Esophageal cancer

Esophageal cancer is a cancer in which malignant cells form in the tissues of the esophagus. The esophagus is a long, hollow tube from the pharynx to the stomach. It is necessary for the body to transport fluids and solids. Cancer cells most often appear in the lining of the esophagus. If not started early treatment, the tumor grows and affects other layers of the esophagus, surrounding tissues and gives life-threatening metastases.

Esophageal cancer can be detected at an early stage if regularly undergo comprehensive diagnostic programs – check-ups. They allow identifying pathological changes in the body before the first symptoms appear. Leave your request on the MedTour platform to learn about the options for complex diagnostics in foreign clinics.

Why does esophageal cancer occur

There is no single cause of esophageal cancer. Doctors and scientists suggest that a tumor occurs when the genetic material inside the cells lining the esophagus is damaged. Disorders in the genetic material affect the division and renewal of cells in the esophagus. This is the cause of mutations and abnormal structure – cellular atypia.

Chronic cell damage is observed with prolonged irritation of the walls of the esophagus with certain substances. Doctors identify risk factors – the most common causes that increase the chances of developing esophageal cancer:

• Gastroesophageal reflux disease (GERD);
• Smoking;
• Barrett’s esophagus is a precancerous condition;
• Overweight;
• Alcohol;
• Achalasia is a violation of the motor function of the esophagus;
• Long-term intake of food that is too hot;
• Lack of fiber (vegetables and fruits) in the diet.

Some hereditary diseases can also cause the development of esophageal cancer, as they cause gene mutations in all cells of the body:

• Hereditary forms of Barrett’s esophagus;
• Fanconi anemia – increased fragility of chromosomes, which leads to the development of anemia and cancer;
• Bloom’s syndrome – a disruption in the BLM gene, which increases the chances of developing esophageal cancer;
• Howell-Evans syndrome is a hereditary hyperkeratosis of the soles and palms with a possible risk of developing cancer of the esophagus and lungs.

Hereditary diseases that cause esophageal cancer can be diagnosed with special genetic tests. These tests are available at leading overseas medical centers.

What are the symptoms of esophageal cancer

Esophageal cancer may be asymptomatic until it reaches later stages, in which the tumor is more difficult to treat. Patients most often complain of difficulty swallowing – dysphagia. This is due to the growth of a tumor that interferes with the normal passage of food from the pharynx to the stomach.

Over time, dysphagia may worsen, and the patient is forced to switch to softer and liquid foods, avoiding the meat and bakery products that cause the most discomfort. Changes in eating behavior are responsible for weight loss in the later stages of the disease.

As the tumor grows, the chance of bleeding increases. Because of this, patients may notice darkening of the stool. Prolonged blood loss leads to the development of anemia.

With cancer of the esophagus, other symptoms are observed:

• Painful sensations in the chest area;
• Nausea and vomiting;
• Weakness and general malaise;
• Hoarseness of voice;
• Prolonged cough;
• Bone pain during the spread of metastases.

How to recognize early esophageal cancer?

The symptoms of esophageal cancer are the same as for other non-oncological diseases of the gastrointestinal tract. If any signs appear, it is important to seek medical attention on time. Foreign clinics carry out diagnostics according to American and European treatment protocols. This ensures that the patient will complete all necessary examinations without waiting and queuing.

Diagnosis of esophageal cancer

The symptoms of esophageal cancer are not unique and, in most cases, do not indicate the presence of cancer. Therefore, it is important to start the diagnosis with a consultation with a gastroenterologist. The doctor will study the medical history, patient complaints and conduct an initial examination. Based on the results of the consultation, the doctor will prescribe the necessary studies to clarify the diagnosis.

If doctors suspect esophageal cancer, the following diagnostic procedures can be prescribed:

• Barium X-ray. If the patient complains of trouble swallowing – dysphagia, the doctor may order a chest x-ray. Before the examination, the patient is given a drink of barium containing the contrast. It is a thick liquid that envelops the walls of the esophagus and allows doctors to detect any irregularities, tumors and pathological narrowings. The study does not provide information on the spread of the neoplasm outside the esophagus. But radiography with barium allows doctors to detect a pathological opening between the esophagus and the trachea – a tracheoesophageal fistula. This complication can also be seen in patients with esophageal cancer.
• Computed tomography with contrast (CT). This study also uses X-rays, but the data obtained during the tomography is processed using a computer and transformed into cross-sections of the entire human body. This allows doctors to assess the spread of the tumor beyond the esophagus – to nearby organs and lymph nodes. If the tumor is deep, a fine-needle biopsy is performed under CT control to collect cancer cells.
• Magnetic resonance imaging (MRI). The MRI machine measures the magnetic field of tissues and cells, creating 3D tissue reconstruction. When diagnosing esophageal cancer, MRI is used to look for metastases in the brain and spinal cord.
• Positron-emission tomography (PET). Before the procedure, the patient is injected intravenously with a glucose-containing contrast, which accumulates most in tumor cells. PET scans the entire body of the patient and identifies foci of distant metastases.
• Endoscopic examination. During the examination, the doctor uses a special device – an endoscope. It is a thin tube with a camera or ultrasound probe at the end. With its help, the doctor can examine the esophagus, chest cavity and bronchi. Endoscopy allows the doctor to see the abnormal area and take tissue samples for histological examination.
• Biopsy. If previous examinations indicate the presence of a pathological formation, the doctor performs a biopsy. During the biopsy, the doctor takes samples of the tumor with a fine needle. The biopsy can be done under ultrasound or CT guidance. Tumor cells are sent to a pathological laboratory, where they are processed and examined.

The cost of endoscopy with biopsy in clinics around the world:

• Ukraine – from $600;
• Turkey – from $1 400;
• South Korea – from $2 000;
• Germany – from $3 200;
• Israel– from $3 500.

How long do people live with esophageal cancer

Life expectancy depends on a number of factors: the stage of the disease, concomitant health problems, the treatment carried out. Properly prescribed therapy improves the general condition of the patient and affects the prognosis of survival in esophageal cancer in general. In oncology, the concept of “five-year survival” is used, which reflects the life expectancy of patients at different stages of the disease. Also, the prognosis is influenced by the indicator of how quickly esophageal cancer develops.

If the tumor is limited to the esophagus and does not go beyond it, the 5-year survival rate is 47%. When cancer spreads beyond the esophagus to nearby tissues and lymph nodes, the survival rate is 25%. The five-year survival rate for metastasis of esophageal cancer beyond the chest is 5%.

Survival is a relative measure. There are cases of complete recovery of a patient in the late stages of esophageal cancer. It is important to diagnose and prescribe the correct therapy. In foreign medical centers, patients have access to new methods of treatment, as well as the opportunity to take part in clinical trials.

How to stage your esophageal cancer

The stage of esophageal cancer is determined by its size and its prevalence throughout the body. Determination of the stage is necessary for doctors to more effectively combine different methods of treatment. Despite the fact that each human body is unique, the prognosis and effectiveness of the prescribed therapy can be determined by the correctly established stage of the tumor.

The American Joint Committee for the Study of Cancer (AJCC) divides the stages of esophageal cancer according to several criteria:

• The degree of tumor invasion into the walls of the esophagus;
• Damage to the nearest lymph nodes by cancer cells;
• Spread of the tumor to distant parts of the body, other organs and systems.

The end stage of esophageal cancer is influenced by the structure of the tumor and the degree of maturity of the malignant cells. There are five stages in total:

• Stage 0. The tumor is located anywhere in the esophagus and is located in the superficial (epithelial) layer without growing into the deep layers.
• Stage 1. Cancer cells are found in the tissues under the epithelium or in the thick muscle layer. The tumor does not affect the lymph nodes or nearby organs.
• Stage 2. The tumor grows in the epithelial, subepithelial, muscle layer, and can also affect the outer layer of the esophagus – adventitia. The lymphatic system is not affected.
• Stage 3. In addition to the tissues of the esophagus, tumor cells are found in the lymph nodes, pleura, diaphragm and pericardium.
• Stage 4. Tumor cells are found in the spine, spinal cord, brain, lungs and liver.

Esophageal cancer treatment

Esophageal cancer is treated comprehensively. The choice of treatment tactics is influenced by the stage of the tumor, the general condition of the patient, the presence of concomitant diseases and previous treatment. Esophageal cancer is easier to treat early when the tumor has not spread outside the esophagus.

Surgery for esophageal cancer

Surgical removal of the tumor is used both independently and in combination with other methods. In modern medical practice, the following methods are used:

• Removal of small tumors. At stage 0 cancer, when the tumor is in the epithelial layer of the esophagus, it is possible to remove the neoplasm and excision of the surrounding tissue. This saves the esophagus and avoids injury to the stomach and the entire digestive tract.
• Removal of part of the esophagus. This operation is called esophagectomy, or Lewis surgery. The doctor removes the tumor along with part of the esophagus. The rest of the esophagus is pulled up and connected to the stomach. If during the operation it is necessary to remove a long interval of the esophagus, a part of the small intestine is transplanted in its place along with the vessels and nerves.
• Removal of part of the esophagus and stomach. The operation is performed when the tumor is located in the lower parts of the esophagus. Part of the organ and the upper third of the stomach are removed. Also, nearby lymphatic vessels and nodes are removed to avoid the spread of the tumor throughout the body.

Operations are performed by open and laparoscopic methods. In open surgery, the tumor is removed through several incisions in the neck, chest, or abdomen. The choice of surgical approach is based on the location of the tumor in the esophagus.

Laparoscopic removal is available for small tumors. The doctor performs the operation through several small punctures through which a laparoscope passes – a special device with a camera and surgical instruments.

How much does esophageal cancer surgery cost?

The cost of the operation is influenced by the complexity of the surgery, the doctor’s qualifications and the country in which the patient is being treated.

Examples of how much esophageal cancer surgery costs in foreign clinics:

• Ukraine – from $6 000;
• Turkey – from $12 000;
• Germany – from $22 300;
• Israel – from $30 000.

Conservative treatments for esophageal cancer

Chemotherapy

A medical oncologist prescribes medications that kill cancer cells by acting on the body in a complex manner. The patient takes chemotherapy drugs in the form of tablets or intravenous solutions. Chemotherapy for esophageal cancer may be given before surgery to shrink the tumor. This type of chemotherapy is called neoadjuvant chemotherapy. Adjuvant chemotherapy is carried out after surgical removal of the tumor to avoid the spread of metastases throughout the body.

The dose and combination of drugs are selected by the doctor individually for each patient. In the later stages of the disease, chemotherapy is used as an independent treatment to reduce symptoms and improve the patient’s general condition.

Radiation therapy

The tumor is exposed to high-energy rays, which consist of X-rays or protons. The radiation comes from special devices – linear accelerators. In this case, it is external radiation therapy for esophageal cancer. In some situations, a radioactive drug is placed near the tumor. This type of radiation therapy is called brachytherapy. As with chemotherapy, the dose of radiation therapy is determined individually after careful diagnosis.

Targeted therapy

This is one of the modern methods of treating cancer. Targeted drugs, unlike chemotherapy, target tumor cells. Targeted therapy for esophageal cancer has strict indications and a number of limitations. Before the appointment, special tests are performed to determine genetic mutations and drug susceptibility.

Immunotherapy

Some drugs can affect a person’s own immune system and help it recognize tumor cells. Immunotherapy for esophageal cancer is used in the later stages or in case of relapse of the disease.

Benefits of esophageal cancer treatment abroad

Modern technological equipment

Foreign clinics are equipped with new medical equipment, which makes the treatment of esophageal cancer more gentle for the patient’s body and effective in combating the disease. For radiation therapy, clinics in Turkey, Israel, Germany, Italy use the latest linear accelerators – Clinac iX, Varian TrueBeam STx, etc.

Operations are performed under the control of CT and ultrasound machines using three-dimensional reconstruction of the tumor and the surrounding vessels.

In the early stages of esophageal cancer, minimally invasive tumor removal using a Da Vinci robot is possible. This is a gentle operation with minimal damage to healthy tissue.

Teamwork of doctors

Treatment of esophageal cancer in foreign clinics is carried out under the supervision of an interdisciplinary team of doctors: surgeons, oncologists, radiotherapists, general practitioners. Every week, the doctor gathers for a consultation, where the current condition of the patient and the further treatment plan are discussed. This approach ensures that the patients are given the right treatment and that any changes in the state of the body during their stay in the clinic are paid attention to.

Quality medicines

The staff of foreign clinics carefully monitors the storage and use of drugs for the treatment of cancer. Before each chemotherapy, the patient can check the tightness and shelf life of the drug, read the documents. Some countries, such as Germany and Turkey, strictly control and prevent any counterfeits from entering pharmacies and clinics.

Current treatment protocols

In foreign hospitals, patients with cancer are treated according to the modern protocols of the World Health Organization. Treatment protocols are drawn up by leading specialists, they are tested in the course of many years of international research.

Esophageal cancer treatment in Turkey, Israel and Europe is most effective because clinics in these countries do not deviate from medical standards. Doctors of foreign oncological hospitals can complement treatment, but not exclude important stages of therapy from the schemes.

Rapid diagnosis of esophageal cancer abroad

Foreign medical centers and oncology departments are aimed at admitting a large number of patients from all over the world. Medical equipment and laboratory are available at any time of the day, including weekends. The average duration of diagnosis of esophageal cancer in a foreign clinic is 3-5 days from the moment the patient is admitted to the hospital.

The cost of treating esophageal cancer in foreign clinics

The total cost of diagnostics and treatment of esophageal cancer abroad depends on several factors:

• Previous diagnosis and treatment;
• Diagnostic procedures performed;
• Stages of esophageal cancer;
• The general condition of the patient;
• The presence of concomitant diseases;
• The country in which the patient wishes to undergo treatment;
• The clinic has international accreditations;
• The qualification level of the foreign doctor.

How much does it cost to diagnose and treat esophageal cancer in Israel, Germany and other countries

Comprehensive diagnostics:

• Turkey – from $ 2 500;
• Germany – from $3 500;
• Israel – from $ 4 500.

Immunotherapy

In clinics in Turkey, Germany, Israel and several other countries, the cost of immunotherapy drugs will be the same. The price may differ depending on the drug itself (the manufacturer and the active ingredient in the composition).

The cost of immunotherapy will average from $1 250 to $2 500.

Targeted therapy

The cost of original drugs is the same, regardless of the clinic and country. The final cost of treatment with targeted drugs in Turkey, Israel, Germany, Spain and other countries is determined by the additional services of a medical institution: accommodation, meals, care, procedures.

The price of drugs ranges from $1 200 to $3 000.

The cost of surgery for esophageal cancer abroad

Esophagectomy (removal of part of the esophagus):

• Turkey – from $12 000;
• Germany – from $22 300;
• Israel – from $30 000.

Patients can get a preliminary cost of diagnostics and treatment without having to come to a foreign clinic. Leave a request on the MedTour platform and send medical documentation. Our coordinating doctor will answer your questions and ask for the cost of treatment in a foreign clinic.

Frequently asked questions about esophageal cancer

1

How to treat esophageal cancer with folk remedies?

Self-treatment of esophageal cancer leads to life-threatening conditions. If you experience any symptoms, you should see a doctor immediately. Treatment with alternative methods often leads to tumor progression and death.

1

What should be the diet for esophageal cancer?

Often, patients with esophageal cancer complain of difficulty swallowing and chewing food. If esophageal cancer is diagnosed, only a doctor determines what can be eaten. Doctors recommend chopping food in a blender or food processor to avoid foods that are hard or hard to taste.

Also, the patient may be concerned about dry mouth. In this case, a diet with an abundance of juicy and soft foods is recommended. Gravy, mashed potatoes, and sauces are added to ordinary dishes.

During the period of receiving radiation or chemotherapy, it is recommended to consume food rich in proteins. This is due to a decrease in appetite and a decrease in the amount of food consumed.

If a patient is undergoing treatment for esophageal cancer abroad, he / she receives proper nutrition and dietitian recommendations for the future. Cancer hospitals in Turkey, Germany, Czech Republic and other countries provide comprehensive medical care for patients.

1

Where is esophageal cancer treated?

When choosing a foreign clinic, it is important to pay attention to the following factors:

• The presence of an international department;
• Own pathological laboratory;
• Treatment of esophageal cancer should only take place in the oncology department.

Most often, patients choose clinics in Turkey, Germany, Israel, South Korea and Spain for esophageal cancer treatment.

To find a clinic that will meet all the necessary criteria, leave a request on the MedTour website. The doctor coordinator will answer your questions, collect the necessary medical documentation and make an appointment for the first visit to the doctor.

Frequently Asked Questions

1

How to treat esophageal cancer with folk remedies?

Self-treatment of esophageal cancer leads to life-threatening conditions. If you experience any symptoms, you should see a doctor immediately. Treatment with alternative methods often leads to tumor progression and death.

1

What should be the diet for esophageal cancer?

Often, patients with esophageal cancer complain of difficulty swallowing and chewing food. If esophageal cancer is diagnosed, only a doctor determines what can be eaten. Doctors recommend chopping food in a blender or food processor to avoid foods that are hard or hard to taste.

Also, the patient may be concerned about dry mouth. In this case, a diet with an abundance of juicy and soft foods is recommended. Gravy, mashed potatoes, and sauces are added to ordinary dishes.

During the period of receiving radiation or chemotherapy, it is recommended to consume food rich in proteins. This is due to a decrease in appetite and a decrease in the amount of food consumed.

If a patient is undergoing treatment for esophageal cancer abroad, he / she receives proper nutrition and dietitian recommendations for the future. Cancer hospitals in Turkey, Germany, Czech Republic and other countries provide comprehensive medical care for patients.

1

Where is esophageal cancer treated?

When choosing a foreign clinic, it is important to pay attention to the following factors:

• The presence of an international department;
• Own pathological laboratory;
• Treatment of esophageal cancer should only take place in the oncology department.

Most often, patients choose clinics in Turkey, Germany, Israel, South Korea and Spain for esophageal cancer treatment.

Published: 21.09.2021

Updated: 01.10.2021

Medical author:

Ilona Baidiuk

Medical expert:

PhD. Olexandr Voznyak

Information on this webpage verified by the medical expert

Medical Doctor, oncologist, PHD student

Kateryna Maliarchuk