Esophageal Cancer

Cancer of the esophagus (gullet) is relatively uncommon condition. But because of its poor prognosis, it ranks among the 10 leading causes of cancer death in Canadian men 45 years of age and older

Dave’s uncle Bill finds out about it when he has difficulty swallowing food.

Bill starts to lose weight. He tries bland and pureed (liquid) diet. But he continues to lose weight. Except for saliva, nothing goes down.

Bill lives alone. He does not like to complain or bother other people.

One day, Dave runs into Bill at a shopping mall. Dave is surprised to see how much weight Bill has lost. Dave invites Bill to come over for a good home cooked meal.

Dave’s wife Susan cooks roast beef. Bill is hungry and takes the first bite. He chokes. The food is stuck in the esophagus. He is unable to swallow saliva. He is rushed to the Emergency Department.

Bill undergoes emergency gastroscopy (a flexible long instrument with light and camera at the tip) to check and remove the food bolus from the esophagus. The physician also finds the cause of the blockage – a tumour. He takes biopsies and within few days the result shows cancer.

Bill undergoes more tests to see if the cancer has spread. These tests are chest x-ray, blood tests, ultrasound of the liver, and CAT scan of the chest. Unfortunately, the results show that the cancer has advanced.

Bill is shocked. So is Dave. Naturally, their first question is – now what? They want to know everything about the cancer.

In an adult, esophagus is a long straight tube, 40 cm. long. It starts in the throat, travels through the chest cavity, behind the heart and the big vessels (aorta), passes through the diaphragm and joins the stomach. About 4 cm. of the esophagus is below the diaphragm.

Esophagus connects the mouth to the stomach. What a journey our food has to take before it gets to the stomach!

The esophagus is kept lubricated by saliva we swallow and the mucous secreted by the esophageal glands.

Esophageal cancer is slightly more common in males than females. Some of the possible causes of this cancer are alcohol, tobacco, chronic inflammation of the esophagus, and previous lye-induced injury.

Esophageal cancer occurs either in the upper, middle, or lower part of the gullet. Since the gullet is fairly small in diameter, the symptoms of blockage occur early. But it does not help improve prognosis. In approximately 95 per cent of cases, surgical cure is impossible by the time diagnoses is made.

Hence treatment options are very limited. Besides surgery, radiotherapy has shown promising results in some cases. But 5 year survival rate for surgery, radiotherapy or the combination of the two is poor (5 to 15 percent).

In most cases, the only treatment option is palliative in nature. This may include chemotherapy to treat the systemic disease (cancer spread), dilatation, stent or laser therapy to keep the esophageal lumen open.

Unfortunately, Bill’s tumor has already spread to lungs and liver. Therefore, he has very limited treatment options. And the prognosis remains poor.

Bill and his family need emotional support in this trying time. Pain control is very important for comfort and to keep the moral up. Therefore, he is referred to Cancer Clinic, Pain Clinic and Palliative Care Program.

This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems.

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