The main symptom of esophageal cancer is a problem of swallowing called dysphagia. This starts mostly discreet and often changing in its intensity. The swallowing disorders can comprise slight foreign body symptoms up to sticking of food in the esophagus. The patients often have a long history of medication because of heartburn, due to elevated gastroesophageal acid reflux. The chronic reflux leads to an inflammation of the esophageal mucosa with partial destruction of the normal squamous cell epithelium. This is replaced by a specialized columnar cell lined epithelium, so called Barrett’s esophagus. These cells have a potential of malignant degeneration to an adenocarcinoma so called Barrett’s cancer. Other causes for esophageal cancer especially squamous cell carcinoma – the second frequent cancer in this organ – are smoking and increased regular alcohol intake.
Esophageal cancer is a rare disease, which develops only in 10 per 100.000 inhabitants per year and mostly in males. However the mentioned adenocarcinoma of the esophagus is increasing and shows in the last two decades the highest growth rate of all malignancies in the industrialized countries.
Compared to esophageal carcinomas gastric cancer is more frequent, but the incidence is decreasing in the Western countries. Gastric cancer usually causes uncharacteristic symptoms in the epigastrium. Only if the tumor is located in the inlet or outlet of the stomach dysphagia or fullness and vomiting can develop due to the stenosing growth of the cancer. The causes of gastric cancer are not clearly defined; one important cofactor is gastritis due to Helicobacter pylori infection of the mucosa.
Concerning adenocarcinomas of the esophagogastric junction it is referred to Therapy.
It is important that initial symptoms are clarified in the early phase and diagnostics are not postponed.
The diagnostics always comprise endoscopy, endoscopic ultrasound and CT scan. During endoscopy of the esophagus, stomach and duodenum (esophagogastroduodenoscopy) biopsies are taken from suspicious areas and are sent for histological examination. Endosonography shows the exact depth of wall infiltration by the tumor. A spiral Computer Tomography of neck, thorax and abdomen is performed in order to detect the extent of the primary tumor in relation to the neighbouring organs and metastasis in lymph nodes or organs like liver or lung.
In case of carcinomas of the upper esophagus a bronchoscopy can be necessary because the esophagus is located directly posterior of the trachea and close to the main bronchi. In case of suspicious CT-findings also a laparoscopy can be indicated. After the diagnostics the exact location, the histology and the stage of the tumor are clarified: TNM-stage (T=Tumor, N=Noduli (lymph Nodes), M=Metastasis).
Further an evaluation of the functional capacity of the patient is necessary for planning an operation, a chemotherapy or a radiochemotherapy. The case is discussed in an interdisciplinary tumor board with all important specialists and a suggestion is given for the most appropriate individual treatment. This is orientated at the national and international guidelines.