Esophagus Cancer

Esophagus is a food pipe connecting mouth, pharynx  to stomach.

Types

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Squamous Cell Carcinoma

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Adeno Carcinoma

Causes

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Experts believe that the irritation of esophageal cells contributes to the development of cancer. Some habits and conditions that can cause irritation include:

  • Consuming Alcohol.
  • Smoking.
  • Having a reflux disorder, such as gastroesophageal reflux disease (GERD).
  • Having Barrett’s esophagus, which is a condition characterized by damaged esophageal lining due to GERD.
  • Being overweight.
  • Not eating enough fruits and vegetables.
  • Having achalasia, a condition where the muscle at the bottom of the esophagus doesn’t relax properly.

Symptoms

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Difficulty in swallowing food.

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Progressive increase in swallowing problem.

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Weight Loss.

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Backache.

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Cough.

Diagnosis / Tests Required

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Endoscopy with Biopsy.

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Contrast CT scan chest and abdomen to assess surrounding organ involvement and extent of spread.

Treatment

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  • Upper 3’rd need Chemo-radiotherapy.
  • Middle & lower 3’rd require either Surgery or Radical Radiotherapy.

Surgery V/S Radio Therapy

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Surgery has better quality of life than radiation and better chance of cure.

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If disease recur after radiation, salvage surgery is extremely difficult,hence fit patient surgery is always first choice.Radiation is generally reserved for patient who are medically unfit for surgery.

Types of Surgery

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Transthoracic (through chest)

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Transhiatal (through abdomen)

What is neoadjuvant therapy ?

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Chemo/radiotherapy given prior to surgery in locally advanced tumors to downstage disease.

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It increases chances of total removal, and decreases recurrence chances.

methods of surgery

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Open Method

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Thoracoscopy / laparoscopy (VATS / LAP)

What is done in VATS ?

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VATS is video assisted thoracic surgery.

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In it, esophagus freed from surrounding attachment and lymph nodes removed.

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Then patient is made supine,and laparoscopically stomach is mobilized removing local lymph nodes to make stomach tube

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This stomach tube is pulled in neck and joined to upper esophagus part.

What is transhiatal esophagectomy ?

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THE (Transhiatal esophagectomy) is mobilizing esophagus through abdomen without opening chest.

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Some part is done blindly and lymph node are not removed.

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Mainly performed for lower esophageal cancer.

How safe is the surgery ?

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This is supramajor surgery.

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Because of advances in anaesthesia technique and VATS/laparoscopy made this much safer.

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Chances of death reduced dramatically with above.

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For fit patients, morbidity is minimal.

What optimization is needed prior to surgery?

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Most common complication is chest infection/pneumonitis, because of ventilator requirement. To prevent if chest physiotherapy in form of incentive spirometer exercises are started from beginning of treatment (right from starting neoadjuvant treatment).

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Second important is nutritional build up. Neoadjuvant chemo / Radiotherapy gives time for both chest optimization and nutritional build up. It is very important for success of surgery.

What are complications of surgery ?

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Complication with good surgery is minimal.

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Known complications are chest infection, bleeding, anastomotic (intestinal joint) leak, stomach tube necrosis, voice change due to nerve handling, thoracic duct leak, etc.

What precaution one should take post surgery ?

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Main thing is decrease in stomach size. Hence food capacity decreases,so these patients should take small but frequent feeds.

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Other is removal of valve which one way passage from esophagus to stomach which prevent food to regurge. Hence these patient should not sleep immediately after food and should always sleep slightly upright(use 2 pillows). This prevent vomiting.