Definition

Esophageal tumor is a disease characterized by abnormal, excessive cell growth in esophageal tissue. The esophagus is a passage consisting of muscles responsible for moving food from the mouth to the stomach. The abnormal growth of cells out of control forms a tumor. Tumors that continue to grow and develop can affect the internal tissues and muscles of the esophagus. Tumors can appear anywhere along the esophagus, including at the junction between the esophagus and the stomach.

Tumors can be malignant or benign. Malignant tumors, or cancer, can grow and spread to other body parts. Benign tumors grow but do not spread. Specifically, esophageal cancer begins in the inner layer of the esophageal wall and grows outward. If it spreads through the esophageal wall, cancer cells can travel to the lymph nodes and blood vessels in the chest and other nearby organs. Esophageal cancer can also metastasize to the lungs, liver, abdomen, and other parts of the body.

There are generally two kinds of esophageal cancer: squamous cell cancer and adenocarcinoma. Squamous cell cancer starts from cells that line the esophagus (squamous cells). This cancer usually affects the upper and middle parts of the esophagus. Adenocarcinoma grows in tissue that produces mucus, which helps the swallowing process, and usually occurs in the lower part of the esophagus.

Causes

Similar to many other tumors and cancers, the exact cause of esophageal tumor is still not fully understood. However, the process is believed to be related to abnormalities (mutations) in the DNA of cells associated with the esophagus. These mutations signal the cells to multiply faster than normal cells. Additionally, they disrupt signals that regulate cell death. The imbalance between cell proliferation and cell death leads to the accumulation of these abnormal cells and the formation of tumors. These tumors can grow, invade nearby structures, and spread to other body parts.

Risk Factors

Several risk factors contribute to the development of esophageal tumors, including:

• Older age: Esophageal tumors are more common in individuals over 60 years old compared to those aged 60 or younger.
• Male gender: Men are three times more likely to develop this disease than women.
• Ethnicity: Squamous cell esophageal cancer is more common in African-American and Asian populations, while adenocarcinoma is more prevalent in white individuals.
• Tobacco use, including smoking and smokeless tobacco.
• Long-term and/or heavy alcohol consumption.
• Barrett's esophagus and chronic acid reflux: Barrett's esophagus, characterized by changes in the cells at the lower end of the esophagus due to untreated chronic acid reflux, increases the risk of esophageal cancer. Even without Barrett's esophagus, long-term heartburn raises the risk of esophageal cancer.
• Human papillomavirus (HPV): In regions with high incidences of esophageal cancer, HPV infection increases the risk of squamous cell esophageal cancer. HPV is known to cause tissue changes in various body parts, including the vocal cords, mouth, hands, feet, and genital organs.
• Other disorders: Conditions such as achalasia, a rare disease causing difficulty swallowing, and tylosis, a rare inherited disorder characterized by excess skin growth on the palms of the hands and soles of the feet, have been associated with esophageal cancer.
• Workplace exposure to certain chemicals: Prolonged exposure to dry cleaning solvents increases the risk of esophageal tumors.
• History of cancer: Individuals with a history of head or neck cancer are at a higher risk of developing esophageal tumors.

Symptoms

Esophageal tumors often do not exhibit clear symptoms in the initial stages. However, as the tumor progresses, the following symptoms may arise:

• Difficulty and pain when swallowing, particularly with solid foods such as meat, bread, or raw vegetables. The growing tumor can also obstruct the passage to the stomach, making even swallowing liquids painful.
• Pressure or burning sensation in the chest.
• Digestive disturbances or abdominal discomfort.
• Vomiting.
• Frequent choking on food.
• Unexplained weight loss.
• Persistent cough or hoarseness.
• Pain behind the breastbone or in the throat.
• Bleeding in the esophagus, which can cause black stools due to blood passing through the digestive tract. Prolonged blood loss can lead to anemia and fatigue as the disease progresses.

Diagnosis

In diagnosing esophageal tumors, doctors typically begin with a medical interview to gather information about the patient's medical history, including present symptoms and potential risk factors. Following this, a physical examination is conducted. 

After the physical examination, the doctor may recommend several tests to aid in the diagnosis of esophageal tumors, including:

• X-ray with Barium swallow: This procedure involves the patient drinking a liquid containing Barium, which enhances the visibility of the esophagus on X-rays, allowing doctors to visualize any abnormalities.
• Esophagoscopy is a procedure that enables doctors to examine the inside of the esophagus using a thin, camera-equipped cable called an endoscope. This cable is inserted through the mouth and down into the esophagus while the patient is sedated. Esophagoscopy can also remove obstructions in the esophagus, with doctors able to widen blocked passages using techniques such as balloon dilation.
• Biopsy: During esophagoscopy, the doctor may take a small tissue sample (biopsy) for examination under a microscope to detect the presence of cancer cells.
• Endoscopic ultrasound (EUS) of the esophagus: This procedure utilizes sound waves to create detailed images of the internal structures of the esophagus. It is typically performed in conjunction with esophagoscopy.
• Computed tomography (CT) scan: Often used to evaluate the extent of tumor spread to the chest and abdomen.
• Additional tests: These may include Positron Emission Tomography (PET) scans, thoracoscopy, and laparoscopy, which are performed to determine if the tumor has metastasized beyond the esophagus.

Management

The success of treating esophageal tumors often depends on early detection, although diagnosis at advanced stages is unfortunately common. Treatment decisions are influenced by various factors, including the stage of the tumor and the overall health of the patient. Treatment options for esophageal tumors include:

• Surgery: Removal of part or all of the esophagus may be necessary.
• Radiation therapy: Using radiation to kill cancer cells.
• Chemotherapy: Administering drugs to attack cancer cells throughout the body, often used alongside radiation therapy and/or surgery.
• Targeted therapy: A newer treatment approach that targets specific aspects of cancer to inhibit its growth and spread.
• Immunotherapy: Stimulating the body's immune system to attack cancer cells.
• Photodynamic therapy: Targeting cancer cells with specific laser light.
• Electrocoagulation: Destroying cancer cells using electrical current.
• Cryotherapy: Freezing cancer cells to shrink the tumor.
• Mucosal resection with endoscopy involves removing the inner layer of the esophagus to treat pre-cancerous or very small early-stage cancers.
• Radiofrequency ablation therapy: This involves using a device that targets cancer cells with radiofrequency energy. It is sometimes used for early-stage cancer.

Complications

Esophageal tumors can lead to various complications, including:

• Esophageal obstruction: Tumors may obstruct the passage of food and liquids through the esophagus, causing difficulty in swallowing.
• Pain: Advanced-stage esophageal tumors can cause discomfort and pain in the chest or throat.
• Bleeding in the esophagus: Esophageal tumors can result in bleeding, which may occur gradually over time or suddenly and severely.

Prevention

While the exact methods for preventing esophageal tumors are not fully understood, there are several ways to reduce the risk:

• Avoid smoking and tobacco products.
• Limit alcohol consumption, as excessive alcohol intake can increase the risk.
• Consuming a diet rich in fruits and vegetables and maintaining an ideal body weight may help lower the risk of developing esophageal tumors.

When to see a doctor?

If you experience symptoms such as prolonged difficulty and pain while swallowing, it's essential to consult your doctor, as these could be indicative of an esophageal tumor. Additionally, if you have a history of Barrett's esophagus, your risk of esophageal cancer is elevated. In such cases, it's advisable to discuss potential signs and symptoms that may indicate worsening of your condition with your doctor. Furthermore, consider discussing screening options for esophageal cancer to ensure early detection and prompt management