind/body technique that could help you manage your symptoms.
  • Elevate the head of your bed by using blocks or foam wedges to reduce reflux while sleeping.
  • Take two enteric-coated baby aspirin a day to reduce your risk of cancer.
  1. Survival Rates for Esophageal Cancer by Stage?

A1: AJCC TNM stage;

  • Localized means that the cancer is only growing in the esophagus. It includes AJCC stage I and some stage II tumors (such as those that are T1, T2, or T3, N0, M0). Stage 0 cancers are not included in these statistics.
  • Regional means that the cancer has spread to nearby lymph nodes or tissues. This includes T4 tumors and cancers with lymph node spread (N1, N2, or N3).
  • Distant means that the cancer has spread to organs or lymph nodes away from the tumor, and includes all M1 (stage IV) cancers.

A2: STAGE & “5-Year” Relative Survival Rate:

  • Localized – 43%
  • Regional – 23%
  • Distant – 5%
  1. What is the survival rate for stage 3 esophageal cancer?

A: “The 3-year survival rate was 32% for patients receiving combined therapy and 6% for patients receiving surgery alone. This clinical trial, in addition to the previous one, suggests that combined modality treatment appears superior to treatment with surgery alone for stage III esophageal cancer.”

  1. What is “stage 0” esophagus cancer?

A: A stage 0 tumor is not true cancer. It contains abnormal cells called high-grade dysplasia and is a type of pre-cancer. The abnormal cells look like cancer cells, but they are only found in the inner layer of cells lining the esophagus (the epithelium). They have not grown into deeper layers of the esophagus. This stage is often diagnosed when someone with Barrett’s esophagus has a routine biopsy.

  1. What are the options for treatment of “Stage 0” esophageal cancer?

A: The treatment typically include endoscopic treatments such as photodynamic therapy (PDT), radiofrequency ablation (RFA), or endoscopic mucosal resection (EMR). Long-term follow-up with frequent upper endoscopy* is very important after endoscopic treatment to continue to look for pre-cancer (or cancer) cells in the esophagus.

  1. What is the surgical option for treating “Stage 0” esophageal cancer?

A: Another optionis to have the abnormal part of the esophagus removed with an esophagectomy. This is a major operation, but one advantage* of this approach is that it doesn’t require lifelong follow-up with endoscopy.

  1. What is “stage I” (T1, T2) esophagus cancer?

A: In this stage the cancer has grown into some of the deeper layers of the esophagus wall (past the innermost layer of cells) but has not reached the lymph nodes or other organs.

  1. What is T1 esophageal cancer?

A: Some very early stage I cancers that are only in a small area of the mucosa and haven’t grown into the submucosa (T1a tumors) can be treated with EMR, usually followed by some type of endoscopic procedure to destroy any remaining abnormal areas in the esophagus lining.

  1. What is the surgical option for treating “Stage 1” esophageal cancer?

A: But most patients with T1 cancers who are healthy enough will have surgery (esophagectomy) to remove the part of their esophagus that contains the cancer. Chemotherapy and radiation therapy (chemoradiation) may be recommended after surgery if there are signs that all of the cancer may not have been removed.

  1. What is T2 esophageal cancer?

A: T2 cancers: For patients with cancers that have invaded the muscularis propia (T2 tumors).

  1. What are the options for treatment of “T2” esophageal cancer?

A: treatment with chemoradiation is often given before surgery. Surgery alone may be an option for smaller tumors (less than 2 cm). If the cancer is in the part of the esophagus near the stomach, chemo without radiation may be given before surgery.

If the cancer is in the upper part of the esophagus (in the neck), chemoradiation may be recommended as the main treatment instead of surgery. For some patients, this may cure the cancer. Close follow-up with endoscopy is *very important in looking for possible signs of cancer returning.

  1. What are the treatment options for People with “stage I” cancers who can’t have surgery?

A: If the patients can’t have surgery because they have other serious health problems, or who don’t want surgery, may be treated with EMR and endoscopic ablation, chemo, radiation therapy, or both together (chemoradiation).

  1. What are the “stages II and III cancer” of the esophagus?

A1: Stage II includes cancers that have grown into the main muscle layer of the esophagus or into the connective tissue on the outside of the esophagus. This stage also includes some cancers that have spread to 1 or 2 nearby lymph nodes.

A2: Stage III includes some cancers that have grown through the wall of the esophagus to the outer layer, as well as cancers that have grown into nearby organs or tissues. It also includes most cancers that have spread to nearby lymph nodes.

  1. What are “the treatment options” for patients with the “stages II and III cancer” of the esophagus?

A: For people who are healthy enough, treatment for these cancers is most often chemoradiation followed by surgery. Patients with adenocarcinoma at the place where the stomach and esophagus meet (the gastroesophageal junction) are sometimes treated with chemo (without radiation) followed by surgery. Surgery alone may be an option for some small tumors.

If surgery is the first treatment, chemoradiation may be recommended afterward, especially if the cancer is an adenocarcinoma or if there are signs that some cancer may have been left behind.

  1. When “chemoradiation” only for the patients with the “stages II and III cancer” of the esophagus?

A: In some instances (especially for cancers in the upper part of the esophagus), chemoradiation may be recommended as the main treatment instead of surgery. Patients who do not have surgery need close follow-up with endoscopy to look for possible signs of remaining cancer. Unfortunately, even when cancer cannot be seen, it can still be present below the inner lining of the esophagus, *so close follow-up is very important.

Patients who cannot have surgery because they have other serious health problems are usually treated with chemoradiation.

  1. What is “stage IV” cancer of the esophagus?

Stage IV esophageal cancer has spread to distant lymph nodes or to other distant organs.

  1. What are “the treatment options” for patients the “stages IV cancer” of the esophagus?

A: In general, these cancers are very hard to get rid of completely, so surgery to try to cure the cancer is usually not a good option. Treatment is used mainly to help keep the cancer under control for as long as possible and to relieve any symptoms it is causing.

Chemo may be given (possibly along with targeted drug therapy) to try to help patients feel better and live longer, but the benefit of giving chemo is not clear. Radiation therapy or other treatments may be used to help with pain or trouble swallowing.

  1. What is the treatment option for cancers that started at the gastroesophageal (GE) junction?

A1: The treatment with the targeted drug ramucirumab (Cyramza) may be an option at some point. It can be given by itself or combined with chemo. Another option at some point might be treatment with the immunotherapy drug pembrolizumab (Keytruda).

A2: Some people prefer not to have treatments that have serious side effects and choose to receive only treatments that will help keep them comfortable and add to their quality of life.

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