2024-02-15 07:37:01
▶ Alcohol and cigarettes are the main causes of esophageal cancer in Korea… 4 times the incidence
▶ Hot coffee, tea, soup, etc. also increase the occurrence by 3 times.
▶5-year survival rate is only 40%, 95% cure when detected early
The esophagus, the passage through which food passes, is a thin tube that extends from the mouth to the stomach. If the mucosal layer inside the esophagus continues to be stimulated, the epithelial cells may turn cancerous, resulting in esophageal cancer.
Esophageal cancer does not occur very often, accounting for 1.1% of all cancers (15th most common cancer), but its prognosis (treatment course) is not good, with a 5-year relative survival rate of 40.9%.
In addition, surgery, which is the standard treatment, causes many complications and has a high mortality rate. This is because the scope of the surgery is large and the level of difficulty is high as the entire esophagus is removed and the stomach and colon are reconstructed so that they can be used instead of the esophagus. Esophageal cancer occurs most often in men in their 60s and 70s.
Esophageal cancer is divided into cervical esophageal cancer, thoracic esophageal cancer, and stomach-esophageal junction cancer depending on the location of occurrence. Depending on the cell type, it is classified into squamous cell carcinoma, adenocarcinoma, sarcoma, lymphoma, and melanoma. Squamous cell carcinoma, derived from epidermal keratinocytes, mainly occurs in the upper esophagus and accounts for 90-95% of esophageal cancers in Korea, but the 5-year survival rate is only 10-25%.
The main causes of esophageal cancer in Korea are alcohol and tobacco. According to epidemiological studies, the incidence of cancer in smokers is 4.5 times higher in smokers than in non-smokers. People who enjoy alcohol have a two to three times higher incidence of cancer than people who abstain from drinking.
There is also a report that the incidence of esophageal cancer increases by 2.28 times when drinking hot coffee, tea, or broth above 65 degrees. Additionally, eating salted foods or processed meat can also be causes.
To detect esophageal cancer early, if you have a family history of esophageal cancer, or if you smoke or drink alcohol, you need to have an endoscopy every year.
Symptoms of esophageal cancer include: As the cancer worsens, the esophagus narrows, making eating difficult, and the amount of food consumed decreases, leading to severe weight loss and malnutrition. If cancer nearly blocks the lumen of the esophagus, swallowed food may come back up into the mouth. Food that comes up through the mouth can enter the respiratory tract and cause coughing or aspiration pneumonia.
If cancer invades the recurrent laryngeal nerve that controls the vocal cords, the vocal cords will be paralyzed, causing hoarseness. If cancer invades the spine right behind the esophagus, the back will hurt. If it invades the respiratory tract, coughing and hemoptysis may occur.
If these symptoms of esophageal cancer appear, treatment is very difficult because the cancer has already progressed to a significant stage. Unlike other gastrointestinal tracts, the esophagus does not have a serosa layer, has abundant development of surrounding lymph nodes, and is adjacent to major organs in the chest, so there is a high risk that the disease has already progressed to a significant stage when symptoms appear.
Shim Young-mok, a professor of pulmonary and esophageal surgery at Samsung Seoul Hospital who pioneered esophageal cancer surgery in Korea, said, “If early-stage esophageal cancer is limited to the mucosal layer, it can be treated relatively easily with ‘therapeutic endoscopic procedures’ that do not resect the esophagus.” “However, if the lesion is deeper than the mucosal layer, it can be treated relatively easily.” “Surgery must be performed first and most of the esophagus must be cut out,” he said. Metastasis to nearby lymph nodes is frequent, and if it has not metastasized to other organs, chemotherapy and radiation treatment along with surgery are considered, but this is not easy.
In addition, when surgical resection, which is the basis of esophageal cancer treatment, is performed, the esophagus virtually disappears, so a new esophagus must be created from the stomach or large intestine. Because incisions are made in the chest, abdomen, and, if necessary, the neck area (neck), the surgery time is long and recovery after surgery is not easy.
For esophageal cancer that is resectable through surgery, minimally invasive surgery using thoracoscopy has recently been widely performed. However, if the quality of life is expected to worsen after surgery, if there are other concurrent diseases, or if the cancer cannot be removed through surgery, radiation therapy and chemotherapy are performed.
Cho Jae-il, professor of pulmonary and esophageal surgery at Samsung Seoul Hospital, said, “Treatment results for esophageal cancer were not good for a while, but with early detection and improvements in surgery, chemotherapy, and radiation therapy, the treatment results have improved significantly recently.” He added, “We can now manage the patient’s quality of life after surgery.” “It is also important,” he said.
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