Esophageal cancer is a malignant cancer of the esophagus. As esophageal cancer is unfortunately often discovered late, the tumor is usually already advanced by the time it is discovered. The most important symptom is difficulty swallowing.
Here you will find further information as well as selected specialists and centers for esophageal cancer.
The esophagus is a muscular tube about 25 centimeters long. It is the connection between the mouth or throat and the stomach. The esophagus has a diameter of about two centimeters.
The esophagus transports food from the mouth to the stomach by means of undulating movements. Sphincter muscles at the upper and lower ends close the esophagus. If necessary, the sphincter muscles open to allow food to pass through.
The oesophagus is divided into three sections:
The inside of the esophagus is lined with a mucous membrane (mucosa), the uppermost layer of which consists of squamous epithelial cells. This is followed by a layer with
and then a muscle layer. A layer of connective tissue connects the oesophagus with other organs. At the transition to the stomach, the mucous membrane of the oesophagus merges into the gland-rich mucous membrane of the stomach.
Esophageal cancer, also known as oesophageal carcinoma, is a malignant cancer of the oesophagus. In Germany, around 5700 men and 1700 women were newly diagnosed with esophageal cancer in 2018. The average age of onset in 2014 was 67 years for men and 71 years for women.
The two most common and most important types of oesophageal cancer are squamous cell carcinoma and adenocarcinoma.
At 50 to 60 percent, squamous cell carcinomas make up the largest proportion, with adenocarcinomas accounting for around a third.
The oesophagus is a very flexible organ. Symptoms therefore only occur at a late stage. The tumor is then so large that it impairs the functionality of the organ. Oesophageal carcinoma is therefore often referred to as "silent cancer".
A leading symptom of the later stages of the disease is dysphagia (difficulty swallowing). The swallowing process is disturbed by the space-occupying tumor. Patients perceive this as pain behind the breastbone or in the upper abdomen, which is accompanied by a feeling of pressure.
For the swallowing difficulties to occur at all, the cancer must have already significantly narrowed the oesophagus. The narrowing of the oesophagus makes it difficult to eat. Many patients are therefore no longer able to eat solid food. As a result, they lose several kilograms of body weight within a few weeks. In the majority of cases, oesophageal cancer is therefore accompanied by unwanted weight loss.
Other symptoms can include
can also occur. Around a third of those affected also complain of
If the cancer occurs in the lower part of the oesophagus, coughing may be a possible symptom. If the tumor also presses on the larynx or vocal cords, hoarseness may also occur.
In advanced stages and in the case of metastasis, enlarged lymph nodes can be felt in the neck area.
It is not yet clear why a tumor develops in the oesophagus. However, there are certain factors that increase the risk of developing the disease.
The most important risk factors for the development of squamous cell carcinoma are
Adenocarcinomas often develop as a result of reflux disease. In this condition, acidic gastric juice flows persistently into the oesophagus and irritates the tissue there (chronic heartburn).
This chronic reflux of digestive fluids into the oesophagus favors the development of Barrett's oesophagus. This is an inflammatory change in the lower part of the oesophagus at the transition to the stomach (oesophagogastric junction) with ulcer formation.
Barrett's oesophagus is a so-calledprecancerous condition from which a carcinoma can develop. This is why adenocarcinoma is also referred to as Barrett's carcinoma. Other risk factors for the development of adenocarcinoma are also
The majority of esophageal tumors develop from a precancerous stage. Plummer-Vinson syndrome is also a precancerous condition on the basis of which an esophageal tumor can develop. The syndrome develops as a result of prolonged iron deficiency anemia. It is characterized, among other things, by torn corners of the mouth and swallowing disorders.
Achalasia (dysfunction of the oesophagus) can also lead to oesophageal cancer in the long term. In oesophageal achalasia, the function of the lower oesophageal sphincter is impaired. Among other things, this allows undigested food to flow back from the stomach into the oesophagus.
In addition to the risk factors mentioned above, other factors can promote the development of esophageal cancer:
Whether infections with human papillomaviruses also have an influence is not certain.
Pre-existing conditions and the presence of risk factors in combination with
can be taken as an initial indication of possible esophageal cancer.
To confirm the diagnosis, however, the doctor must perform an esophagoscopy . This involves inserting a thin, flexible, tube-shaped instrument with an integrated light source and camera (endoscope) into the esophagus via the mouth. This allows the doctor to examine the surface of the oesophagus for pathological tissue changes.
For better detection of tissue changes, areas of the mucous membrane can be stained(chromoendoscopy) and analyzed with the aid of a computer. If suspicious areas are found, the doctor can also take a tissue sample immediately. In the laboratory, a pathologist examines this sample for histology. This allows esophageal cancer to be clearly diagnosed.
The size and spread of the tumor must be determined in order to be able to initiate the appropriate treatment. An endoscopic ultrasound examination(endosonography) can be used to assess
Computed tomography (CT) of the neck, chest and abdomen as well as an ultrasound examination of the liver are used to diagnose the spread of the tumor. This involves searching for possible metastases and the involvement of neighboring tissue.
In the case of advanced tumors, metastases can also be detected using
can be used. The results of these examinations make it possible to classify the tumor stage (tumor staging) using the TNM classification. This allows the most promising therapy to be determined.
Patients with oesophageal cancer should be treated by experienced experts at specialized centers.
As part of an interdisciplinary tumor board with the participation of
The best possible treatment for the patient is discussed in detail during the consultation.
The treatment methods used to treat esophageal cancer depend on
of the tumor. It is therefore very important whether the tumor is localized or has already spread to neighbouring tissue or other organs.
The decisive procedure is esophageal surgery, in which the tumor is removed from the esophagus. Chemotherapy or combined radiation chemotherapy is often carried out before the operation. These neoadjuvant treatment methods can increase the chances of success.
In the early stages of cancer, an endoscopy is often sufficient. The surgeon removes the upper parts of the esophageal mucosa with a snare. This is possible if the tumor is still confined to the oesophageal mucosa (so-called early carcinoma). Under certain circumstances, the esophagus can be completely preserved in this way.
However, larger tumors usually require complete or at least partial removal of the esophagus. Depending on the patient's condition and the extent of the cancer, esophagectomies can be performed
can be performed. The use of minimally invasive esophageal surgery can significantly reduce the complication rates of esophageal cancer surgery. Studies have demonstrated the benefits of minimally invasive esophageal surgery for patients. The hybrid technique or a completely minimally invasive procedure is therefore considered the new gold standard.
The remaining parts of the oesophagus are then connected to the stomach. This makes it possible to eat even after the operation. Part of the stomach, which has been formed into a stomach tube, then acts as a replacement oesophagus. With this technique, a very good swallowing function and therefore quality of life can be achieved.
If the stomach also has to be partially or completely removed, part of the small intestine can be reshaped into an esophagus.
To improve the prognosis, the lymph nodes in the abdomen and chest/mediastinum (so-called 2-field lymphadenectomy), and in some cases also in the neck (so-called 3-field lymphadenectomy), are also removed.
If metastases have already formed in other organs, the operation is not intended to cure the cancer, but rather to alleviate the symptoms. This is referred to as palliative therapy.
The prognosis for esophageal carcinoma is rather unfavorable. Unfortunately, the tumor is often discovered late. In most patients, the tumor has already metastasized. Only one in seven tumors is discovered at an early stage.
Five years after diagnosis, around 21 percent of patients are still alive.
Patients with oesophageal cancer should be treated in hospitals with special experience in this field. There, various esophageal cancer experts work together in a tumor conference. Together they develop an individual treatment strategy for the patient.
This usually involves specialists from the following fields
together. The experts take into account the diagnostic and therapeutic procedures recommended by guidelines.
The oncology treatment centers, which are generally certified by the German Cancer Society, guarantee consistently high quality in the care of patients with oesophageal cancer.
The Leading Medicine Guide's quality assurance is ensured by the following acceptance prerequisites.
