The esophagus is a hollow muscular organ that is a direct pharynx continuation and connects it to stomach. The main function of esophagus is to carry food and liquid from mouth and pharynx to stomach. Esophagus malignant diseases are fairly common oncological pathologies that occur mainly in adulthood. This is a whole group of malignant tumors, among which squamous cell carcinoma and adenocarcinoma prevail.
Unfortunately, esophagus tumors are diagnosed mainly in the late stages, when specific symptoms appear for damage to this organ. Accordingly, in such cases, the prognosis is unfavorable. In the early stages, disease proceeds imperceptibly and is detected only during a preventive examination or when diagnosing another disease.
Esophageal cancer is, of course, a serious disease, but with timely detection and modern comprehensive treatment application, it is completely curable. Oncology Department Maimonides Multidisciplinary Medical Center employs highly qualified specialists who will help you overcome this desease. Our clinic operates in close and fruitful cooperation with the best Israeli oncology centers and according to their model. Each individual clinical case is observed not only by attending oncologist, but also monitored by the head of the department – Dr. Stefanska Iryna and an authorized oncologist directly from Israel. All decisions are made in consultation, and if necessary, each doctor can organize an online consultation of an Israeli oncologist for his patient.
Malignant neoplasms treatment is quite expensive, and not all patients who need such highly specialized care can afford it. All patients of Maimonides MC have the opportunity to receive help for treatment, because our clinic works under the patronage of “Keren Or for our Child” the Charitable Foundation.
One of treatment advantages at Maimonides Medical Center is a whole multidisciplinary specialists teaminvolvement in treatment process of each patient. Patient is assisted not only by oncologists, but also by surgeons, gastroenterologists, endoscopists, radiation therapists, chemotherapists, rehabilitation specialists, psychologists and other narrow specialists, depending on the patient's needs. In their work, specialists of our department are guided only by modern clinical recommendations and global treatment protocols, so patients can not worry about quality of medical services. At the same time, the approach to each person is individualand not templated. Making up an examination plan and a therapy scheme, doctor takes into account all the details – age, sex, main disease, tumor location, its size and characteristics, serious concomitant diseases presence in patient, his personal wishes regarding the treatment and diagnostic process.
All our doctors are highly qualified, they have repeatedly completed training courses at the best world’s oncology centers (Israel, Germany, USA).). The department uses only modern medical and diagnostic equipment of an expert class. All specialists have psychological skills in communicating with oncology patients. If a certain narrow specialist or rare medical and diagnostic equipment is not available, the patient is referred to subsidiary institutions of Maimonides Medical Center or our Israeli partner clinics, where he is guaranteed to receive the full range of necessary medical services, where he is guaranteed to receive the full range of necessary medical services.
Esophageal cancer causes and symptoms
About 400,000 new cases of esophageal cancer are diagnosed annually in the world. Men are affected twice as often as women. Most cases of esophageal cancer are recorded in Central and Southeast Asia . Ukraine, like most European countries, is characterized by a moderate incidence of esophageal cancer.
The direct cause of any malignant tumor development is a mutation in a certain cell, as a result of which it acquires the ability for uncontrolled growth and division. Such a single cell, which has escaped the immune system's view and has not been destroyed by immune cells, gives rise to a tumor. Unfortunately, causative factor that leads to this mutation development is currently not known, but there is a certain connection between some negative effects of external and internal environmental factors and esophageal cancer frequency in such people.
Risk factors of esophagus malignant tumors development are:
- abuse of alcoholic beverages;
- smoking (in any form), chewing tobacco;
- high temperature of food and drinks;
- fresh vegetables and fruits deficiency in the diet;
- protein and saturated fats excess in the diet, non-esterified linoleic acid contained in corn, nitrosamines (saltiness);
- human infection with Human papilloma virus, Helicobacter pylori bacteria, and mold fungi;
- certain chemicals negative carcinogenic effect – benzene, quartz dust, asbestos;
- ionizing radiation effect – increased radiation background, radiation therapy applied against cancer of another location in anamnesis;
- esophagus chronic diseases – cardia achalasia, gastroesophageal reflux disease, Barrett's esophagus, esophagus congenital anomalies, esophageal mucosa chemical burns, etc.;
- obesity.
Esophagus malignant lesions symptoms appear as the tumor progresses. Among them, 4 more or less specific esophageal cancer syndromes can be distinguished:
- The main esophagus function violation – carrying food to stomach. This is one of early pathology manifestations and appears, as a rule, by dysphagia – swallowing process violation. At first, difficulties arise swallowing solid food, over time they progress and it becomes difficult for patient to take even a sip of liquid (esophagus complete obstruction).
- Saliva increased production . Hypersalivation is a reflex response of salivary glands to constant food particles presence in esophagus.
- Pain. As a rule, it is localized, behind sternum, in epigastric region, in thoracic region of back. In the beginning, pain is associated with eating, and later it transforms into a permanent one.
- Loss of body weight, exhaustion.
In addition to the main 4 complaints, patients with esophageal cancer may experience vomiting with blood impurities, voice hoarseness, peripheral lymph nodes enlargement, cough after eating, hemoptysis and other symptoms.
Types of esophagus malignant tumors
The most common form of esophageal cancer is squamous cell carcinoma (carcinoma) . It develops from flat epithelium cells that lines inside esophagus mucous membrane.
Esophagus adenocarcinoma is the second most common. The tumor grows from glandular cells located in thickness of esophagus mucous membrane. Remaining forms of esophagus malignant neoplasms are less common.
Patients may have:
- spindle cell cancer (low-differentiated variant of squamous cell cancer);
- warty cancer (highly differentiated variant of squamous cell cancer);
- pseudosarcoma of esophagus;
- esophagus mucoepidermoid carcinoma;
- glandular squamous cell carcinoma;
- Glandular-cystic carcinoma (cylindroma) of esophagus;
- primary oat cell carcinoma of esophagus;
- chorionic carcinoma;
- esophageal carcinoid;
- primary malignant melanoma;
- infiltrative sclerosing esophageal cancer.
According to tumor growth characteristics, esophageal cancer can be exophytic and endophytic. The exophytic form of cancer s when the tumor grows into esophagus lumen, has a clear base and visible borders with surrounding healthy tissues. Symptoms of the disease appear quite early, which are primarily associated with a violation of food passage through esophagus. The endophytic form of cancer is when the tumor grows deep into esophagus, spreads along its walls, has no clear boundaries, and grows into neighboring organs and tissues. Such a tumor is not detected for a long time, since cancer symptoms appear already in late stages of process, when there are metastases and sprouting into neighboring organs.
Sometimes esophagus malignant lesion can be secondary (metastatic). Such tumors make up 3% of organ lesion’s total number by malignant process. Most often, these are metastases of melanoma and breast cancer, in addition, tumors of head and neck, lungs, stomach, liver, kidneys, prostate gland, testicles, and bone tissue metastasize to esophagus. These tumors metastases usually spread in connective connective tissue stroma surrounding esophagus, while primary esophageal cancer begins to grow from mucosa or submucosa of esophagus itself.
Esophageal cancer diagnosing methods
As you know, timely and accurate diagnosis is the key to successful treatment of any malignant disease, including esophageal cancer. At Maimonides Clinic, we use only modern and accurate diagnostic equipment, all our doctors have an impeccable command of all examination methods and interpret the received data without error.
Examining patient with esophageal cancer suspicion, doctors pursue two main aims – to confirm (or refute) cancer diagnosis and to determine the stage of process, since all subsequent treatment depends on this.
The diagnostic process begins with a visit to doctor and an eye consultation. Specialist will ask the patient about all complaints, collect medical and life anamnesis, determine possible provoking factors for esophageal tumor development, conduct a thorough physical organs and systems examination. Unfortunately, an objective examination by a doctor is not very informative in terms of disease diagnosing, but it allows us to suspect esophageal cancer and made up a plan for more detailed diagnosis.
The main and mandatory examination method is esophagoscopy – esophagus endoscopic examination. This examination is affordable, easy to perform, during examination of mucous membrane, you can take a photo or video recording. Suspicious area biopsy must also be performed during esophagoscopy.
After biopsy we send all materials to the best foreign pathogistological laboratories for revision. Thanks to such double checks, we are absolutely sure of diagnosis correctness and selected treatment tactics.
Our patients also have access to innovative molecular diagnostics of biopsy specimens of biopsy specimens (molecular genetic studies). This is a mandatory part of modern oncological diseases diagnosis. As is known, the direct cause of many tumors is certain gene mutation. Thanks to molecular genetic diagnostics, we can find these mutations and choose the most effective treatment regimens. Because the response to certain drugs effect depends on the type of changes. An example of such modern diagnostics is Foundation One and Caris Molecular Testing.
Also, all patients esophageal tumor suspected undergo a contrast X-ray examination with barium . Patient drinks a barium solution, after which x-rays are taken. This makes it possible to detect a tumor in esophagus – it will appear on images as a filling defect. This simple examination allows not only to visualize the tumor, but also to determine its level, type of growth (exophytic or endophytic), extent along esophagus length.
All other studies allow establishingf malignant process prevalence and the stage of the disease. For this, bronchoscopy, CT, chest cavity and abdominal organs MRI with contrast, PET-CT, PET-MRI and bone scintigraphy are used to detect all possible metastases, Ultrasound ultrasound.
Based on obtained data during examination, doctor makes an accurate diagnosis indicating the stage of malignant process and formulates treatment scheme. It include individual patient’s characteristics and modern clinical recommendations. All necessary diagnostic procedures can be performed directly in clinic, without leaving Ukraine.
Esophageal cancer modern treatment
One of the biggest esophageal cancer treatment advantages at Maimonides MC is application of comprehensive approach . For disease treatment, we immediately use a combination of several basic, and sometimes innovative or even experimental therapy methods. Among the main available treatment methods are surgical tumor removal in combination with radiation therapy and/or chemotherapy. Also, patient’s treatment complex can include innovative methods – target therapy, immunobiological drugs application, etc.
Tumor surgical removal is the main and radical treatment of esophagus malignant tumors. Cancer in initial stages, as well as superficial, non-invasive forms of lesion, can be treated with the help of endoscopic mucous membrane resection or endoscopic submucosal dissection. All our surgeons master these surgical techniques.
But in the vast majority of cases, an extensive, complex surgery is necessary – a radical resection in a single block, which involves completely tumor removing within healthy tissues, all lymph nodes that may be affected by metastases, and fragment of stomach proximal part. At the same time, stomach is pulled up and a gastroesophageal anastomosis is applied, or a segment of small or large intestine is replaced. This is a very serious surgical intervention that can be performed only by highly qualified surgeons with experience in similar surgeries. Such specialists work in our medical center.
Chemotherapy, as an independent esophageal cancer treating method, is ineffective. Chemotherapy drugs are used in combination with radiation therapy before or after surgery in order to reduce the size of primary tumor and prevent the disease recurrence in future.
In most cases, a combination of cisplatin and 5-fluorouracil is used. Some other drugs are effective in squamous cell cancer, in particular, mitomycin, doxorubicin, vindesin, bleomycin, and methotrexate.
Radiation therapy is also not used as the main treatment method. It is used in combination with chemotherapy before or after surgery. At the beginning of radiation therapy course, edema that develops can worsen esophagus patency and increase dysphagia and odynophagia. This problem may require prior dilation and/or stent placement. As a rule, in esophageal cancer treatment, remote irradiation is used with the help of modern and safe devices – linear accelerators. In recent years, the high efficiency of contact radiation therapy (brachytherapy, which is used in combination with remote radiation (combined radiation technique), has been demonstrated.).
Immunotherapy combined with chemotherapy is currently recommended as first-line therapy for advanced esophageal squamous cell carcinoma. This treatment method is offered as first-line therapy for advanced esophageal adenocarcinoma with overexpression of PD-L1protein. Currently, such drugs are actively used – racurirumab, pembrolizumab.
Several other immunotherapy drugs are currently in clinical trials for esophageal cancer treatment. Their interim results look very promising. These include checkpoint drugs, anti-EGFR antibodies, vaccines, cytokines, and cellular immunotherapy.
Making decisions about complex treatment of esophagus malignant lesions, that is, how to combine the main and additional treatment methods correctly (surgery, chemotherapy, radiation therapy, targeted drugs, etc. ), where exactly to start and with which method to end – this is experienced oncologists prerogative. Because treatment does not always take place according to protocol, as specialists take into account many nuances of patient's illness and his individual data. Therefore, it is important to get into doctor’s skilled hands and treatment result will be as good as possible.