Carcinoma of the oesophagus (the food pipe) is more common in men as compared to women. It usually occurs after 45 years of age. The incidence is higher in China, Japan and Russia. The oesophageal carcinoma arising from upper two third portion of the oesophagus is usually a squamous cell carcinoma while that arising from lower one third of the oesophagus is an adenocarcinoma. There has been a constant rise in the incidence of adenocarcinoma of the oesophagus in recent years. Alcohol and tobacco are considered as the most common causes of oesophageal carcinoma. It has been observed that more a person smokes, greater is the risk of oesophageal carcinoma. Studies have shown that there is 30 times higher risk of the oesophageal carcinoma in those persons, who have the habit of smoking as well as drinking as compared to the teetotallers. Certain nutritional factors such as deficiency of vitamin A, vitamin C, riboflavin and iron may cause oesophageal carcinoma.
Risk factors of oesophageal carcinoma include:
Progressive dysphagia, weight loss and regurgitation (oesophageal pseudo-vomiting) are the most common symptoms of oesophageal carcinoma. Sometimes, there is a sensation of pressure or burning in the throat. There may be a pain in chest or back due to the spread of the tumour into the mediastinum. Involvement of recurrent laryngeal nerve may lead to hoarseness of the voice. Direct spread of the tumour into the tracheobronchial tree may form tracheo-oesophageal fistula, which is characterised by the initiation of cough on swallowing. The tracheo-oesophageal fistula may lead to choking and pneumonia. Carcinoma of the oesophagus usually metastasises to the supraclavicular lymph nodes, cervical lymph nodes and the liver.
Staging of oesophageal carcinoma is done as follows:
Procedures used in diagnosis and evaluation of the oesophageal carcinoma include barium swallow study, CT scan, endoscopy (oesophagoscopy) and biopsy.
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