Esophageal cancer: first symptoms, early stage signs, treatment, survival

One day hospital 3rd KO

Dadyev

Islam Arturovich

11 years of experience

Oncologist (OMC), surgical oncologist, candidate of medical sciences, member of the Russian Association of Oncologists, member of the Russian society of chemotherapists RUSSCO

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Esophageal cancer is a malignant pathology that involves the degeneration of cells in the mucous membrane of the esophagus and the subsequent formation of a tumor. Increasing in size, the neoplasm partially or completely blocks the lumen of the esophagus, grows through its wall and spreads to nearby organs. Without treatment, death is inevitable. The disease affects men four times more often than women. The main risk group is elderly people: the average age of male patients is 64 years, female patients – 70 years.

General information

A malignant tumor of the esophagus, emanating from its mucosa, is a highly malignant disease (has a high aggressiveness index), which is difficult to treat.
Esophageal cancer is one of the most aggressive tumors. Recently, survival rates have improved, but still the prognosis remains worse than for other cancers - only 20% survive five years. The tumor process affects any part of the esophagus: cervical, thoracic or abdominal. Treatment results are the most disappointing when the tumor is localized in the cervical region. Tumors of the esophagus are histologically squamous (more often) and glandular, which is important, since there are treatment features depending on the cellular composition of the tumor. Esophageal cancer is more common in older people and three times more common in men. Most patients (up to 65-70%) already have stage III-IV disease at the time of treatment and a cure is impossible for them (they are offered palliative care). Moreover, most of these patients are elderly people with severe concomitant diseases, which sharply limits treatment options. The ICD-10 code for this pathology is C15.

Statistics

This is one of the most aggressive malignant diseases. Esophageal cancer is the 8th leading cause of death worldwide. According to the International Agency for Research on Cancer, in 2018 the incidence was 7.49 cases per 100,000 people per year, and the mortality rate was 6.62. Calculations by Rosstat of the Russian Ministry of Health say that the incidence is 5.6 cases per 100,000 people. Among men – 9.43 per 100,000, among women – 2.29 per 100,000. The disease is most often diagnosed in the so-called “Asian belt”, that is, from the northern part of Iran, through Central Asia and to the central regions of Japan and China, also capturing Siberia. This is largely due to the peculiarities of the diet of people living in these areas.

Most often (up to 80% of cases), the neoplasm is located in the lower and middle thoracic sections of the esophagus. With a frequency of 10-15% of cases, cancer of the cervical esophagus is diagnosed.

Pathogenesis

Carcinogenesis is a multistage process that occurs under the influence of lifestyle, environmental factors, genetic, immunological and hormonal factors. The transition from one stage of carcinogenesis to another (subsequent or previous) also occurs as a result of the influence of exogenous and endogenous factors, which can both promote and counteract this process. The formation of carcinogen-DNA and carcinogen-protein under the influence of these factors causes local mutations and damage in genes. This in turn activates oncogenes and suppresses suppressor genes.

In esophageal cancer, mutations (DNA damage) occur that are associated with carcinogenic substances in tobacco smoke. In addition, chemical and thermal effects on the mucosa cause an inflammatory process in the mucosa (esophagitis) and dysplasia . With continued exposure to negative factors, cellular changes increase and malignant tissue degeneration occurs. Thus, the neoplasm occurs against the background of prolonged inflammation of the esophagus ( esophagitis , Barrett's esophagus ), which are considered as precancerous conditions. It is assumed that malignant formation of the esophagus is associated with changes in the p53 gene, which leads to the synthesis of an abnormal protein that is unable to protect the mucosa.

Classification

There are two types of esophageal cancer.

The most common types of tumors are:

Squamous cell carcinoma . It develops from mucosal epithelial cells, affects the upper and middle third of the esophagus, and is amenable to radiation treatment.
Adenocarcinoma . It comes from the glands of the esophagus, as well as from the altered mucosa, where intestinal metaplasia against the background of gastroesophageal disease (reflux of gastric contents into the esophagus), called Barrett's esophagus . This type of tumor is located in the lower part of the esophagus.

Other types of cancer ( small cell , adenoacanthoma , carcinosarcoma ) are rare.

Squamous cell carcinoma of the esophagus (or squamous cell carcinoma) is more common in people who drink alcohol, smoke, or have had an alkali burn to the esophagus.

The degree of tumor differentiation (G) is important in the prognosis of the disease:

G1 is a highly differentiated tumor, there are signs of keratinization of tumor cells, signs of atypia are minimal, and mitotic activity (the ability to divide and grow) is low. Therefore, such highly differentiated tumors grow slowly.
G2 - moderately differentiated, having an average degree of growth and malignancy.
G3 is a poorly differentiated squamous cell nonkeratinizing carcinoma characterized by aggressiveness and rapid progression.

Like all tumors, esophageal cancer is classified according to TNM criteria

T1-2 - early stages of the tumor, when it spreads deep into the mucosa and affects the muscle layer.
T3 - the tumor grows into the outer connective tissue membrane.
T4 - adjacent organs of the pleura, pericardium, veins, diaphragm, vertebral bodies, trachea are affected.
N0 there are no metastases to regional lymph nodes.
N1 affects 1-2 lymph nodes.
N2 affects 3 to 6 lymph nodes;
N3 more than 7 nodes are affected.

Distant metastases are designated by the letter M.

Risk factors

The main risk factors for the occurrence and development of such a disease:

male gender, because men are more often susceptible to bad habits - smoking and drinking alcohol in large quantities;
age - the older it is, the higher the risk; only 15% of patients were under 55 years old;
excess body weight;
smoking and alcohol abuse;
drinking very hot drinks and food;
Barrett's esophagus (when cellular degeneration occurs in the lower part of the esophagus caused by chronic acid damage);
reflux;
achalasia (when the obturator function of the opening between the stomach and esophagus is impaired);
scars in the esophagus, leading to its narrowing;
Plummer-Vinson syndrome (this syndrome is characterized by a triad, that is, three types of disorders simultaneously: impaired swallowing function, narrowed esophagus, iron deficiency anemia);
contact with chemicals.

Approximately 1/3 of patients are diagnosed with HPV (human papillomavirus).

The risk of getting this type of cancer can be reduced by eating a varied diet, not drinking strong alcohol, and if you have Barrett's syndrome, monitoring changes in the mucous membrane.

There is no screening for this disease. However, if there is an increased risk of esophageal cancer, it is recommended to undergo an endoscopic examination, if necessary, with a biopsy of the suspicious area.

Causes

The main causes of esophageal tumors are:

Dietary features - consumption of hot dishes, drinks, roughage has a chemical and mechanical effect. A diet rich in spicy, fried foods, containing nitrates and molds in foods, irritates the mucous membrane and causes epithelial dysplasia . Deficiency of vitamins A , B , vegetables and fruits, zinc and selenium has a negative effect.
Alcohol abuse.
Smoking. It is considered a direct cause of cancer of the pharynx, mouth, larynx, esophagus and lung. Smoking is a factor whose carcinogenicity has been proven, since tobacco smoke contains dozens of carcinogenic substances. Smoking and drinking alcohol are independent causes and risk factors, but when combined with others they increase the risk of the disease.
Mutations of the p53 gene.
Gastroesophageal reflux disease , which is considered a major risk factor for adenocarcinoma . Excess weight, stomach diseases, hiatal hernia, dysfunction of the esophageal sphincters - all this causes reflux (reflux of gastric contents into the esophagus), chronic inflammation, epithelial dysplasia and aplasia (the appearance of malignant cells).

Symptoms of esophageal cancer

The disease does not manifest itself for a long time and the general condition does not suffer. The first symptoms of esophageal cancer are dysphagia (difficulty swallowing), chest discomfort and a feeling of a foreign body in the esophagus appear at an early stage. But first of all, the patient pays attention to the fact that it is difficult for him to swallow solid food. He chews his food thoroughly and constantly drinks it with water or prefers to eat liquid pureed food or mushy porridge. Dysphagia indicates that 50% of the lumen of the food tube is filled with tumor. The second relatively early symptom is burning and discomfort behind the sternum, extending to the back or neck, belching and heartburn .

Many do not pay attention to the first signs, and those patients who consult a doctor are prescribed treatment for gastroesophageal reflux. Another part of patients suffering from alcoholism do not pay attention to changes in their health at all. Thus, the period from the appearance of the first signs to the moment of examination can be 3-5 months. At the same time, the tumor of the esophagus increases, and as it grows, it becomes more and more difficult to swallow food, including liquid food. In advanced cases, the tumor completely closes the lumen, so the patient cannot swallow saliva.

In the advanced stage, pay attention to the following signs:

constant pain in the chest;
weight loss;
hoarseness, cough (if the tumor grows into the trachea and larynx);
vomit;
vomiting of blood or “coffee grounds” (when disintegrating or spreading to blood vessels).

Clinical picture

There are physiological narrowings in the esophagus, where malignant growth primarily begins. These narrowings are caused by passing near other anatomical formations - the aorta and the forks of the trachea into the bronchi; at the junction of the pharynx into the esophagus and the esophagus into the stomach there is also a slight narrowing. It is believed that the mucous membrane here is more susceptible to minor injuries from rough food, which means inflammation occurs more often. However, in the cervical region the incidence of cancer is 10%, in the lower third of the esophagus - 30%, and 60% of cancers are formed in the middle segment.

Malignant cells not only grow into the thickness of the organ, as happens with most cancers, they also migrate through small lymphatic vessels. The vessels form a complete lymphatic network inside the esophageal wall, spreading the tumor inside, so the length of the tumor can be 5, 10, or 15 centimeters.

In the advanced stage, localization determines the symptoms, and the first signs are considered to be the feeling of food sticking to the same place or scratching the mucous membrane with a piece of food. As it progresses, it becomes difficult to pass first solid pieces, then porridge, then liquid. All this is called dysphagia. First, the patient washes down pieces of food with water, pushing them through, but after that this no longer helps, nutrition is disrupted, and the person loses weight. Contact of the tumor with food leads to inflammation, an unpleasant putrefactive odor appears, and with regular trauma, the loose mucous membrane of the tumor begins to bleed, and life-threatening bleeding can develop.

Pain occurs as the esophagus contracts with peristaltic waves, the pain is spastic in nature. The growth of the tumor through the entire thickness of the esophageal wall makes the pain constant; it is localized between the shoulder blades. Infiltration of the mediastinal tissue by the tumor involves the recurrent nerve, which is responsible for the movement of the vocal cords, in the process, hoarseness and choking when drinking appear. The nerve can be compressed by lymph nodes enlarged by metastases and the sonority of the voice will disappear.

As with achalasia, a tumor forms an expansion above the narrowing of the esophagus, where food accumulates. Nighttime reflux of accumulated food masses into the windpipe can also lead to pneumonia. And during the day I am worried about severe weakness and fever. If the respiratory tract is involved in the process, an anastomosis may form between the esophagus and the trachea or large bronchi - a fistula, through which food crumbs will enter the breathing tube, causing coughing and pneumonia. If such a fistula opens from the esophagus into the mediastinum, its inflammation will lead to death.

Get a treatment program

Tests and diagnostics

The most informative method is EGDS (esophagogastroscopy). This study makes it possible to see the tumor, determine its location, size, and evaluate complications (perforation, bleeding). In addition, during the study, material is collected for research. To do this, perform 3 to 5 biopsies using endoscopic forceps.
Endosonography (endoscopic ultrasound). This study provides information about the depth of tumor invasion into the esophagus (“T” according to the classification). The study is performed using echoendoscopes, which have a built-in optical device and an ultrasound sensor. This test also includes a biopsy.
X-ray of the esophagus. Determines the extent of the process and allows you to evaluate the passage of the contrast agent through the narrowed part of the esophagus.
Computed tomography of the OGK with contrast. This examination is necessary to evaluate the lymph nodes and identify distant metastases.
CT scan of the abdomen.
Ultrasound of the abdominal cavity.
Videothoracoscopy and videolaparoscopy. Examination of the chest and abdominal cavity. This allows you to more accurately examine the lymph nodes and the presence of distant metastases in the chest and abdominal cavity. The sensitivity of these methods is higher than CT. Ultrasound and CT do not establish the dissemination of the tumor process throughout the peritoneum. Videothoracoscopy is more effective than CT to determine tumor resectability.
Bronchoscopy. Inspection of the bronchial trachea and bronchi to exclude tumor growth into neighboring organs.
Necessary laboratory tests.

Investigations for suspected disease

Cancer can be detected using endoscopic or x-ray methods. To definitively verify the diagnosis, it is necessary to examine a tumor sample under a microscope.

Types of diagnostics.

X-ray examination of the esophagus. The esophagus is not visible on a standard x-ray, because its image merges with the surrounding organs. Therefore, examination of the esophagus is carried out using X-ray contrast agents that do not transmit X-ray rays. The most popular drug is a barium suspension, which, when passing through the esophagus, follows its contours and the contours of the stomach. Filling defects can be seen in the picture.
Esophagogastroduodenoscopy. During the procedure, the esophagus, stomach and duodenum are examined. An endoscope allows you to evaluate the internal surface of organs. This diagnostic method allows you to take a biopsy sample for examination under a microscope. The main advantage of the method is early diagnosis of the disease in the absence of obvious signs.
Biopsy studies. During EGD, the doctor may take material for histological examination. Next, the pathologist will determine the changes in the tissue of the esophagus that preceded the tumor, the presence or absence of tumor cells and the type of cancer.
Optical endoscopic coherent tomography. A new research technique using an endoscope, which has an optical sensor and emitter. The method makes it possible to examine the structure of tissues to a depth of 2 mm; the information is sent to a computer using an infrared laser beam. The method is similar to ultrasound, but uses a light wave. If it is possible to conduct this study, then the need for a biopsy disappears.
Determination of the presence of tumor markers in the blood. Tumor cells release specific substances called markers. Esophageal cancer is diagnosed using several markers: TRA, CYFRA 21-1, SCC. But it should be borne in mind that their presence is observed in less than half of patients with esophageal cancer. A significant increase in the number of markers is observed in the later stages of the disease, so the method is not suitable for early diagnosis of the tumor.
CT scan. A method for detecting a tumor, metastases, determining the boundaries of spread and the size of the lesion. Based on X-rays. During the examination, the doctor receives images from different positions of the area of the body being examined. The technique allows you to detect pathology with a diameter of 1 mm.
Ultrasound. The method involves the use of high-frequency sound waves; the sensor receives feedback signals from organs and transmits information to the computer. The intensity of reflection of the waves is different, in accordance with this, the computer creates an image of the organ under study. To examine the esophagus, a sensor is used that is inserted into the cavity of the organ. In this way, it is possible to assess the size of the tumor and the presence of lymph nodes affected by metastases.
Bronchoscopy. The method is used to assess the condition of the trachea and larynx, vocal cords, and bronchial tree.
Positron emission tomography. For the study, it is necessary to first inject the patient with radioactive glucose, which selectively accumulates in malignant cells. A special scanner rotates around the patient, taking several pictures in which all malignant tumors ranging in size from 5-10 mm can be identified.

People at risk (with reflux esophagitis, frequent heartburn) need to undergo regular preventive examinations with a gastroenterologist and perform esophagoduodenogastroscopy (the gold standard in diagnosing esophageal cancer). Make an appointment and esophagogastroscopy at Medical by calling 8 (49244) 9-32-49

Diet

Diet for esophageal cancer

Efficacy: no data
Terms: 6 months/lifetime
Cost of food: 3200-4500 rubles per week

The diet before surgery should be high-calorie with a high protein content (1.5-2.0 g per kg of weight) to prevent protein-calorie deficiency. The diet includes high-calorie foods: butter, salmon, trout, herring, caviar, cream, sour cream, honey, meat and liver pates, chocolate, eggs, porridge with butter, and various vegetable oils. If the patient has a swallowing disorder, then the food should be ground to a pulp or puree. If necessary, you can drink liquid. Meals are split and in small portions, dishes should be warm.

After surgery or if the patient is severely malnourished, enteral nutritional support is recommended. Special therapeutic nutritional mixtures with a high protein and calorie content are used. A patient by sipping (drinking in small sips or through a straw) can drink 2-3 servings a day of Nutridrink , Nutridrink Compact Protein , Peptamen , Fortiker , Nutrizon Energy . Nutrient mixtures can be the patient’s main diet or as an additive to the main diet.

Once the patient has fully recovered from surgery, chemotherapy or radiation therapy, he can switch to his usual diet. With good tolerance, it is important to include vegetables, herbs and fruits in your diet, if not raw, then poached. They contain active substances that inhibit the development of tumors: beta-carotene , selenium , vitamins C , E , vitamin A , quercetin , folic acid , phytoestrogens (isoflavinols), flavonoids .

Rehabilitation

In the first few days after surgery, the patient is usually prescribed intravenous nutrition, or nutritional mixtures are introduced into the stomach through a thin tube. Routine pain relief is performed to facilitate the recovery process. An important element of clinical recommendations after esophageal cancer is therapeutic and breathing exercises, which are first performed in bed, and then in a sitting and upright position. A bed with a raised headboard prevents the development of reflux. As the patient recovers, he is allowed to eat normally while following a special diet.

Prevention

To prevent the disease, it is recommended:

Quitting drinking alcohol and smoking. It is known that 90% of esophageal cancer is associated with these factors. Synergism (increased action) of the carcinogenic effect of smoking and alcohol consumption was also noted.
A diet excluding damaging thermal and mechanical effects on the mucous membrane. A balanced diet with sufficient amounts of antioxidants - vitamins A, C, E, selenium, beta-carotene, quercetin. Recent studies have shown that zinc slows down the growth and division of cancer cells, so you need to include foods containing it in your diet. The daily intake of zinc for men should be 11 mg, and for women 8 mg.
Identification and treatment of pre-tumor and background pathologies. These include Barrett's esophagus , chronic esophagitis , gastroesophageal disease , achalasia cardia (lack of relaxation of the lower esophageal sphincter), esophageal stricture , hiatal hernia . Esophageal adenocarcinoma is known to be a complication of Barrett's esophagus found in individuals with reflux, so those suffering from heartburn or belching should undergo regular endoscopic examination of the esophagus and stomach. Endoscopic examination and biopsy will help to identify epithelial metaplasia in the early stages and take appropriate measures (endoscopic radiofrequency ablation of the altered area of the mucosa is performed). Patients with esophageal reflux, in addition to treatment, must constantly follow a diet.

Stages

Oncologists distinguish the following stages of esophageal cancer.

Zero. The neoplasm is located on the surface of the epithelial layer, without even growing deep into the epithelium, and is a cancer “in situ”, i.e. "on the spot." It can only be detected by chance during an endoscopic examination of the esophagus from the inside.
First. Malignant cells spread to the entire epithelium, but do not yet affect muscle tissue. The lymph nodes are not affected, there are no metastases.
Second. The tumor either grows through the entire wall of the esophagus, including muscle and connective tissue, but without affecting the lymph nodes, or spreads only to the muscle layer and metastasizes to several nearby lymph nodes.
Third. The size of the tumor creates obstacles to swallowing. Malignant cells affect nearby organs and regional lymph nodes.
Fourth. Regardless of the size of the tumor and the degree of its spread to neighboring tissues, metastases of esophageal cancer are detected in distant organs - liver, lungs, bone structures.

Forecast

In general, patients with adenocarcinoma have a better prognosis than those with squamous cell carcinoma . The disappointing prognosis of the disease is explained by the aggressive course and early dissemination of the tumor. The reasons for the poor prognosis are the difficulties of detection in the early stages, which is associated with a hidden course. Therefore, in 70% of patients the disease is diagnosed at grades 3 and 4. 83% have metastases , and half of these patients die within one year.

How long do people live with esophageal cancer? Five-year survival in the localized form (without metastases) is observed in 37% of patients. In the presence of metastases to regional lymph nodes, it is reduced by half. How long do patients live with distant metastases? In such cases, radical treatment is not carried out and the prognosis is unfavorable - life expectancy is no more than 5-8 months. Symptoms before death include various complaints associated with tumor growth into nearby organs. From the respiratory system - constant cough, breathing problems, pneumonia, which is associated with the formation of esophageal-tracheal fistulas. A late symptom is hoarseness, which indicates involvement of the laryngeal nerve in the process. The disintegration of the tumor is accompanied by chronic bleeding, which causes hypochromic anemia . If the tumor spreads to the great vessels, profuse bleeding may develop before death, which also leads to death.

Treatment

The main method of treatment is surgery, but an integrated approach can improve results. Therefore, various techniques are combined.

Surgery

During the operation, the esophagus is removed entirely or part of it, it all depends on the extent and localization of the pathological process.

When the tumor is in the cervical region, most of the esophagus is removed. After this, the stomach is lifted and sutured to the remaining part of the esophagus. In addition, instead of the removed part through plastic surgery, part of the large or small intestine can be used. If it is possible to perform resection of the cervical esophagus, intestinal plastic surgery with microvascular anastomosis of vessels in the neck can be performed.

When the tumor is localized in the cervical esophagus with a large spread, it is necessary to perform an operation in the amount of: removal of pharyngolaryngoectomy with simultaneous plasty of the esophagus with a gastric graft, suturing it to the root of the tongue.

Surgical intervention to remove part of the esophagus with subsequent replacement with a graft can be performed openly or by thoracoscopy and laparoscopy.

With any type of intervention, regional lymph nodes are removed, which are then examined in the laboratory using histology. If cancer cells are found in them, then after surgery the patient is prescribed radiation treatment or chemotherapy in combination with RT.

There are also palliative surgeries. They are carried out so that the patient can eat if, due to the tumor, he cannot swallow. This type of intervention is called a gastrostomy, that is, the insertion of a special feeding tube through the anterior abdominal wall into the stomach.

Radiation therapy

Ionizing radiation is used to destroy tumor cells. This therapy can be carried out:

Those patients who cannot undergo surgery for health reasons. In this case, radiation, usually along with chemotherapy, is the main treatment modality.
When the tumor is localized in the cervical esophagus, chemoradiotherapy is the first stage of the combined treatment method.
Before surgery along with chemotherapy. This is to shrink the tumor so it can be removed better (called neoadjuvant therapy).
After surgery along with chemotherapy. In this way, residual tumor that could not be seen during surgery is treated (called “adjuvant therapy”).
To relieve symptoms of advanced esophageal cancer. Allows you to reduce the intensity of pain, eliminate bleeding and difficulties with swallowing. In this case, it is palliative therapy.

Types of radiation treatment:

External (remote). The source of ionizing radiation is located at a distance from the patient.
Contact (called “brachytherapy”). The radiation source is placed endoscopically as close as possible to the tumor. Ionizing rays travel a short distance, so they reach the tumor, but have little effect on nearby tissue. Treatment can reduce the tumor and restore patency.

Dose distribution obtained with external beam conformal radiotherapy and intraluminal brachytherapy

Chemotherapy

This technique involves the introduction into the body of drugs that inhibit the vital activity of tumor cells or destroy them. Medicines are taken orally or injected into a vein, after which they enter the bloodstream and reach almost every area of the body.

Chemotherapy is given in cycles. This is due to the fact that the effect of the drug is aimed at those cells that are constantly dividing. The administration is repeated after a certain number of days, which is associated with the cell cycle. Chemotherapy cycles typically last 2-4 weeks, and patients are usually given multiple cycles.

Like radiation, chemotherapy is indicated in the adjuvant and neoadvant regimens. It is also used to relieve symptoms for those patients whose cancer is widespread and cannot be treated surgically.

Some drugs:

"Cisplatin" and "5-fluorouracil" ("5-FU");
"Paclitaxel" and "Carboplatin";
"Cisplatin" together with "Capecitabine";
ECF regimen: Epirubicin, Cisplatin and 5-FU;
DCF regimen: Docetaxel, Cisplatin and 5-FU;
"Oxaliplatin" together with either "Capecitabine" or "5-FU";
"Irinotecan".

Targeted therapy

It is aimed at blocking the growth of a tumor by influencing certain targets, that is, those molecules that determine the division and growth of the tumor. If such protein molecules are found in biomaterial taken by biopsy, then targeted therapy may be effective.

Palliative methods

When carrying out palliative therapy, the following methods are used:

Bougienage, that is, expansion of the esophagus.
Installation of stents using the endoscopic method. Stents are hollow cylinders that are placed into the esophagus to allow food to pass through.

Stenting for esophageal cancer

Laser photocoagulation (the neoplasm is destroyed with a laser).
Photodynamic effect. The patient is injected with a photosensitizer, which accumulates in tumor cells. Then, under the influence of a laser beam with a specific wavelength, these cells die.
Chemotherapy and radiation. They can be used to reduce the size of the tumor and restore patency.

List of sources

Kirkilevsky S.I. Esophageal cancer: current state of the problem/Oncology. Hematology. Chemotherapy. - 2015. - No. 2/1.
Clinical recommendations Cancer of the esophagus and cardia. All-Russian National Union "Association of Oncologists of Russia" 2020, 62 p.
Davydov M.I., Ter-Ovanesov M.D., Stilidi I.S. and others. Barrett's esophagus: from theoretical foundations to practical recommendations. Practical oncology. − 2003. − T. 4. − No. 2. − P. 109–119.
Khalikova E.Yu. Individualization of parenteral nutrition in surgical oncological practice/Difficult patient. 2014. - No. 6. - With. 15-19.
Mamontov AS. Combined treatment of esophageal cancer / Practical Oncology 2003; 4 (2): 76–82.

Symptoms

As in other types of oncology, the initial stages of the disease are usually asymptomatic. The disease reveals itself with symptomatic manifestations in the active phases.

Among the symptomatic manifestations of esophageal cancer:

There are difficulties when swallowing food;
Choking while eating;
Heartburn;
Burning and squeezing in the chest;
Hoarseness and cough;
Significant weight loss;
Fatigue;
Pain.

Finding these symptoms is a good reason to see a doctor.