Esophageal cancer – What does the diagnosis mean?

Around 6000 people in Germany develop esophageal cancer every year. As with many other cancers, the risk of disease depends on lifestyle and the prognosis depends on early detection and treatment. Compared to other cancers, esophageal cancer is a relatively rare disease.

The most important things at a glance

• Esophageal cancer is usually an aggressive cancer and occurs most often after the age of 50.
• The main symptoms are difficulty swallowing, weight loss, bad breath and chest pain.
• Important risk factors include smoking, alcohol consumption and frequent heartburn.
• The diagnosis takes place after an endoscopic sampling of tissue.
• Operable early cancer tumors have a good prognosis and are often curable. Advanced tumor stages, however, have a drastically poorer prognosis and can often only be treated with radiation or chemotherapy.
• Therapy must always individually be matched to the spread of the tumor and the physical requirements.

What are the symptoms of esophageal cancer?

Esophageal cancer can manifest itself in several ways. Common symptoms are swallowing problems (Dysphagia) and pain when swallowing (odynophagia). Initially, these symptoms only occur with dry dishes; as the disease progresses, dysphagia and odynophagia also appear with moist foods. Unwanted weight loss (up to 10 percent of body weight) can also indicate the disease.

Other features:

• Hoarseness
• Swollen lymph nodes in the area of the clavicle
• Persistent pain behind the breastbone
• Increased baseless hiccups

How does esophageal cancer develop?

The exact developmental processes of esophageal cancer are still the subject of current research. However, it is assumed that the disease develops over a longer period of time. According to the thesis, damage accumulates in the cell over time and leads to normal cells developing into cancer cells. Tobacco, for example, contains harmful and carcinogenic substances that come into direct contact with the lining of the esophagus when smoking.

Almost all cases of esophageal cancer can be classified into two types, squamous cell carcinoma or adenocarcinoma. Both types affect men more often than women.

The main risk factors for squamous cell carcinoma:

• Smoking
• Alcohol consumption
• Insufficient ability of the esophageal sphincter to open (achalasia)
• A starchy diet without fruits and vegetables
• Plummer-Vinson syndrome
• Radiation therapy in the area of the esophagus
• Caustic burns of the esophagus
• Previous squamous cell carcinoma in the head / neck area
• Age between 60 and 70 years

The main risk factors in adenocarcinoma:

• Gastroesphageal reflux disease (GERD) or frequent heartburn
• Certain tissue changes in the esophagus (Barrett's esophagus)
• Diaphragmatic hernia (hiatal hernia)
• Age between 50 and 60 years

If you would like to know whether you suffer from reflux disease or are worried about heartburn, you can register here for a free consultation.

Are there any typical early stage symptoms?

In the early stages, esophageal cancer often has little or no symptoms. The first symptoms include difficulties swallowing, strong weight loss and halitosis. Since a large proportion of esophageal cancer is due to frequent, severe heartburn, a burning sensation behind the breastbone can also be counted among the early symptoms of possible cancer precursors.

What are the consequences in the late stages?

In the late stages of the disease, symptoms are mainly caused by the spread of the tumor. In addition to increasing swallowing disorders, increased hiccups and hoarseness, damage to certain nerves can cause so-called Horner's syndrome. This is shown by a narrow pupils, a drooping eyelid and a retracted eyeball. Some patients also report that they no longer sweat in their face and neck area. Furthermore difficulty breathing can occur, which results from tumor growth in the area of the trachea or from involvement of the diaphragm.

In case of emergancy: Artificial nutrition

Due to increasing swallowing problems, some patients with esophageal cancer consume only small amounts of food. This leads to further deficiency symptoms and pronounced physical weakness and may make artificial nutrition necessary.

At what age does esophageal cancer appear most frequently?

Esophageal cancer is a disease of people in advanced age. Typically, patients with adeno or squamous cell carcinoma of the esophagus are older than 50. Cancers of the esophagus before the age of 40 are very rare. In men, the peak of the disease is around 70 years. Overall, women fall ill much less often, but unlike men, the likelihood increases even after the age of 70. Overall, there has been an increase in new cases in the past 20 years.

Men get sick more often than women

The risk of illness is one percent for men and around 0.3 percent for women

How is esophageal cancer diagnosed?

The diagnosis of esophageal cancer is based on several steps. First, a detailed medical history of the risk factors is taken, such as smoking, alcohol consumption or chronic heartburn. The doctor then asks about typical symptoms of esophageal cancer, such as difficulty swallowing. If the suspicion of the disease is confirmed, endoscopy of the upper digestive tract follows. Possible changes in the mucous membrane in the area of the esophagus can be reliably detected and tissue samples taken at the same time. Based on tissue samples, a pathologist can then check whether it is really esophageal cancer. If the suspicion of a malignant change is confirmed, the doctor carries out further examinations such as computed tomography (CT), magnetic resonance imaging (MRI), ultrasound examinations of various organs and laboratory tests before starting the therapy.

Does esophageal cancer have a good prognosis?

As with many other cancers, the depends on the stage of the tumor. The more advanced the tumor, the worse the chances of survival. The chances of survival decrease drastically if the cancer has broken through the lining of the esophagus or even metastasized. Overall, esophageal cancer is considered an extremely aggressive cancer that has a poor prognosis compared to other malignant ulcers of the gastrointestinal tract.

How do you die from esophageal cancer?

Very extensive tumors are usually no longer curable. The actual cause of death in esophageal cancer varies individually. It can be caused by the rapidly growing tumor and by increasing difficulty swallowing, malnutrition and physical exhaustion. This makes patients more vulnerable to dangerous infections. The tumor can also constrict the trachea, causing difficulty breathing and pneumonia, which can also be fatal. Another possible cause of death is the failure of other organs (e.g. the liver) through the formation of distal metastases. If the tumor penetrates large blood vessels such as the main artery, they can tear leading to a fatal loss of blood. With regular monitoring and palliative therapy, some of the consequences mentioned can be delayed and made bearable even in the case of advanced, incurable tumors.

Is esophageal cancer curable?

The chances of recovery from esophageal cancer, like survival rates, depend on the stage of the disease. In the case of small tumors, the chances of healing by endoscopic or surgical removal of the tumor are relatively high. If surgical therapy is out of the question, radiation and chemotherapy are further treatment options. However, the chances of recovery decrease with inoperability and with tumors that have already metastasized. However, no general statement can be made because esophageal cancer can spread very differently and the treatment depends heavily on the patient's physical condition and previous illnesses. The therapy must therefore be tailored to the individual. Accordingly, statements about the curability of an esophageal tumor can only be made by the attending doctor.