Esophagus Cancer

How often is this type of cancer encountered?

We treat more than 200 patients per year in our center. What we have been observing over the last years was a clear trend towards higher incidence rates especially in patients suffering from adenocarcinoma of the esophagus.

 

Symptoms of Esophagus Cancer

Unfortunately early cancer stages are asymptomatic in many cases. In these patients rather the risk factors can lead to typical symptoms (Reflux disease, heartburn, regurgitation). In advanced stages. dysphagia (difficulties with normal swallowing), sometime retrosternal pain are typical symptoms besides general “cancer-symptoms” as weakness, fatigue, weight loss and chronic anemia.

 

Who is at increased risk of developing this type of cancer? 

Concerning the risk factors we have to differentiate into two groups: the first group is patients who are at risk for developing squamous cell carcinomas of the esophagus. This cancer is typically located in the upper part of the esophagus. Proven risk factors for this cancer type are smoking, severe alcohol consumption and HPV infection. Generally we see a clear decrease in the incidence of this kind of esophageal cancer over the last 15 years.

The other type of esophageal cancer (the adenocarcinoma of the esophagus) in contrast is a cancer with incredible dramatic increasing incidence numbers. We have seen an increase of over 400% within the last years. The best known risk factor for this cancer type is the gastroesophageal reflux disease (GERD) with  typical symptoms as heartburn, chronic coughing or regurgitation. A further risk factors is obesity. Today we know that esophageal  cancer develops via premalignant stages. Induced trough reflux (heartburn) the so called Barrett Esophagus can develop. If reflux is not treated (Anti-reflux-surgery) in some cases (risk is dependent on the amount of reflux and additional, mostly unknown risk factors) dysplasia (localized cancer precursor) can develop.

The typical patient with high risk for esophageal (adenocarcinoma) cancer is a little overweighed with a history of heartburn or mouth-burnin.

 

What are the modifiable and unchangeable risk factors?

The most important modifiable factor is Reflux Treatment! Today we have very precise methods to evaluate the severity of GERD and have a broad spectrum of treatment modalities in a highly specialized GEDR-treatment center.

 

Can too cold or too hot food and drink increase the risk of developing this type of cancer? 

We do not really know if the food’s temperature really is a significant risk factor. However in countries where hot food is typical, especially squamous cell cancer of the esophagus is observed at higher incidences.

Throat infections are often induced via GERD and can therefore be seen as an indirect risk factor.

 

Diagnosis of Esophagus Cancer

The most important modalities are gastroscopy, (PET-) CT scan and in some cases endoscopic ultrasound.

 

Treatment of Esophagus Cancer and the chances of leading a normal life after treatment?

Today around 30% of patients that suffer from esophageal cancer are candidates for surgery. Even though esophageal resection (where the esophageal cancer is removed including big parts of the esophagus and the stomach) can be performed minimally invasive and survival rates have significantly improved it is a kind of surgery that should exclusively be performed in high output clinics with highly specialized surgeons.

In the same way it is absolutely crucial that these kind of patients have to be treated in a multidisciplinary (oncology, surgery, gastroenterology, radiology) setting. In most patients preoperative treatment with (Radio)Chemotherapy will influence the patients survival significantly.