What is the Esophagus?
The esophagus is a tube like organ lined with muscle located between the pharynx and the stomach. İt transfers food from the mouth to the stomach. İt is divided into three anatomical parts due to the fact that it is found in the neck, thoracic cavity and abdomen. Esophageal cancer arises from its flat epithelial cells that line the inner wall /squamous cell carcinoma/. Adenocarcinoma, which is cancer that originates from secretory cells, can be seen in parts of the esophagus that are close to the stomach. Esophagus cancers spread to neighbouring structures via the lymph nodes and lymphatic channels. The principle of esophagus cancer surgery is to excize the esophagus with its relative lymph nodes as a whole without disturbing its integrity.
How are Esophageal Cancers Diagnosed?
The most common symptom is dysphagia/difficulty in swallowing/. There is usually weight loss of more than 10kg in a 6 month period and pain radiating to the chest or back. Patients with difficulty swallowing should have a barium enema X-ray to detect any mass, but the diagnosis of esophagus cancer is made with endoscopic evaluation of the esophagus and stomach with biopsy of any mass visualized. Computerized tomography is a valuable radiologic examination that gives detailed information about the situation of the esophagus, neighbouring organs ie:heart, lung and distant organs ie: liver metastasis.
Treatment of Esophageal Cancer.
Esophagus cancer that originates in the throat area is treated with radiotherapy. Radiotherapy alone has the same long term outcome of that of surgery minus the possible surgical complications. Esophagus cancer originating for anywhere else is treated surgically. Preoperative chemotherapy and radiotherapy should be recieved to decrease the size of the tumor and postoperatively to prevent reoccurence. Surgery for esophagus cancer involves all three of its anatomical areas. The thoracic cavity is opened and the esophagus along with its lymph nodes and nodes of the lungs are liberated from surrounding structures. The lower esophagus is detached form the stomach and lymph nodes from this lower gastric are all collected, thus the whole esophagus with surrounding lymphatic systems are excized. To create a “new” esophagus the stomach or a part of the large intestine is prepared and fitted to the pharynx in the neck. Due to the great risks and technical difficulty of this surgical procedure, extensive surgical experience is required.
Which Patients are Eligible for Surgery?
Esophageal cancers if untreated unfortunately have a very short survival rate. Preoperatively a CT scan is essential to evaluate the tumor. İf metastasis for major organs such as the liver are detected, surgery should be postponed and onchologic therapy given first. PET/CT is superior to CT in the detection of metastasis and is frequently used preoperatively as well as for postoperative followup. Weight loss and loss of bodily nutrients are frequently seen. For a patient to tolerate this surgical procedure and heal well afterwords, good nutritional status is a must. For this reason, a feeding tube can be placed into the stomach or intestine before any treatment is started. Another alternative is i.v. feeding.
What awaits you after Surgery?
The opening of the thoracic cage may cause problems after surgery. Respiratory distress and serious pnomonia are just a few of the lifethreatening problems encountered. The surgical technique used and the patients preoperative nutritional status are key to avoid complications such as leakage from the sutures or fistula formation. These forms of leakage can quickly become lifethreatening. After esophageal cancer surgery patients can eat as usual. Rarely the newly created esophagus may narrow causing obstruction, which is treated endoscopically. Further surgery for this situation is rarely required but possible.