The diagnosis of esophageal cancer
The diagnosis of esophageal cancer can finally be made only by esophageal speculation, the so-called esophagoscopy, and the associated removal of tissue at sites with typical alteration.
This biopsy is then examined under the microscope. Sometimes, a small esophageal cancer can be removed and cured with this exam.
If the suspicion of esophageal cancer has been confirmed, further investigations will follow to assess the size and progression of the tumor. Often the endosonography is used, an ultrasound of the esophagus from the inside. The swallowing of a contrast agent-containing slurry allows a good assessment of the esophageal cancer on the radiograph.
Sometimes esophageal cancer produces typical proteins that can be detected as tumor markers in the blood. These are less helpful for the diagnosis, because they can also occur in healthy people and are unspecific.
Nevertheless, they are a good means of follow-up, as a renewed and / or rapid reacquisition of tumor markers may indicate new or enhanced tumor growth.
Esophageal cancer: treatment by surgery
Basically, the treatment and chances of recovery of esophageal cancer depend on the type, stage of the disease and on the age and health of the patient. The best chance of recovery involves a surgical operation.
Almost always a complete removal and thus healing of esophageal cancer is sought. The diseased part of the esophagus can be removed.
The surgeon then attempts to "pull up" the stomach and form a tube to form a replacement for the removed piece of esophagus.
Sometimes the tumor is too high or the esophageal cancer is too large, then a piece of small intestine is sewn into the esophagus as a replacement.
Very good chances of recovery exist if the esophageal cancer is discovered at an early stage. If it is very small and limited to the uppermost layer, it can be tried to scrape off the upper layer of the mucous membrane and thus achieve a cure.
In most cases surgery not only removes the tumor itself, but also the surrounding tissue in order to remove very small metastases, so-called micrometastases as well. The surrounding lymph nodes are removed, as the tumor often spreads through the lymphatic system.
Treatment with radiotherapy or chemotherapy
To increase the success of surgery, it can sometimes be useful to shrink the tumor with chemotherapy or radiotherapy before removing it surgically. Rarely do doctors recommend radiotherapy as the sole treatment for esophageal cancer.
This is the case, for example, when the patient's state of health does not permit surgery. If necessary, the irradiation can also be carried out from the inside by placing small radiating materials within the esophagus close to the tumor (endoluminal brachytherapy).
Often, the doctors also recommend combined radiotherapy and chemotherapy following surgery to destroy any residual tumor cells that may remain in the body.
If the tumor is already at the end stage, so that metastases have already formed in the body in several places, the esophageal cancer is often no longer curable and the life expectancy of the patient is very low.
It is then important to provide the patient with the best possible quality of life by relieving pain and halting the course of the disease. In this case, for example, a so-called stent can be used.
A stent is a plastic tube that is inserted into the esophagus. Thus, the esophagus is dilated, so that the patient receives the normal food intake.
If this is no longer possible, a probe can be placed in the stomach from the outside via the abdomen (percutaneous endoscopic gastrostomy, PEG) in order to facilitate food intake via the gastrointestinal tract and to avoid an artificial diet.
Life expectancy in esophageal cancer
Often, the cancer of the esophagus is discovered late and metastases have already formed in the surrounding lymph nodes or more distant organs. Then there is little chance of recovery for affected patients and the life expectancy is only a few years.
At an advanced stage, only about 20 percent of patients with esophageal cancer survive five years.
Nevertheless, healing may be possible, especially if the esophageal cancer can be detected early and completely removed.
If an esophageal cancer has been successfully cured, good aftercare is particularly important.
It is best to have patients regularly monitored at specialized clinics so that the recurrence of esophageal cancer can be treated as quickly as possible.