Which are the symptoms?
The most common symptom is pain or difficulty swallowing food (dysphagia) and weight loss. Other early symptoms may include gastroesophageal reflux, regurgitation, vomiting, and anemia.
- difficulty swallowing food
- weight loss
- gastroesophageal reflux
How is it diagnosed?
The most commonly used diagnostic tools are esophageal esophagogram and endoscopy with biopsy. After diagnosis, it is important to assess the spread of the tumor into the esophagus or other parts of the body (staging) using the following diagnostic tools:
- echo-endoscopy to assess the degree of tumor spreading deep into different viscera tones and involvement of periesophageal lymph nodes;
- abdominal and thoracic CT with contrast to check for localization of disease in lymph nodes or distant spread (liver, lungs, and structures adjacent to the esophageal wall);
- PET (positron emission tomography) to detect the presence of neoplastic cells in remote organs by absorbing radioactive glucose molecules;
- bronchoscopy to assess possible involvement of the bronchial tree;
- laparoscopy to check the spread of small nodules to the peritoneum or to take a biopsy.
How is it treated?
The most common standard treatment is esophagectomy. It is performed under general anesthesia and involves an almost complete resection of the esophagus by a combined abdominal, thoracic, and cervical route. Continuity of the digestive system is restored by suturing the esophagus in the neck region to the stomach (less often to the colon), which is appropriately prepared using abdominal surgery. Disease staging is also performed, including removal of lymph nodes closer to the intestine for histological examination, which is especially important for subsequent treatment decisions.
This procedure can be performed with a classic abdominal and thoracic incision (called a laparotomy and thoracotomy, respectively) or with laparoscopy or thoracoscopy, procedures that reduce pain in the postoperative period and allow for faster recovery.
Other treatments, which may be used alone, in combination, or in sequence depending on the stage of the tumor include:
- radiation therapy in combination with preoperative chemotherapy in locally advanced disease or with radical intentions in cases of inoperable disease due to site or patient characteristics;
- exclusive chemotherapy for metastatic disease;
- local laser treatment or electrocoagulation;
- installation of endoscopic palliative endoprostheses for metastatic disease.