Cancer of the esophagus

Esophageal cancer can be of two types. The first type is adenocarcinoma , which is the most common, and the second type is epidermoid cancer, also called squamous cell cancer.

The risk factors for esophageal adenocarcinoma  are Barrett's esophagus, gastroesophageal reflux disease , tobacco, and obesity. The risk factors for esophageal epidermoid cancer are alcohol consumption and certain diets, regular ingestion of very hot drinks in large quantities, and smoking.

Symptoms and diagnosis of esophageal cancer

Manifestations of cancer of the esophagus include dysphagia , and / or unexplained weight loss. In some cases, esophageal cancer is discovered during a follow-up gastroscopy for Barrett's esophagus or during the diagnostic workup for gastroesophageal reflux disease.

The diagnosis requires various examinations, such as eso-gastroscopy with biopsies, echo-endoscopy, laryngoscopy and bronchoscopy in cases of epidermoid cancer, CT scan of the thorax and the abdomen, as well as PET-scan in some cases. 

Surgical treatment for esophageal cancer

Each cancer case is discussed during a weekly multidisciplinary meeting named tumor board  

In case of low tumors localized in the abdominal esophagus, a surgical exploration by laparoscopy prior to definitive surgery may be recommended. 

If the tumor can be removed, surgery is the treatment of choice. A neoadjuvant radio-chemotherapy is sometimes considered.

Depending on the type of cancer and its location, an esophagectomy  is suggested. This procedure is performed under general anesthesia by laparotomy or laparoscopy , and includes a right mini-thoracotomy . Surgical reconstruction (with the stomach or colon) is performed to reconnect the digestive tract. Thereafter, chemotherapy with or without radiotherapy is usually indicated.

In certain situations and in cases of early stage cancer, i.e. limited to the superficial layers of the wall of the esophagus, ablation of the tumor by endoscopy may be proposed.

When the tumor is not operable, chemotherapy with or without radiation therapy can be given.

Lorsque la tumeur n’est pas opérable, une chimiothérapie avec ou sans radiothérapie peut être administrée.

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