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Cancer of the Esophagus
The esophagus is the part of the digestive system that connects and conducts swallowed food from the throat to the stomach. When cells in this organ grow abnormally they can develop into malignant tumors of which there are two more common types: the squamous cell carcinoma and adenocarcinoma.
Esophageal cancer is not common, but it is the 7th most common cause of cancer deaths among men, and less than 20% will survive in 5 years. Most cases are diagnosed while in the advanced stage already, when the cancer cells have metastasized (spread to distant sites) and conventional treatment modalities usually are not successful.
More men in their middle and old age are affected, with African Americans being more prone to the disease. Other risk factors include tobacco smoking, history of heavy drinking, chronic esophagitis, obesity, ingestion of lye and a condition called achalasia which is tightening of the lower esophageal muscles.
Signs and symptoms may be absent or mild, and may be mistaken for other diseases. These are:
- Difficulty and/or pain in swallowing
- Pain behind the breast bone
- Frequent choking while eating
- Coughing or hoarseness of the voice
- Indigestion or heartburn
- Weight loss
Diagnosis is usually confirmed with a biopsy of a specimen obtained during endoscopy, where an instrument is passed through the mouth and esophagus. Other imaging techniques like x-rays, ultrasound, CT scan and MRI may also be done to evaluate the size, location and extent of the tumor.
Once staging is done to determine the extent of the malignancy, appropriate treatment can be started.
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Chemotherapy for Esophageal Cancer
Surgery is only recommended as a first option in the early stages of the disease, when the tumor is still small and localized.
More often than not, esophageal cancer is diagnosed rather late, and surgery is done only when the tumor has shrunk by using chemotherapy and radiotherapy.
Chemo for esophageal cancer is now considered the mainstay of treatment because most cases are found in the advanced stages where cancer cells have become systemic or widespread. Many clinical trials have been done to study the effects of the use of anti-cancer drugs either used singly or in combination. Among these drugs are: Cisplatin and carboplatin, fluorinated pyrimidines (5-fluorouracil), taxanes (paclitaxel), irinotecan, and mitomycin. Combining two drugs have improved results very little, but this mode of therapy is usually done to reduce the toxic effects of each drug. Cisplatin and 5-fluorouracil are often used in combination, or each of these may be combined with another drug. Recent trials have also been done to add a third drug to the combination and have initially shown a modest improvement in response.
Cancer chemotherapy can be given intravenously or as oral agents. These may be done in the hospital or in an out-patient basis. Dosages are based on body surface area. This is critical because if the dosage given is inadequate, then therapy will not be effective; however, if the dose is too high, more harmful effects will be incurred, including cardiac, liver and kidney toxicity.
Chemo and radiation are also better combined than used alone.
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Benefits and Risks of Chemo
The action of chemotherapeutic drugs is to kill cancer cells and decrease their harmful effects on the body. It can therefore prolong one’s life or improve symptoms to a certain extent.
However, these drugs can also be damaging to normal cells, so that they may produce many side effects like fatigue, hair loss, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. For these reasons patients are usually afraid to undergo chemo and may opt for other treatment options like targeted therapy, immunotherapy or other palliative measures. Some hospitals give fractionated-dose chemotherapy, where instead of the drugs being given in a single dose, they are given in fractions over a few days, thus decreasing side effects.
The decision to undergo chemo and other treatment options are usually done after careful consideration and planning with a team of doctors including the primary physician, medical oncologists, radiologists and surgeons.
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American Society of Clinical Oncology, “Esophageal Cancer" accessed 12/18/10
Gastrointestinal Cancer Research, “Esophageal Cancer Chemotherapy: Recent Advances" accessed 12/18/10