What is esophageal cancer?

• Esophageal cancer results from the abnormal division of cells, forming a malignant tumor. This not only damages the esophageal tissue but can also spread to other organs.
• Causes of esophageal cancer include smoking and alcohol consumption, chronic acid reflux, unhealthy eating habits, obesity and being overweight, age, and genetics.
• Treatment for esophageal cancer includes surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, endoscopy, and palliative care.
• What foods are suitable for people with esophageal cancer? They should eat easily chewable, soft foods such as porridge, thick soups, steamed eggs, soft steamed fish, soft tofu, mashed potatoes, yogurt, mousse, and soft fruits.

Esophageal cancer is a disease caused by the abnormal division of esophageal cells, leading to the formation of tumors or masses. It can spread to other organs. Although it often shows no symptoms in its early stages, early detection and treatment can significantly improve symptoms in high-risk groups such as heavy alcohol consumption, smoking, or frequent acid reflux. This article will explain how esophageal cancer is treated and what foods are suitable for you to eat.

What is Esophageal Cancer?

Esophageal cancer is caused by the abnormal division of cells, forming a malignant tumor. This not only damages the esophageal tissue but can also spread to other organs. This disease is a more common risk than you might think, as it can be caused by genetics, increasing age, lifestyle habits, and over time. Even those who believe they maintain good health may be at risk if certain factors trigger cellular abnormalities over time.

What are the different types of esophageal cancer?

Esophageal cancer can be categorized into several types, but currently, two main types are known, based on their origin:

Squamous Cell Carcinoma

Squamous cell carcinoma is commonly found in the middle to upper esophagus. It results from changes in epithelial cells, primarily triggered by smoking, alcohol consumption, and carcinogens in food. Although it grows slowly initially, it can eventually spread to surrounding tissues and lymph nodes.

Adenocarcinoma

Adenocarcinoma typically occurs in the lower esophagus, near the stomach. This type of cancer is directly related to chronic acid reflux or Barrett's esophagus (abnormal lining of the esophagus). It is characterized by its rapid growth and higher likelihood of spreading to other organs more quickly than normal.

Causes of Esophageal Cancer:

• Smoking and Alcohol Consumption: Chemicals from cigarettes directly damage DNA in esophageal lining cells, while alcohol causes chronic inflammation. Combining these significantly increases the risk.
• Gastroesophageal Reflux Disease (GERD): Prolonged reflux of stomach acid into the esophagus causes inflammation, potentially leading to Barrett's esophagus, a condition where lining cells become cancerous in the future.
• Unhealthy Dietary Habits: Frequently consuming very hot foods, fermented foods, smoked foods, and high-fat foods, along with a lack of fruits and vegetables, negatively impacts the esophageal lining and increases carcinogens in the body.
• Obesity and Overweight: Excess weight increases intra-abdominal pressure, making acid reflux more likely and continuously stimulating inflammation of the esophageal lining.
• Age and Genetics: The risk increases with age, especially in those over 50 due to cell degeneration. Those with a family history of esophageal cancer also have a higher risk.

Symptoms of Esophageal Cancer:

• Difficulty swallowing or a feeling of obstruction (or blockage in the throat). Symptoms often begin with difficulty swallowing solid foods, gradually progressing to soft foods and liquids. A feeling of a blockage in the throat or chest may be present, forcing swallowing to be slow.
• Chest or throat pain is another symptom, usually caused by the growth of a tumor or inflammation. This can result in a tightness or pain in the center of the chest or a sore throat while swallowing, gradually worsening.
• Rapid, unexplained weight loss is another symptom. The effects of cancer cells and decreased food intake can lead to rapid weight loss, even without intentional diet changes or changes in eating habits.
• Chronic cough and hoarseness can occur when cancer spreads to the trachea or larynx, causing hoarseness or persistent coughing, even without symptoms of a cold or other respiratory illness.

Esophageal cancer has several stages:

• Stage 0: Abnormal cells are confined to the outermost epithelial layer of the esophagus and have not spread deeper into other tissues.
• Stage 1: The tumor has begun to infiltrate the muscle layer of the esophagus but remains confined and has not spread to the lymph nodes.
• Stage 2: Cancer cells have eaten deeper into the muscle layer. In some cases, metastasis to nearby lymph nodes may already be detected.
• Stage 3: The tumor grows deeper and wider, encroaching on surrounding tissues around the esophagus, and has spread to numerous lymph nodes in the area.
• Stage 4: This is the final stage, where cancer cells have spread from their initial location through the bloodstream or lymphatic system to distant organs such as the liver, lungs, or bones. A more complex treatment plan is required.

Esophageal Cancer and Acid Reflux: What's the Difference?

The difference between esophageal cancer and acid reflux can be observed from the symptoms and main causes. Acid reflux occurs when the esophageal sphincter weakens, allowing acid to flow back and irritate the intestines, resulting in symptoms such as heartburn, sour belching, or abdominal pain. These symptoms are often intermittent and improve with lifestyle changes.

Esophageal cancer, on the other hand, results from the abnormal growth of tumor cells caused by accumulated risk factors or chronic acid reflux leading to cell transformation. Important warning signs include difficulty swallowing, starting with solid foods and progressing to liquids, and rapid, unexplained weight loss. Esophageal cancer symptoms tend to worsen progressively and do not resolve on their own.

Esophageal Cancer Diagnosis

1. Upper endoscopy is the standard method doctors use to examine abnormalities within the esophagus. A small camera is inserted through the mouth to assess the characteristics of tumors or ulcers and accurately determine the severity of the disease at an early stage.
2. Biopsy: During an endoscopy, the doctor takes a tissue sample from a suspicious area for pathological examination. This step confirms whether or not it is cancerous and identifies the type of cancer cells to aid in treatment.
3. Radiographic imaging (CT scan/PET scan) is a comprehensive examination to determine the stage of cancer progression. A CT scan provides cross-sectional images of the esophagus and surrounding organs, while a PET scan helps detect small cancer cells and metastasis to lymph nodes or other organs throughout the body.

Esophageal Cancer Treatment Options:

Surgery

Surgical treatment is suitable for patients diagnosed with early-stage cancer that has not yet spread. The doctor will remove the cancerous tissue and surrounding lymph nodes to eliminate cancer cells. Afterward, patients need to adjust their eating habits and restore their digestive system under medical supervision.

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells throughout the body. It is often used in combination with surgery or radiation therapy to reduce tumor size and inhibit spread. While there may be side effects such as nausea or hair loss, methods are now available to manage and alleviate these symptoms.

Radiation Therapy

Radiation therapy uses high-energy radiation to target and destroy cancer cells specifically in the esophagus. This can be done both before and after surgery to increase the effectiveness of tumor removal. However, it may cause temporary irritation or burning in the throat in the irradiated area.

Palliative Care

Palliative care focuses on reducing pain and improving the quality of life for patients with advanced cancer. A medical team will help manage nutrition and manage pain. And closely monitor the mental health of both the patient and their family.

Targeted Therapy

Targeted therapy for HER2 protein targets cancer cells with abnormally high levels of HER2 protein, often found in cancers at the esophagus-stomach junction. The drug inhibits the protein that promotes the growth of these cancer cells. It is often used in combination with chemotherapy to increase treatment effectiveness. Trastuzumab is the primary targeted therapy used in HER2-positive patients, helping to inhibit progression and extend patient survival.

Immunotherapy

Immunotherapy uses drugs to modify and stimulate the body's immune system to effectively detect and destroy esophageal cancer cells on its own. It is often used in cases of advanced or metastatic disease, or in patients who do not respond to other primary treatments.

Endoscopic Treatment

If cancer is detected in its early stages, doctors can use endoscopy to immediately remove the cancerous tissue, avoiding major surgery. In advanced stages, Upper gastrointestinal endoscopy is a standard procedure used for diagnosis, confirmation of disease, biopsy, and insertion of an esophagus to help patients in advanced stages of the disease eat more easily.

Preventing Esophageal Cancer

• Avoid smoking and alcohol to reduce the accumulation of carcinogens in the body and prevent chronic inflammation of the esophageal tissue, a major cause of the disease.
• Adjust your eating habits. Focus on eating vegetables, fruits, and high-fiber grains, while avoiding very hot foods, fermented foods, or smoked foods high in nitrates.
• Control your weight and manage acid reflux. Maintaining a healthy weight reduces abdominal pressure, preventing acid reflux and reducing acid erosion that can deform esophageal cells.
• Avoid exposure to hazardous chemicals. Be careful not to swallow or inhale irritants and toxins from industrial processes that may directly damage the esophageal lining.
• Regularly monitor your symptoms and have health checkups. If you experience any unusual symptoms, such as difficulty swallowing, chest pain, or chronic hoarseness, see a doctor immediately for a thorough diagnosis. Early detection significantly increases the chances of a cure.

What to Eat for Esophageal Cancer

• Soft, easy-to-chew foods, or those that have been finely mashed or blended, are recommended to facilitate swallowing, reduce irritation, and prevent injury to the esophageal tissue.
• Sample Menu Recommendations
  Savory Foods Finely blended porridge, various thick soups, steamed egg custard, soft steamed fish, soft tofu, or mashed potatoes.
  Snacks and fruits: yogurt, mousse, soft fruits, or easy-to-chew canned fruits.

Esophageal Cancer Treatment at Vibhavadi Hospital

If you experience any abnormalities, such as difficulty swallowing or pain while swallowing, do not ignore them, as they may be signs of esophageal cancer. This disease is curable if detected and treated early. Consult the Gastroenterology Center at Vibhavadi Hospital, where we have state-of-the-art diagnostic technology, allowing for targeted treatment so you can enjoy eating more.

Summary

Esophageal cancer results from the abnormal division of cells, forming a malignant tumor that can spread. Major risk factors include smoking, alcohol consumption, and chronic acid reflux. Unlike typical acid reflux, acid reflux presents with difficulty swallowing and rapid weight loss as warning signs. Treatment options range from standard methods such as surgery, chemotherapy, and radiation therapy to innovative targeted therapies and immunotherapy to increase survival rates.

If you experience any abnormalities, such as difficulty swallowing, do not ignore them, as they may be signs of esophageal cancer. You should seek treatment and advice at Vibhavadi Hospital. They are equipped with expert gastroenterologists and state-of-the-art technology to provide more targeted treatment, ensuring you can enjoy healthy eating every day.