Who is More Prone to Esophageal Cancer?

In Turkey, particularly due to dietary habits, squamous cell carcinoma, also known as squamous-type esophageal cancer, is more commonly observed in the Eastern regions such as Erzurum, Ağrı, Kars, Van, Bitlis, and Muş. Drinking very hot tea and having a diet low in vegetables but rich in meat play a significant role in the prevalence of esophageal cancer in these areas. Squamous cell carcinoma of the esophagus is more frequent in the region starting from the eastern part of Turkey, including the area referred to as the Turkic Republics, and extending to China, compared to the global average. The mountainous and cold nature of this region contributes to the excessive consumption of hot beverages. The consumption of hot beverages, when combined with smoking and alcohol, further increases the incidence of esophageal cancer.

Esophageal cancer is typically a disease of individuals aged 60 and above, with rare occurrences below this age range. While more common in males, due to the consumption of hot tea in the Eastern provinces, it can also occur in females at nearly the same rate. Esophageal cancer is rarely seen in the younger population, but it can be more common in families with a history of esophageal or colon cancer.

What are the types of esophageal cancer?

Esophageal cancer is classified based on the type of cells it originates from and the region where it develops. Esophageal cancer is generally divided into two main types: squamous cell carcinoma and adenocarcinoma.

Squamous Cell Carcinoma: Squamous cell carcinoma of the esophagus is a cancer that arises from the thin layer of flat cells lining the inside of the esophagus. In Turkey, squamous cell carcinoma is more commonly observed.

Adenocarcinoma: Adenocarcinoma of the esophagus occurs in the lower region of the esophagus where the mucosa (inner lining) is exposed to stomach acid and bile. Over time, these cells transform, resembling glandular cells and the inner lining of the stomach. Adenocarcinoma is more frequently seen in Western countries compared to squamous cell carcinoma.

In addition to these two main types, there are very rare types of esophageal cancer that originate from muscle tissues.

Esophageal cancer can also be classified based on its location within the esophagus:

1. Cervical Esophagus (Neck)

2. Thoracic Esophagus (Chest)

3. Lower End - Near Stomach Entrance

Due to the damage caused by stomach acid and bile reflux being closer to the stomach, adenocarcinoma of the esophagus is usually found at the entry to the stomach or in the lower portion of the esophagus. On the other hand, squamous cell carcinoma often occurs in the upper or middle part of the esophagus.

Can Esophageal Cancer Be Detected Through a Blood Test?

Esophageal cancer cannot be determined through a blood test.

What Should Be Done for the Early Diagnosis of Esophageal Cancer?

There is no screening program for the early diagnosis of esophageal cancer in Turkey. However, among the precautions that can be taken personally, undergoing endoscopic examinations is a priority.

For patients with Barrett's esophagus (BARRETT) developed due to reflux, regular annual endoscopic follow-up is important to detect any potential esophageal cancer at an early stage.

Routine endoscopic screenings in Eastern provinces where squamous cell (Squamous) esophageal cancer is prevalent are of vital importance for early diagnosis.

What Are the Stages of Esophageal Cancer?

Esophageal cancer consists of 4 stages.

Esophageal cancer stage 1: Due to the late onset of symptoms, diagnosing stage 1 esophageal cancer is quite challenging. The disease is confined to the inner lining of the esophagus and hasn't reached the muscle layer. In the treatment of stage 1 esophageal cancers, it is possible to remove only the affected lining through an endoscope inserted through the mouth, rather than completely removing the esophagus.

Esophageal cancer stage 2: In stage 2, the disease has breached the lining and reached the muscle tissue of the esophagus.

Esophageal cancer stage 3: The tumor is not very large. The disease is present in the esophagus but has also spread to nearby lymph nodes. In the treatment of stage 3 esophageal cancers, chemotherapy and radiotherapy are initially administered. The aim is to shrink the tumor and lymph node involvement. If regression is achieved, surgical removal of the tumor becomes necessary.

Esophageal cancer stage 4: In stage 4 esophageal cancers, the tumor has metastasized to distant parts of the body. Esophageal cancer most commonly metastasizes to the liver, bones, lungs, and lymph nodes near the stomach entrance. At this point, the opportunity for surgery is limited. Treatment involves chemotherapy.

Which department and doctor should be consulted for esophageal cancer?

A significant portion of esophageal cancer patients undergo a treatment process that involves the collaboration of multiple departments. In cases of esophageal cancer, which require a multidisciplinary treatment approach, in addition to thoracic and esophageal surgery, departments such as gastroenterology, medical oncology, radiation oncology, and general surgery can work together. The support of the diet and nutrition department is crucial during this process. In cases that require specialized microsurgery (such as constructing the esophagus from the small intestine), support is also obtained from the Department of Aesthetic, Plastic, and Reconstructive Surgery. Since there are highly specialized surgical approaches in the treatment of esophageal cancer, it is important to choose hospitals with experienced doctors and adequate infrastructure in this field.

How is Esophageal Cancer Surgery Performed?

Unlike intestinal surgeries, a part of the esophagus cannot be cut and rejoined with the remaining part. When the esophagus is removed during surgery, a new esophagus must be constructed in its place. The main goal is to ensure the continuity of the digestive tract. When the esophagus is removed, the stomach, small and large intestines, or rarely, the esophagus can be reconstructed from the skin.

In very rare cases where the tumor is not removed, lateral intestinal continuity can be established to allow the patient to eat. Thanks to advancing technology, this situation can now be addressed by placing a stent.

In cases where a completely blocked tumor cannot be removed and a stent cannot be placed, nutrition can be provided by placing a tube into the stomach (gastrostomy) to directly deliver food to the stomach.

How is minimally invasive esophageal cancer surgery performed?

The majority of esophageal cancer surgeries (80-90%) at our Esophageal Diseases Center are performed using minimally invasive techniques. Globally, minimally invasive esophageal cancer surgeries are conducted through 6 incisions in the chest area and 4 incisions in the abdominal area. At Memorial Ataşehir Hospital's Esophageal Diseases Center, minimally invasive esophageal cancer surgery can be performed through 3 abdominal incisions and a single incision in the chest. The abdominal portion of the surgery takes 45 minutes to 1 hour, while the chest portion takes 1 to 1.5 hours. Minimally invasive esophageal cancer surgery reduces complications by minimizing bleeding, surgical time, and trauma.

What are the risks of esophageal cancer surgery?

Esophageal cancer surgery is one of the most critical surgical procedures. The most significant risk is leakage at the junction between the esophagus and the stomach or the new reconstructed esophagus. Hoarseness is also a potential risk in esophageal cancer surgery. However, this risk is less than 10%, and hoarseness is generally temporary. Prolonged hoarseness can be resolved with a minor procedure. As an outcome of major surgery, pneumonia, cardiac arrhythmias, and lymphatic leaks might occur.

Is esophageal cancer fatal?

Cancer evokes thoughts of death in people's minds. Therefore, doctors frequently encounter the question "Does esophageal cancer kill?" The majority of patients with Stage 1 and Stage 2 esophageal cancer, as well as a portion of those with Stage 3 that can be operated on, have a chance of overcoming the disease. However, esophageal cancer is a disease that progresses without clear symptoms. Symptoms become distinct only in Stage 4.

There isn't a general answer to the question of whether esophageal cancer kills. Each case comes with individual conditions. Factors such as the tumor type, stage, and location, as well as the patient's age and the presence of accompanying illnesses, contribute to the variation in lifespan.

Regardless of these factors, research indicates the following 5-year survival rates for esophageal cancer:

Stage 1 esophageal cancer: 80-90%

Stage 2 esophageal cancer: 50-60%

Stage 3 esophageal cancer: 30-40%

Stage 4 esophageal cancer: 5%

If the disease doesn't recur within the first 2-3 years after treatment, it generally does not reoccur at all. That's why the initial 2-3 years after treatment are crucial.

Are there any herbal treatments for esophageal cancer?

There is no herbal treatment for esophageal cancer. However, consuming a diet rich in vegetables is important, and consuming anti-inflammatory foods like onions, garlic, and turmeric can provide support in fighting against cancer.

Foods high in sugar such as molasses, honey, sugary compotes, and desserts should be avoided. Instead, it's important to consume a diet rich in protein and vegetables.

What to pay attention to after esophageal cancer surgery?

After esophageal cancer surgery, patients need to pay attention to their diet. Consuming anti-inflammatory foods and avoiding sugar while prioritizing quality sleep, exercise, and regular health check-ups is crucial.

Acidic beverages should be avoided after esophageal cancer. Patients need to use gastric protective medications for the rest of their lives.

Due to absorption issues following surgery, where food directly enters the stomach, patients might experience a 10% weight loss and occasional diarrhea depending on the type of food. To avoid these issues, it's recommended to stay away from foods like honey, molasses, and syrupy desserts. Eating small amounts frequently is necessary. Patients are usually advised to limit the quantity rather than the variety of food.