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
