What is Oesophageal cancer
The Oesophagus is a long, muscular organ that connects the mouth to the stomach. It is made up of layers of muscles that contract to push food into the stomach.
At the opening of the stomach, there is the organ known as the oesophageal sphincter that functions as a valve to allow foods and liquids consumed to enter the stomach for digestion.
Oesophageal Cancer occurs when DNA in cells becomes damaged causing the cells to multiply in an uncontrolled manner. This forms a tumour. Consulting Oesophageal Cancer specialist in Singapore is the only way to detect the cancerous condition in the patient and get the proper treatment.
Causes of Oesophageal Cancer
The exact cause of oesophagal cancer is not known, but there are several risk factors for the disease. Risk factors for oesophagal cancer as gathered by Oesophageal Cancer specialist include:
- Older age: Esophageal cancer occurs more often in people older than 60 years than in those aged 60 or younger.
- Male gender: Men are three times more likely to develop the disease than women.
- Ethnicity: Squamous cell oesophagal cancer happens more often in African Americans and Asians. Adenocarcinoma happens more often in Caucasians.
- Tobacco use: This includes smoking and using smokeless tobacco.
- Alcohol use: Chronic and/or heavy use of alcohol increases the risk of oesophagal cancer.
- Barrett’s oesophagus and chronic acid reflux: Barrett’s oesophagus is a change in the cells at the lower end of the oesophagus that occurs from chronic untreated acid reflux. Those without this condition but have been suffering from long term heart burn also have a higher risk of cancer.
- Human papilloma Virus: In areas of the world that have a high incidence of oesophagal cancer (such as Asia and South Africa), infection with HPV carries an increased risk for developing oesophagal squamous cell cancer.
- Other disorders: Other conditions have been linked to oesophagal cancer. These include Achalasia, an uncommon disease that causes difficulty swallowing, and tylosis, a rare, inherited disorder in which excess skin grows on the palms of the hands and the soles of the feet.
- Occupational exposure to certain chemicals: People exposed to dry cleaning solvents over long periods are at higher risk for oesophagal cancer.
- History of cancer: People who have had cancer of the neck or head have a greater risk for oesophagal cancer.
Symptoms of Oesophageal Cancer
Common symptoms of oesophagal cancer:
- Pain in the throat or back, behind the breastbone, or between the shoulder blades
- Vomiting or coughing up blood
- Hoarseness or chronic cough
- Unintentional weight loss
Oesophageal Cancer Specialist Singapore conducts a series of physical tests coupled with lab testing to diagnose the condition.
This is a special series of X-ray imaging to visualize the oesophagus. The patient drinks a liquid containing barium, which makes the oesophagus along with any tumours easier to see on the X-ray.
The surgeon will place a tube fitted with an LED light and camera at one end into the oesophagus to directly visualise the tumour. It can also be used to release any obstruction by inserting a balloon to dilate the constricted oesophagus and allow the obstruction to move downwards.
During the Esophagoscopy, the surgeon may remove sample oesophageal tissues to end for lab testing to look for any abnormal or cancerous cells.
This procedure uses ultrasound technology to image internal structures during the Oeosphagocopy. This helps in looking for any tumours growing within the tissues of the oesophagus.
This test is often used to evaluate the extent of the tumour spread to the chest and abdomen.
PET CT Scan is often used to evaluate the spread of the disease and helps in the process of staging and also in response to treatment.
The most common procedure used to treat Oesophageal cancer would be the Oesophagectomy. This type of procedure is done to remove parts of or most of the oesophagus along with the tissues surrounding it that contain the cancerous cells. The surgeon would then reposition the stomach further up the chest or use a piece of the small intestine to preserve the oesophageal function. He may also remove samples from the lymph nodes to check for lymph cancer.
Surgery can cure cancer in some patients who do not have the spread of the tumour beyond the oesophagus. Unfortunately, less than 25 per cent of oesophagal cancers are discovered this early. Therefore, surgery is often offered to ease symptoms. Here at our centre, the preferred mode of doing the procedure is Robotic-assisted Oesophagectomy. With this method, the patient will only require 3 to 4 tiny incisions in the abdomen and 3 to 4 tiny incisions in the chest, allowing for a speedier recovery. The other modes of approach will be Video-assisted surgery or conventional open surgery. Oesophagal cancer surgery often requires extended hospitalisations.
This form of treatment involves the use of X-rays and protons to generate powerful beams of energy that will be precisely directed to the locations of the cancer cells to kill it. This may be used pre-surgery for those with cancer that has not spread to the rest of the body. For people who are unable to undergo surgery, this combined with chemotherapy would be the primary treatment method. Lastly, for those with cancer that has spread to the rest of the body, this may be a form of treatment to reduce pain.
This is usually a combined treatment of both oral and injectable medication administered over weeks or months. These are extremely strong drugs used to kill the cancer cells and can be used pre-surgery to shrink cancer. It can also be coupled with radiation treatment for those that are unable to undergo surgery. Lastly, for those with cancer that has spread throughout the body, this is a form of treatment to reduce pain.
These are used to treats tumours detected when they are small and have not spread to the rest of the body. This is done endoscopically without having the patient undergo the removal of their oesophagus.
In cases where the tumour is large enough to cause a blockage in the oesophagus, endoscopic laser therapy may be used to cut a hole in the blockage to improve swallowing.
This treatment makes use of drugs that can be activated by non-thermal light. It will be taken up by the cancer cells thereby destroying it when activated. This is used to ease the symptoms of oesophageal cancer, in particular, difficulty swallowing.