Identifying and Evaluating Esophageal Cancer
Symptoms, Diagnosis and Staging of Cancer of the Esophagus
Sep 22, 2009
The esophagus is the narrow tube that carries food and liquid from the mouth into the stomach. In the adult, it is around 11 to 13 inches long and has an internal diameter around three quarters of an inch.
Cancer of the esophagus occurs when cells of the internal surface of the esophagus begin to grow out of control, and form a malignant tumor. The tumor is often undetected until it has reached a size that restricts the passage of food and liquids. By this time the cancer is usually quite advanced.
Esophageal Cancer Types
There are two main types of esophageal cancer; squamous cell and adenocarcinoma. Squamous cell cancer can occur anywhere along the length of the esophagus, while adenocarcinoma usually occurs at or near the junction of the esophagus and the stomach, known as the gastroesophageal, or GE, junction.
Esophageal Cancer Symptoms
There are few, if any, early symptoms. Most often, the first symptom of esophageal cancer is difficulty swallowing. This usually occurs when bread or meat is eaten. Rather than go to the doctor, many people will change their eating habits, eating softer food or chewing food more carefully. The tumor of course continues to grow until food and even drink is unable to pass. Other symptoms are pain in the chest, which many attribute to heartburn; hiccupping, weight loss, and blood in the stool.
Esophageal Cancer Diagnosis
Most often, a patient presenting with swallowing difficulties will undergo a barium swallow test. In this test, the patient swallows a liquid barium mixture while at an x-ray machine. The barium is opaque to the x-rays and is therefore able to indicate any area of narrowing in the esophagus.
If narrowing is found, a more direct test is usually performed known as an endoscopy. An instrument called an endoscope - a narrow flexible stem with a light and camera at the end - is passed into the esophagus and the esophageal lining can be seen on a video screen. If a tumor is found, a portion of the tumor is taken for biopsy.
If the biopsy confirms that the tumor is malignant, then further tests, such as an ultrasound endoscopy, can determine the extent of the growth of the tumor. The extent to which the tumor has invaded the esophagus is evaluated, and the degree of advancement of the disease is assigned a value called the staging number.
Esophageal Cancer Staging
The esophagus has several layers of tissue; some are mucous membranes while others are muscular layers. The tumor starts inside the esophagus on the mucosal lining. As it grows it begins to invade other layers. Eventually the tumor may penetrate the esophagus completely and spread to lymph nodes, adjacent structures, and other organs. The extent of this growth progression is the basis for staging. There are three factors to account for in staging for esophageal cancer, as follows:
T stages - How far the tumor has penetrated the esophageal layers
- Tis - The tumor is only in the very first internal layer (known as carcinoma in situ).
- T1 - The tumor is in the next layer.
- T2 - The tumor is in the muscular layer.
- T3 - The tumor is in the outermost layer.
- T4 - The tumor has invaded nearby structures such as the trachea or lungs.
N stages - Whether the cancer has progressed into nearby lymph nodes
- N0 - No local lymph node involvement
- N1 - Local lymph node involvement
M stages - Whether the cancer has spread to distant lymph nodes or organs
- M0 - No spread
- M1a - Distant lymph node involvement but no organ involvement
- M1b - Other organ involvement
Stage Grouping
The T, N, and M stages are grouped together to arrive at the overall stage group number, as follows:
- Stage 0 - Tis, N0, M0
- Stage 1 - T1, N0, M0
- Stage 2a - T2 or 3, N0, M0
- Stage 2b - T1 or 2, N1, M0
- Stage 3 - T3, N1, M0 or T4, N0 or 1, M0
- Stage 4a - Any T, any N, M1a
- Stage 4b - Any T, any N, M1b
Once the disease is diagnosed and the progression of the cancer is determined, then the appropriate treatment steps can take place.
Important Note
The author is not a medical professional and is writing from both experience of open surgery and research carried out before and after surgery.
Related Articles
Fighting Esophageal Cancer:Prognosis and Treatment of Cancer of the Esophagus
Recovery from Esophageal Cancer Surgery:What to Expect After Surgery for Cancer of the Esophagus
Sources
American Cancer Society Web Site on Esophagus Cancer
National Cancer Institute Web Site on Esophageal Cancer
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