▶ Alcohol and cigarettes are the main causes of esophageal cancer in Korea… 4 times the incidence
▶ Even hot coffee, tea, soup, etc. increase the incidence by 3 times.
▶5-year survival rate is only 40%, 95% cure if detected early
The esophagus, the passage through which food passes, is a thin tube that extends from the mouth to the stomach. If the mucous layer within the esophagus continues to be stimulated, the epithelial cells can become cancerous, resulting in esophageal cancer.
Esophageal cancer does not occur very often and accounts for 1.1% of all cancers (the 15th most common cancer), but its prognosis (course of treatment) is not good, with a 5-year relative survival rate by 40.9%.
Furthermore, 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 in place of the esophagus. Esophageal cancer occurs most often in men between 60 and 70 years old.
Esophageal cancer is divided into cervical esophageal cancer, thoracic esophageal cancer and stomach-esophageal junction cancer depending on where it occurs. Depending on the cell type, it is classified into squamous cell carcinoma, adenocarcinoma, sarcoma, lymphoma and melanoma. Squamous cell carcinoma, derived from epidermal keratinocytes, occurs mainly 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 also 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 2.28 times when drinking coffee, tea or hot broth above 65 degrees. Additionally, consuming salty foods or processed meats can also be a cause.
To detect esophageal cancer early, if you have a family history of esophageal cancer or if you smoke or drink alcohol, you should have an endoscopy every year.
Symptoms of esophageal cancer include: As the cancer worsens, the esophagus narrows, making it difficult to eat, and the amount of food consumed decreases, leading to severe weight loss and malnutrition. If the cancer nearly blocks the lumen of the esophagus, swallowed food may travel back into the mouth. Food that leaves the mouth can enter the airways and cause cough or aspiration pneumonia.
If the cancer invades the recurrent laryngeal nerve that controls the vocal cords, the vocal cords will be paralyzed, causing hoarseness. If the cancer invades the spine just 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 reached a significant stage. Unlike other gastrointestinal tracts, the esophagus does not have a serous layer, has abundant development of surrounding lymph nodes, and is adjacent to the major organs of the chest, so there is a high risk that the disease has already progressed to a significant stage when symptoms to appear.
Shim Young-mok, professor of lung and esophageal surgery at Samsung Seoul Hospital and a pioneer of esophageal cancer surgery in Korea, said: “Early esophageal cancer limited to the mucous layer can be treated relatively easily with ‘therapeutic endoscopic procedures ‘ that do not resect. However, if the lesion is deeper than the mucous layer, “surgery must be performed first and most of the esophagus must be removed,” he said. Metastases to nearby lymph nodes are common, and if have not metastasized to other organs, chemotherapy and radiotherapy are considered along with surgery, but this is not easy.
In addition, when surgical resection is performed, which is the basis of the treatment of esophageal cancer, the esophagus practically disappears, so it is necessary to create a new esophagus from the stomach or large intestine. Since incisions are made in the chest, abdomen and, if necessary, in the neck (neck) area, the surgery time is long and recovery after surgery is not easy.
For esophageal cancer resectable by surgery, minimally invasive surgery using thoracoscopy has recently been widely performed. However, if a worsening of the quality of life is expected after surgery, if other concomitant diseases are present, or if the cancer cannot be removed by surgery, radiotherapy and chemotherapy are performed.
Cho Jae-il, professor of lung and esophageal surgery at Samsung Seoul Hospital, said: “The results of treatment for esophageal cancer have not been good for a while, but with early diagnosis and improvements in surgery, chemotherapy and radiotherapy, treatment outcomes have improved significantly recently.” He added: “Now we can manage the patient’s quality of life after surgery.” “This is also important,” he said.
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