The esophagus is about 25 cm long and lies behind the trachea. It connects the mouth and throat with the stomach. As a muscular tube, it transports food into the stomach with its wave-like movements. Both at the upper and lower end it is closed by sphincters, which are opened briefly during the swallowing process. The lower sphincter prevents the aggressive, acidic gastric juice from flowing back into the esophagus and causing damage there. The esophagus is lined with a mucosal covering layer (a so-called squamous epithelium), which changes into a glandular mucosa in the area of the transition to the stomach ( esophagogastric transition).
Experts in esophageal cancer treat all malignant tumors of the esophagus:
- Squamous cell carcinoma arises from cells of the squamous cell and can occur in all sections of the esophagus.
- Adenocarcinoma develops from cells of the glandular mucosa and is therefore usually found only in the lower part of the esophagus.
- Gastrointestinal stromal tumors (GIST) are an umbrella term for cancers of the digestive system, and thus also of the esophagus, which develop from connective or supporting tissue. GIST are considered to be soft tissue sarcomas (malignant soft tissue and soft tissue tumors).
- Malt lymphoma originates from cells of the immune system.
- In undifferentiated esophageal carcinoma, it is no longer possible to determine from which cell type the esophageal cancer has developed.
In addition to these malignant tumors, esophageal cancer experts also treat benign tumors of the esophagus:
- Leiomyoma (tumour of the smooth musculature)
- Hemangiomas (formation of new blood vessels, blood sponges)
- Fibromas (tumor of the connective tissue)
- Neurinomas (tumors of parts of the nervous system)
- esophageal polyps, also known as fibrovascular polyps or giant polyps of the esophagus
Benign esophageal tumors are relatively rare. Since they cannot always be reliably distinguished from malignant tumors, they are usually removed surgically.
Symptoms of esophageal cancer and side effects of the treatment are also treated by esophageal cancer specialists. These include, among other things:
- Treatment of cancer pain according to the WHO classification scheme
- Treatment of exhaustion and permanent fatigue that can be caused by the cancer itself or the treatment itself
- Treatment of side effects of a therapy, such as mucositis, which can be the result of radiation and/or chemotherapy, nausea and vomiting or diarrhea.
During the patient survey (anamnesis), the doctor inquires about previous illnesses and complaints, about lifestyle habits and which medications are taken. The physical examination consists, among other things, of palpating the lymph nodes. If the patient reports swallowing disorders, bleeding in the digestive tract, frequent vomiting, digestive problems, loss of appetite and inexplicable weight loss, the doctor will perform an endoscopic examination of the esophagus, stomach and duodenum. This so-called esophagogastroduodenoscopy can detect or rule out changes in the esophagus, such as cancer of the esophagus.
Other diagnostic methods used by experts in esophageal cancer are:
- Virtual or classical staining spray chromoendoscopy of the esophagus: method of esophageal endoscopy, in which the esophagus or parts thereof are stained
- Computer-aided, endoscopically applicable digital filter methods for the representation of surfaces and vessels
- Modern endoscopic procedures for imaging the upper mucosal layers (e.g. endocytoscopy, confocal laser scanning endomicroscopy, optical coherence tomography)
- Taking a tissue sample (biopsy) as part of the esophageal endoscopy for the examination of fine tissue; this can be used to clarify whether the cancer is actually present and what type of cancer it is.
- Detection of human epidermal growth factor receptor type 2 (HER2) in adenocarcinoma in tissue samples
- Ultrasound examination (sonography) of the abdominal cavity and in particular of the liver for metastases
- Ultrasound examination (sonography) or computed tomography (CT) of the neck for metastases in the cervical lymph nodes
- Endosonography of the esophagus, i.e. ultrasound examination from the inside to determine how deep the tumor reaches into the wall of the esophagus and whether the surrounding lymph nodes are affected.
- Diagnosis of the spread of oesophageal cancer by means of contrast-enhanced computed tomography or magnetic resonance imaging (MRI) of the neck, chest and abdomen to clarify the extent to which the cancer has spread (metastasized) into the body.
- PET-CT is a combination of positron emission tomography (PET) and CT in locally advanced esophageal cancer that can be used to accurately assess the spread of the tumor.
- Bronchoscopy (respiratory endoscopy) for locally advanced esophageal cancer
- Assessment of the esophagus by X-ray examination
- Laparoscopy to rule out the possibility that the liver and peritoneum are already affected
- With an barium swallow X-ray, swallowing movements and the shape and size of the esophagus can be assessed, constrictions can be detected.
On the basis of these investigations, the tumor stage can be estimated with the help of TNM classification and the course of the disease and the therapy can thus be planned.
The range of services offered by a specialist in esophageal cancer includes the following treatment methods:
- Endoscopic resection (removal) of tumors that were detected early: The cancer of the esophagus is removed locally via the esophagus in this gentle and low-stress procedure, the esophagus remains intact.
- Surgical removal of the esophageal carcinoma by open technique: Depending on the location and stage of the tumor, the entire esophagus is usually removed together with the adjacent lymph nodes.
- Minimally invasive removal of esophageal carcinoma (keyhole technique) as an alternative to the open procedure
- Sole radiation therapy in combination with chemotherapy (radiochemotherapy)
- Accompanying radiochemotherapy before surgery to shrink the tumor in advance
- Accompanying chemotherapy before and after surgery
- Removal of infected lymph nodes
- Procedure for alleviating complaints (palliative therapy):
- Chemotherapy and antibody therapy
- Radiochemotherapy to treat symptoms (difficulty swallowing, bleeding, pain)
- Brachytherapy (internal irradiation) for the treatment of swallowing disorders
- Inserting stents (tubes) into the esophagus to keep it open
- Reduction of the tumor by means of heat (thermoablative methods)
- Treatment with new drugs or methods within the framework of clinical studies
- after-care treatments
- Psycho-oncological care
Patients with esophageal cancer should be treated in hospitals with special experience in this area. There, various experts in esophageal cancer - usually specialists in gastroenterology, oncology, radiotherapy, radiology, surgery and pathology - work together in a tumor conference to develop an individual treatment strategy for the patient. The experts take into account the diagnostic and therapeutic procedures recommended by guidelines. The oncological treatment centres, which are usually certified by the German Cancer Society, guarantee a permanent high quality in the care of patients with esophageal cancer.
- Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2018) S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus, Langversion 2.0, AWMF Registrierungsnummer: 021/023OL
- Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2016) Krebs der Speiseröhre. Eine Leitlinie für Patientinnen und Patienten
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