Esophagus Neoplasm Treatment and Evolution

It represent 15% of digestive cancers. Histological, most of them are epidermoid carcinomas.
It is more frequently met in men (men/ female ratio=3/1), the average age of apparition being 60-65 years.

Some definite etiologic factors (causes) are:

• cigarette smoking
• excess alcohol intake
• alimentary factors : proteic deficiency, low intake of vitamins A, B, C, nitrosamine excess, lack of zinc and molybdenum.
• other conditions: excessively hot liquids intake (tea), ion radiations exposure, infectious agents(Papiloma-virus), genetic factors.

There are also a series of pathological states predisposing to the onset of esophageal cancer:

• ENT cancers
• Barrett’s esophagus
• mega esophagus
• esophageal diverticula’s
• postcaustic stenosis
• peptic stenosis
• Plummer-Vilson syndrome(esophageal iron deficiency dysphagia)

There are aspects that are more pathological:

• they most frequently occur in the lower third (over 50%) and only 20% in the upper third
• macroscopically, the most frequent form is ulcero - vegetant
• microscopically, 90% are epidermoid(squamous) carcinomas. Other rare forms are adenocarcinoma, or very rarely, sarcoma, lymphoma, melanoma.

There are a series of clinic symptoms described, unfortunately they present only in phases when surgical treatment is surpassed: dysphagia, regurgitations, thoracic pains, weight loss, dysphonia.

The diagnosis is mainly endoscopic, with endoscopic biopsies; contrast radiographs may also be useful. Echoendoscopy is useful for the preoperatory staging, CT-scan as well.

Evolution of  esophageal cancer is rapid, with poor prognosis and 5 years-survival of only 5%.

Complications that might appear can worsen the prognosis: eg aspiration pneumonia, eso-bronchic fistula, perforations, hemorrhages.

The treatment has more possibilities:

1. Surgical- the best treatment, perform an esophagectomy with minimum 5 cm above the superior pole of the lesion.
2. Radiation therapy - is a palliation method.
3. Chemotherapy – using Bleomycine,Cisplatine,5-fluorouracil.
4. Endoscopic:

• the mucosal endoscopic resection, mucosectomia – in incipient forms;
• photocoagulation using laser or autofluorescence – also in incipient cancers;
• edoscopic prosthesis – is a palliation method, used to increase life quality and treatment of dysphagia (in advanced cancers).
• endoscopic dilatation has the same purpose, but shorter-term effects.
• rechanneling of esophageal lumen with laser