A malignant cell proliferation in the esophagus is called esophageal cancer. In technical terms, esophageal cancer is referred to as esophageal carcinoma. Every year, around 11, 000 people in Germany contract esophageal cancer, mostly affecting men and older people.
The esophagus is a muscular tube that transports the ingested food from the mouth to the stomach. Due to its high extensibility, a patient with esophageal cancer feels the symptoms caused by the increasing constriction late, so that the tumor is usually already well advanced in the diagnosis.
For example, a late diagnosis usually has little chance of recovery and life expectancy is rather low.
Esophageal cancer can be classified into two different types: squamous cell carcinoma and adenocarcinoma. If the covering cells of the mucous membrane proliferate, this is called squamous cell carcinoma, which is the more common form of esophageal cancer. An overgrowth of the glandular cells is a so-called adenocarcinoma.
Esophageal cancer: causes of squamous cell carcinoma
The causes of esophageal cancer are very diverse and many factors are not yet clear. Nevertheless, some factors are clearly linked to the development of esophageal cancer. Esophageal cancer of the squamous cell carcinoma type is usually found in the upper part of the esophagus. Squamous cell carcinoma is due in particular to the following causes:
- The most important risk factors are smoking and alcohol. They are responsible for three quarters of all squamous cell carcinomas. Especially the simultaneous consumption of nicotine and alcohol multiply the risk of developing esophageal cancer.
- Too hot or too spicy foods and drinks attack the mucosa of the esophagus and can lead to esophageal cancer.
- Also, certain food additives increase the risk of developing esophageal cancer. These include nitrosamines, which are present for example in salted meat in high concentration or the substance Aflatoxin of certain fungi. Ingredients of betel nut, which is commonly eaten in Southeast Asia, also increase the risk of oesophageal cancer.
- Chemical burns with lye or radiation can damage the mucous membrane and lead to esophageal cancer even after many years.
- Furthermore, certain congenital malformations may be the cause of esophageal cancer.
Esophageal cancer: causes of adenocarcinoma
The rarer, but increasingly common, form of esophageal cancer is adenocarcinoma, which usually forms in the lower part of the esophagus. In adenocarcinoma, the main cause is the reflux of gastric acid from the stomach into the esophagus, which is called reflux disease in the medical community.
As a symptom, the patient usually feels heartburn, but not always the reflux is perceived by the patient. The main causes of the reflux disease are these factors:
- A high-fat diet with low fruit and vegetables promotes the reflux of stomach acid. Therefore, especially overweight people often have an increased risk of esophageal cancer.
- Smoking is also a risk factor in adenocarcinoma.
- More rare causes of reflux are medications that lower the pressure of the sphincter between the esophagus and the stomach.
- Frequent vomiting of food and stomach acid causes chronic mucosal irritation in bulimia patients and can therefore also lead to esophageal cancer.
In reflux disease, the delicate mucous membrane of the esophagus is constantly irritated by the gastric acid and inflamed. As it progresses, the mucosal cells transform into the more robust gastric mucosa, which is called Barrett's mucosa or Barrett's disease.
The altered mucosa is a potential precursor to esophageal cancer, but not every Barrett's mucosa needs to develop into cancer. Nevertheless, patients with Barrett's disease should be regularly monitored in order to detect any possible tumor development as quickly as possible and to increase their chances of recovery.
Esophageal cancer and its symptoms
Because the esophagus is very dilated, the onset of esophageal cancer can go on to go unnoticed for a long time before symptoms and symptoms first appear. The first symptoms are usually dysphagia, pain when swallowing or the feeling of having a "lump in the throat".
Often the esophageal cancer is already well advanced at this time and the chances of recovery and thus the life expectancy of the patient are very limited.
The first symptoms are usually subtle and unspecific, they can quickly be misunderstood as mundane complaints. Therefore, it is particularly important to detect signs of esophageal cancer at an early stage. In addition to the difficulty in swallowing, the main symptom is pain or pressure behind the chest, which is sometimes seen as back pain.
Difficulty swallowing as a first sign
Other symptoms may be choking while swallowing, constant heartburn after eating or frequent vigorous belching. Later, spasms in the esophagus can also indicate an esophageal cancer. These symptoms may have many causes and may not always be equal to esophageal cancer, but in these cases a doctor should be consulted.
Patients with esophageal cancer suffer from severe weight loss due to the difficulty in swallowing food. If the esophageal cancer has widened beyond the esophagus and has entered the trachea, food may enter the airways and cause pneumonia.
Ingrowth of the tumor into the larynx can cause hoarseness. These symptoms signify a cancer outgrowth of the organ border and additionally worsen the life expectancy of esophageal cancer.