Esophageal cancer

"In most cases, esophageal cancer is diagnosed in advanced stages. That is why it is important to consult a doctor with any stomach upset to try to diagnose it early and prevent it."

DR. JORGE BAIXAULI
SPECIALIST. DIGESTIVE TRACT TUMOURS AREA

Esophageal cancer is caused by the uncontrolled growth of cells in the innermost layer of the esophagus causing a mass or ulcer that grows deeper into the different layers of the esophagus.

There are two types of tumors: 

  • Epidermoid or squamous carcinoma: generally located in the middle and upper esophagus.
  • Adenocarcinoma: appears predominantly in the lower esophagus and the most important predisposing factor is "Barrett's Esophagus".

The Clínica Universidad de Navarra has a Digestive Tumors Area, made up of specialists in Digestive, Digestive-Endoscopies, General Surgery, Radiology, Medical Oncology and Radiation Oncology, Nuclear Medicine and Pathological Anatomy, which makes it possible to select treatment on an individualized basis according to each case.

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What are the symptoms of esophageal cancer?

Unfortunately, esophageal cancer does not cause symptoms until a more advanced stage. In this situation, the fundamental symptom is the difficulty in swallowing or the sensation of food stopping when swallowing, also known as dysphagia. This difficulty is caused by the obstruction of the esophagus by the tumor. Generally, it starts with solid foods and gradually increases, having greater difficulty with liquids. If the evolution of the mass continues it can reach the complete obstruction of the esophagus with total impossibility to swallow. 

Other common symptoms are: regurgitation, voice alterations, chest pain, weight loss of unjustified cause, vomiting.

The most common symptoms are:

  • Difficulty in swallowing.
  • Dysphagia.
  • Regurgitation.
  • Voice alterations.
  • Loss of weight.

Do you have any of these symptoms?

You may have cancer of the esophagus

What are the causes of esophageal cancer?

The high consumption of alcohol and tobacco must be highlighted independently, and a multiplier effect can be seen when the two factors are combined.

There are esophageal lesions that are considered precancerous such as caustic esophagitis, Barrett's esophagus, achalasia or Plummer-Vinson syndrome (sideropenic dysphagia).

Barrett's esophagus is the most important predisposing factor and it is related to a long history of gastroesophageal reflux and hiatal hernia.

The consumption of a diet poor in fresh vegetables and fruits, the intake of excessively hot drinks and foods and the high consumption of foods containing nitrosamines (beer, fish and its derivatives, in meats and cheese as a preservative...) are also risk factors.

What is the prognosis of esophageal cancer?

The prognosis of esophageal tumors depends on many factors, among which are the stage at diagnosis and the histologic characteristics of the disease, there are other factors that must also be considered such as the location, extension and degree of differentiation of the primary tumor, histopathological data such as vasculolymphatic invasion, the presence of viable residual tumor after preoperative treatment, the margin in the surgical resection specimen, the extension of tumor cells beyond the lymph node capsule, and the expression or amplification of receptors in the primary tumor (HER2 in adenocarcinoma).

In addition, the general and nutritional status of the patient, as well as the surgery and the multidisciplinary nature of the treatment, also play a role. However, despite the fact that all the factors mentioned above must be taken into account, it must be considered to have an ominous prognosis with a five-year survival rate in localized tumors of less than 50%.

How is esophageal cancer diagnosed?

To reach the diagnosis of esophageal cancer, before any invasive test is performed, an exhaustive clinical history and an adequate physical examination must be carried out.

If the presence of an esophageal tumor is suspected, the main diagnostic method is esophagogastroscopy. This exploration allows obtaining direct images of the cause of obstruction, the exact location and obtaining samples to confirm the diagnosis by means of a biopsy.

Once the diagnosis is confirmed, the extent of the disease must be studied in order to assess the most appropriate treatment. Some of the most common tests used to complete the study are:

  • Thoracic-abdomino-pelvic CAT scan
  • PET Staging
  • Bronchoscopy

The Clínica Universidad de Navarra has an Esophago-Gastric Tumor Area, made up of specialists in Digestive, Digestive-Endoscopies, General Surgery, Radiology, Medical Oncology and Radiation Oncology, Nuclear Medicine and Pathological Anatomy, which makes it possible to select treatment on an individualized basis according to each case. 

How is esophageal cancer treated?

The treatment will be conditioned by the stage, the type of tumor, the functional status of the patient, as well as the possible side effects when deciding on the best therapeutic plan.

If the esophageal cancer is localized, a surgical approach is possible and the patient can be cured in a high percentage of cases. Surgical treatment aims at complete removal of the tumor and reestablishment of digestive transit. This intervention is called esophagectomy. Depending on the location of the tumor, surgery may require an approach through the abdomen, thorax and neck.

Currently, laparoscopic and thoracoscopic surgical techniques are being used in order to reduce the morbidity and mortality of surgical treatment. 

In those patients with locally advanced disease, in order to reduce tumor size and favor adequate tumor resection, preoperative treatment is administered. This treatment consists of a combination of chemotherapy plus/minus radiotherapy. 

It is important to bear in mind that due to the complexity of this intervention, it is essential to carry it out in specialized centers. The Clínica Universidad de Navarra has a highly qualified medical-surgical team to perform this procedure. In addition, we carry out a follow-up by the nursing service that helps to improve symptomatic control and favor the recovery of our patients.

Sometimes surgery or local techniques are used to alleviate or prevent symptoms related to the disease.

Some of these procedures are:

  • Percutaneous gastrostomies or jejunostomies: is the placement by endoscopy of a tube or tube in the stomach (gastrostomies) or jejunum (jejunostomies) through the abdominal wall.
  • Esophageal balloon dilation: with this procedure an attempt is made by inserting a small device to push through the narrowed area to stretch it.
  • Placement of an esophageal prosthesis (stent).
  • Electrocoagulation (electrofulguration): with this procedure a probe is passed into the esophagus through an endoscope to burn the tumor with electric current.
  • Laser ablation: consists of directing a laser beam through the endoscope to destroy the cancerous tissue.
  • Photodynamic therapy: this technique consists of the intravenous administration of a light-activated drug (photofrin). In the following days, the drug will accumulate in the cancerous cells, at which time a special type of laser light must be directed through the endoscope.

Chemotherapy is the medical treatment that consists of the application of chemical substances to the organism. It is mainly administered intravenously or orally, although there are other less common forms of administration.

Sometimes it is necessary to place a device called a port-a-cath. Treatment is prescribed according to a specific schedule depending on the regimen chosen. Prior to the administration of the medication, an assessment of the patient and an analytical determination must be made. Each administration is called a cycle, with the possibility of each cycle being divided into several sessions.

Depending on the moment of the administration of the treatment it is called:

  • Neoadjuvant treatment: is the administration of chemotherapy prior to possible surgery. The objective is to reduce the size of the tumor and thus facilitate surgery.
  • Adjuvant treatment: is the administration of chemotherapy after surgical resection. The objective is to eliminate possible microscopic disease in order to avoid recurrence of the disease.
  • Palliative treatment: is the administration of treatment in a palliative manner. The intention is to reduce the burden of the disease and thereby derive a clinical benefit. 

The Department of Medical Oncology of the Clínica Universidad de Navarra has a specialized area nurse who is in permanent contact with the patients to minimize the side effects derived from the medication. In addition, a telephone follow-up is carried out during treatment to detect possible toxicities and alleviate them in an early and effective manner.

Biological therapies are substances that are produced by living organisms. This substance is produced either naturally in the organism or in the laboratory. From an oncological point of view, there are different biological therapies, each of which has the function of stimulating or inhibiting the immune system.

Other types of biological therapies attack cancer cells in a specific way because they have a specific characteristic, such as monoclonal antibodies.

Immunotherapy is another type of biological therapy. These substances are used to stimulate or inhibit the immune system and thus help the body fight cancer.

Radiotherapy is a fundamental part in the management of esophageal cancer, either before definitive surgery or as an exclusive treatment combined with chemotherapy. The location of the esophagus, surrounded by important structures such as the heart, lungs or spinal cord, makes it very important to treat with the utmost precision. Combinations of external irradiation with brachytherapy, or, in the best of scenarios, treatments with proton therapy, achieve the best results both in terms of cure and tolerance.

The Clínica Universidad de Navarra has a Proton Therapy Unit. This therapy, due to its lower toxicity, is especially indicated for the treatment of tumors that are difficult to access or close to organs at risk.

In esophageal cancer, radiotherapy is used either in combination with chemotherapy in patients with locally advanced disease preoperatively or adjuvantly after surgery with risk factors.

In patients with advanced disease it can be an effective therapy for pain relief (antalgic radiotherapy), bleeding (hemostasis radiotherapy) or local control.

In addition to all of the above, we must not forget the emotional aspect of cancer patients.

At the Clínica Universidad de Navarra we have the possibility of carrying out a joint evaluation with the Palliative Medicine Service in order to achieve an adequate symptomatic management as well as the possibility of expressing and orienting the possible emotional effects that this disease causes in the patient and his family.

The combination of an adequate symptomatic and emotional control has shown a better tolerance to medication and a better coping with the adverse events that occur during the evolution of this process.

Proton therapy against cancer

Proton therapy is the most precise external radiotherapy modality, providing better distribution of radiation dose and therefore less irradiation of healthy tissues.

The Proton Therapy Unit of the Clínica Universidad de Navarra in its Madrid headquarters is the most advanced in Europe and the first in a Cancer Center, with all its healthcare, academic and research support.

Where do we treat it?

IN NAVARRE AND MADRID

The Digestive Tract Tumors Department
of the Clínica Universidad de Navarra

The Digestive Tube Tumors Area is composed of a multidisciplinary team of experts in the diagnosis and treatment of diseases of the digestive tract.

It includes specialists in the digestive system, radiology, pathological anatomy, surgery and medical and radiotherapeutic oncology and nursing support.

What diseases do we treat?

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