Esophageal Cancer: A Case Study

Esophageal Cancer: The Quest for Understanding

Cancer, the uncontrollable growth of cells, is the second most common cause of death in the United States and the fifth most common cause of death in the world (WHO, 2014; CDC, 2013). In 2012, there were 14.1 million cancer cases worldwide, and more than 4 million of those were associated with the gastrointestinal (GI) tract (WCRF, 2014). Within the GI tract, cancers of the colon and rectum are the most common, but pancreatic, liver, and stomach cancers are also part of the same category (University of Chicago, n.d.). Gastrointestinal cancers have lower survival rates compared to other common kinds of cancer; for example, only twenty-seven percent of those with stomach cancer, and six percent

For the same reason, esophageal cancer often occurs in the cells lining the sides of the organ, a condition called squamous cell carcinoma (SCC) (Mayo Clinic, n.d.). Major risk factors for developing SCC include heavy alcohol consumption, obesity, and tobacco use; therefore, getting regular exercise, quitting smoking, and decreasing alcohol consumption are methods of preventing the disease (MSKCC,n.d; NCI, 2013). Figure 1 shows an example of where SCC occurs within the esophagus. Esophageal cancer also appears in the glands lining the lower part of the esophagus, a condition called adenocarcinoma (AC), and is sometimes attributed to acid reflux, or the upward flow of acid into the esophagus from the stomach (NCI, 2013). Extreme levels of acid reflux may be a symptom of a severe condition called Barrett’s esophagus, a condition causing ulcers and inflammation to occur in the lower esophagus, and may significantly increasing the risk of developing AC (MSKCC,n.d.). The specific caused by SCC and AC may raise red flags leading to a

The plan of treatment is usually developed by a team of doctors, such as a gastroenterologist, who specializes in the digestive system, chest surgeon, to aid in surgery on the esophagus, and a medical oncologist, who specializes in treating cancers with drugs like chemotherapy (NCI, 2013). For tumors located before undergoing metastasis, the often select radiation, chemotherapy and surgery as a three-pronged approach (ASCO, 2014). This combination of chemotherapy and radiation followed by surgery is used for both AC and SCC, as each tactic has a specific purpose (ASCO, 2014). Chemotherapy is the use of drugs given through a needle to kill cancerous cells, but can also harm non-cancerous, rapidly dividing cells such as those in the blood, hair, or stomach lining (NCI, 2013). Radiation is used in conjunction with chemotherapy, in a process called chemoradiation, and is the main course of treatment for SCC and AC used to shrink the tumor (MSKCC,n.d.). Surgery is performed during the early stages of SCC and AC, or if the tumor doesn’t respond to chemoradiation, to remove the cancerous parts of the esophagus, also the surrounding tissue and lymph nodes, and reattach the healthy portion of the organ to the stomach (Hwang, Iyer, Mulligan, 2014). Despite the in-depth approach to treatment currently available, there are still around 16,000 deaths from