The esophagus is the tube that connects the throat to the stomach. It descends from the neck through the mediastinum and pierces the diaphragm to enter the abdominal cavity and the stomach join. Its interior is covered by a flat cells that form several layers and under them there is a layer of cells which allow the muscle to contract and esophageal peristalsis to advance through food.
Between 85% and 90% of esophageal cancers are epidermoid or squamous type, ie generated from flat cells that line the inner surface of the conduit esophagus.Approximately half are located in the middle third of the esophagus, while 35% occur in the lower third and a lower 15%.
Esophageal cancer affects 5 out of 100,000 people and the main risk factors are alcohol and snuff. Other risk factors include hot food intake, consumption of nitrosamines, radiation esophagitis or ingestion of caustic substances. There are other conditions that may predispose to esophageal squamous cancer, as Plummer-Vinson syndrome, achalasia or certain thyroid disorders.
15% of esophageal cancers are adenocarcinomas, containing fabrics produced on glands. The majority of these cancers are based on an esophagus esophageal tissue altered because of the existence of gastroesophageal reflux, which is known as Barrett’s esophagus. Furthermore, these cancers have also been linked with alcohol and snuff, like squamous esophageal cancer.
Esophageal cancer usually spreads by contiguity to neighboring structures, as well as via the lymphatic system, especially at the left supraclavicular. It can also lead to distant metastases in other organs, mainly liver, lung or pleura.
Most of these injuries, since they occupy a space within the duct esophageal produce difficulty swallowing, a mechanical dysphagia, initially to solids but is that as the lesion grows is also reflected in food intake liquids.Dysphagia, with the passage of time can be motor also by alteration of the swallowing mechanism, which is called achalasia. Feeding difficulty entails a significant weight loss with consequent fatigue.
It may also be sore throat, pain in the chest, regurgitation, vomiting, drooling or hiccups. Because of the bleeding that may occur in the tumor mass may set a state of anemia.
You can sometimes fistula into the respiratory system. This fact and impaired swallowing mechanisms can cause episodes of aspiration are given, with subsequent involvement of the airway and possible secondary respiratory infections.
esophageal cancer can compress various nerves adjacent to it, giving different symptoms in Depending on which nerve compressed. If it affects the recurrent nerves can affect speaking, giving what is known as a bitonal voice. If it affects the phrenic nerves can result in dyspnea. In case of compressing fibers of the sympathetic nervous system may lead to a Horner’s syndrome.
Unfortunately most of the time the cancer is not diagnosed until the patient has no clinical dysphagia, which implies that the state is already advanced tumor. Esophageal cancer should be suspected in any patient who refers dysphagia clinic and present a picture of weight loss, fatigue and lack of appetite.
The barium contrast radiography appreciate allows approximately 80% of all esophageal cancers. Anyway, since some injuries are very small, it is always appropriate to perform an endoscopy to biopsy the lesion and obtain a definitive diagnosis.
It is also desirable to have a chest X-ray, an endoscopic ultrasound and computed tomography (CT) to determine the extent of the tumor. If cancer occurs in the upper two thirds of the esophagus is necessary to perform a bronchoscopy to determine feasibility of surgical removal of the tumor.
In principle the main therapeutic option would be surgery, especially in tumors smaller than 5 cm and are not invasive. If the tumors were larger than this measurement or could arise were treating invasive surgery or radiotherapy.
The surgery involves the removal of the esophagus, as well as adjacent lymph that could be affected by the disease. In the same intervention rebuild the conduit through a gastroplasty, ie the stomach would be used and surgically alter shaping tube for attachment to the area of the pharynx and allow passage of food.Failure to use the stomach by previous surgery or gastric problems may use a portion of the colon.
In cases where the tumor is usually disseminated opt for treatment by radiotherapy. Surgical interventions can be palliative such as dilation or endotumorales prosthesis (through the tumor).
However, despite surgical options, the five-year survival of patients with esophageal cancer is not very high.
The main preventive actions to prevent esophageal cancer undergo avoid its major risk factors, alcohol and snuff. Similarly, it is important to avoid excessively hot meals regularly and certain substances such as nitrosamines. In case of developing GERD, a fact that may influence the development of esophageal adenocarcinoma, it is desirable that the gastroenterologist regularly go to track.
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