Generality
The carcinoma or malignant tumor of the esophagus is an event with a very poor prognosis, that is, it is a pathology that (due to the mostly late diagnosis) is often identified in phases that are already too advanced to be successfully treated.
The diagnosis of esophageal carcinoma is simple and uses technologies that leave no room for routine errors.
Esophagus tumors are ALMOST all malignant in nature, although (due to the low incidence: 0.8-4.9 per 100, 000 inhabitants) in our country they have a lower clinical importance than many other neoplasms (in Italy, the region most affected is Friuli-Venezia-Giulia); on the contrary, in Russia, China and South Africa it is a much more common pathology. The cancer of the esophagus affects the male sex more than the female one in a ratio of 3: 1.
Risk factors
To date there are absolutely certain elements that can demonstrate the actual importance of risk factors with respect to the pathogenesis of esophageal cancer, however, the statistical correlations between lifestyle and esophageal cancer do NOT leave room for imagination.
Risk factors induced by food
The dietary factors most involved in the pathogenesis of esophageal cancer are: the presence of nitrosamines, iron and magnesium deficiency in the diet, retinol deficiency (vit. A) and alcohol abuse.
Other risk factors
Other elements that contribute to increasing the possibility of contracting cancer of the esophagus are: achalasia (one of the diseases of the esophagus), infection with HPV (human papilloma virus), infection with Helicobacter pylori, black race, cigarette smoke (factor of risk amplified by the association of smoking and alcohol), oesophageal scars (for example induced by the ingestion of caustics), polyps, diverticula, inflammatory stenosis, Barrett's esophagus (congenital or acquired pathology as a complication of gERD gastroesophageal reflux disease).
NB . Barrett's esophagus, if properly treated, shows a reduced statistical correlation (by 3%) with the onset of esophageal cancer. Hereditary factors also play a decisive role, among which the best known is tylosis (palmar and plantar hyperkeratosis associated with esophageal polyposis).
Pathological anatomy and metastatic pathways
The tumor of the esophagus can be shown to be vegetating, meaning it grows (irregularly and often with bleeding) adherent to the esophageal lumen; it can appear ulcerated, therefore in the shape of a crater; or infiltrating the esophageal wall, with a thick and whitish color. From a microscopic point of view, it differs in adenocarcinoma and squamous carcinoma . The tumor of the esophagus is called in situ, when it affects only the superficial layer, that is the mucosa; infiltrating when it invades the submucosa and goes beyond it. Rare other forms of esophageal cancer.
The metastatic pathways of esophageal cancer are different; the most precocious, that is the first to be compromised, is the lymphatic way (lymphatic circle) which determines the compromise of numerous lymph nodes located in different districts. Later on, the metastatic blood pathway, which compromises the liver, lung and brain, acquires a certain importance; while by contiguity it proves dangerous with respect to adjacent structures, namely: pharynx, trachea, left bronchus, pulmonary veins, aorta, pericardium, lower part of the lung, body of the pancreas, spleen and left adrenal gland.
Diagnosis
The fundamental element for the diagnosis of esophageal cancer is the "clinic", which must be able to address and request appropriate tests for the recognition of carcinoma. Among the routine investigations, the most useful as well as (currently) the first to be suggested is esophagoscopy; this exam allows to evaluate the tumor size, the anatomic aspect and to perform more fundamental biopsies at the diagnosis.
The RX of the esophagus is always useful, even if a little outdated; this exam allows to identify the site, the stenosis and the extension, besides identifying the morphological alterations and the movements of peristalsis. Currently, endoscopy can be integrated with two new tools: 1. Chromiumendoscopy, very useful in screening pathways; 2. Ecoendoscopy, very useful in delineating the neoplastic area and infiltration. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrate similar applications and results but are very useful for staging.
The average survival of patients with esophageal cancer is one year and that at five years does not exceed 10%.
Prevent esophageal cancer "
Bibliography:
- Clinical Oncology lessons - V. Abasciano - Aracne - pag 6:15
