Roughly 13,000 Americans develop this cancer each year and 12,000 die from it. It is more commonly seen in men than women. Smoking and tobacco use along with alcohol impose a great risk in development of this cancer. The incidence of adenocarcinomas of esophagus has been rising dramatically since 1970 in both United States and Europe. This rise has been purely due to Barrett's Esophagus and subsequent development of almost all of adenocarcinomas of esophagus.
CAUSES OF ESOPHAGEAL CANCER
Following is list of factors that increase the risk of esophageal cancer:
• Barrett's Esophagus
• Tobacco
• Alcohol
• High fat, low protein diet
• Exposure to nitrosamines
• Esophageal irritation
SIGNS AND SYMPTOMS
Very few cases are diagnosed at early stages. Most patients present with later stages of this cancer, at which point they complain of difficulty in swallowing solid food. Others may present with
• Weight loss
• Loss of appetite
• Cough
• Hoarseness
• Bone pain
• Shortness of breath
TREATMENT
Most patients are treated with a combination of Surgery, Chemotherapy and Radiation therapy. Surgery is most appropriate for patients in the very early stages of a disease, especially when the location of cancer makes it easy to operate. Even for patients with more advanced disease, a combination of chemotherapy and radiation therapy may control a disease in a high percentage of patients. Cancers that are located in the upper esophagus are almost always treated with chemotherapy and radiation. The majority of patients are treated with a combination of 5-FU and Cisplatinum and radiation. This regimen has become a standard for the majority of esophageal cancers. 5-FU is given as a continuous infusion over four to five days and Cisplatinum is given in one dose on Day 1 of 28-day cycles. The same regimen is repeated every four weeks. Patients benefit from having a Port-A-Cath for administration of chemotherapy. The most significant side effects of this regimen are:
• Hair loss
• Nausea, vomiting
• Low white blood count
• Anemia
• Soreness of the mouth
Other drugs may also be used in some form of combination:
Leucovorin, Methotrexate, Bleomycin, Carboplatin, Cytoxan
