Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus. The esophagus is a muscular tube that carries food and liquid from the mouth to the stomach and is 10 to 13 inches long. Esophageal tumors usually lead to difficulty in swallowing, pain and other symptoms, and are diagnosed with biopsy. Prognosis is fairly poor.
Esophageal cancer starts from the inner layer and grows outward (the wall of the esophagus has several layers). The outside layer is called the mucosa and has 2 parts: the epithelium and the lamina propria. The epithelium forms the lining of the esophagus and is made up of flat, thin cells called Squamous cells. The lamina propria is a thin layer of connective tissue right under the epithelium. The next layer is the submucosa and under it is a thick band of muscle called the muscularis propria. The outside layer of the esophagus is called the adventitia.
The stomach has acid and enzymes that digest food. The epithelium or lining of the stomach have special features that protects them from the stomach’s acid and digestive enzymes. Acid can escape from the stomach into the esophagus and is called reflux or gastro esophageal reflux disease (GERD). Reflux can cause heartburn and if it continues for a long time, the acid can cause injury to the lining of the esophagus and eventually cancer.
There are 2 types of esophageal cancer: Squamous cell carcinoma and adenocarcinomas. Squamous cell carcinoma can occur anywhere along the length of the esophagus and is also called epidermoid carcinoma. Adenocarcinomas start in glandular tissue and usually forms in the lower part of the esophagus, near the stomach If esophageal cancer is found very early, there is a better chance of recovery but it is often in an advanced stage when it is diagnosed. Esophageal cancer rarely can be cured in advanced stages.
The overall 5-year survival rate in patients ranges from 5% to 20%. Patients with severe dysplasia in distal esophageal Barrett's mucosa often have invasive cancer within the dysplastic area and these patients usually have an excellent prognosis.
There are a number of risk factors for esophageal cancer:
Age, gender (it is more common in men) and race (more common in African-Americans)
Smoking and excessive alcohol use
Swallowing lye and other caustic substances
Dietary substances, such as nitrosamine
A history of head and neck cancers
Plummer-Vinson syndrome (anemia and esophageal webbing) Tylosis and Howel-Evans syndrome (thickening of the skin of the palms and soles)
Radiation therapy
Celiac disease and primary biliary cirrhosis
Gastro esophageal reflux disease (GERD) and its resultant Barrett's esophagus
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