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Esophageal Cancer: Risk Factors, Symptoms, Diagnosis & Treatment

Esophageal Cancer Risk Factors

Smoking, alcohol intake, obesity and GERD are common esophageal cancer risk factor. Smoking and alcohol cause squamous cell carcinoma. Obesity and acid reflux are risk factors for adenocarcinoma. Healthy life style can prevent esophagus carcinoma

  • Esophageal Cancer Symptoms

Esophageal CancerThe most common symptom is dysphagia. Initially it is for solid food and gradually to liquid also. Patient can have chest pain/regurgitation. Anorexia and weight loss are common. Advance carcinoma patients can have bony pain, abdomen distension due to ascites, respiratory distress due to pulmonary effusion

  • Esophageal Cancer Diagnosis

Upper GI Endoscopy is done by gastroenterologist and is the investigation of choice. It will show growth or stricture in the esophagus. Biopsy will confirm the diagnosis. Most common type of esophagus carcinoma is adenocarcinoma located in the lower third of esophagus. Squamous cell carcinoma is other type and mainly found in the upper and middle third of esophagus

  • Investigations

CECT Chest and upper abdomen is done.CECT will show the growth in the esophagus, its relation with surrounding structures, any associated lymph nodes, and metastases. It helps in planning of Esophagus Carcinoma  Treatment

  • Treatment

The recommended first line Esophagus Cancer Treatment is surgery if cancer is resectable. For locally advance tumor pre-operative chemotherapy is given.If patient respond to chemotherapy and tumor become resectable surgery is done. For metastatic disease endoscopic esophageal stent is placed for relief of dysphagia. If endoscopic stenting is not possible feeding jejunostomy is done surgically for nutrition

Consult Dr Amit Jain MS MCh (GI Surgery) Senior Consultant Max Hospital Patparganj Delhi and Vaishali Ghaziabad for Esophagus Surgery. Dr Amit is Best Oncosurgeon in Delhi Noida Ghaziabad India. He is Fellow in Advance Laparoscopy Upper GI Surgery.To know recent advance in management of esophagus cancer visit our facebook page Dr Amit Jain Laparoscopic Gastrointestinal and Bariatric Surgeon

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GERD (Gastroesophageal Reflux Disease)

  • What is GERD (Gastroesophageal reflux disease)

GERD

(GERD) Gastroesophageal reflux disease as the name indicates is the reflux of stomach contents back into the esophagus. Generally what happens, when we ingest food it passes through the esophagus, there is a valve at the lower end of esophagus which relax or opens and food enter into the stomach and after that valve gets closed. When this valve is not competent enough stomach contents reflux back

  • GERD Causes

  • Improper function of lower esophageal sphincter muscle as described above is the reason for gastroesophageal reflux
  • Symptoms of GERD

  • Heartburn (Burning sensation in chest, usually after eating, worsened at night)
    Regurgitation of food contents
    Difficulty swallowing
    Chronic cough/ New or worsening asthma
  • Risk Factors

  • Obesity
    Hiatus Hernia
    Delayed stomach emptying
    Pregnancy
    Smoking
    Alcohol/ Coffee
    Eating large meal
  • Complications
  • Esophagus ulcer is the first finding on endoscopy in simple reflux disease. Long standing reflux can cause Barretts esophagus which is a premaligant condition which predispose to esophagus cancer. Continuous reflux can cause benign esophageal stricture
  • Diagnosis
    Esophageal pH monitoring is the gold standard test to confirm the prsence of reflux
    Upper GI Endoscopy
    Esophageal Manometry
  • Treatment
    First step in acid reflux treatment is life-style modification
    Medical treatment include proton pump inhibitors which decrease the amount of acid produced by the stomach. these includes pantocid, rabeprazole. Another group of medicines which are beneficial include H2 blockers, Antacids, Prokinetics
    Surgical management: Surgery is indicated if above methods fail, and lower esophageal sphincter muscle is weak, associated hiatus hernia. In these cases Niissen fundoplication is done
  • GERD Diet
  • There is no special diet for GERD. Small frequent meal. Certain foods which trigger GERD symptoms should be avoided. These foods include coffee, alcohol, spicy foods, chocolate, peppermint
  • Prevention
  • Stop alcohol & Smoking
    Take small amount of meal at one time
    Donot lie immediately after eating
    Loose weight
    Stop eating 2 to 3 hours before sleeping
  • Consult Dr Amit Jain Best Gastroenterologist in Noida for reflux disease
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Gastrointestinal Cancer: An Overview

Gastrointestinal CancerThe incidence of gastrointestinal cancer is increasing. Reason being change in lifestyle, dietary habits, increased alcohol intake and smoking.The prognosis of gastrointestinal cancer patients is good if it is detected early and treated at early stage.Anorexia and weight loss are common symptom in cancer patients, along these symptoms with some GI symptoms if present should not be ignored and doctor should be consulted. There are various screening programmes for early detection of colo-rectal and liver cancer. These programmes are done for high risk patients. Screening Colonoscopy is done for patients with inflammatory bowel disease, family history of colo-rectal cancer diagnosed at early age. Regular ultrasound is done in chronic liver disease patients. Neo-adjuvant therapy for locally advance cancer of esophagus, rectum and pancreas has shown good result. Pre-operative biliary drainage is done in patients with high bilirubin who require liver resection

  • Upper Gastrointestinal Cancer

It include cancer of the esophagus, stomach, duodenum and small intestine.Dysphagia, Vomitting,melena are common symptom. Upper GI Endoscopy is helpful for diagnosis. CECT chest and abdomen for staging.

  • Lower Gastrointestinal Cancer

Cancer of the colon and rectum are lower gastrointestinal cancer. Most common symaptoms are altered bowel habits, blood in stool. Diagnosis is made by Colonoscopy. CECT abdomen for staging.MRI is done for cancer rectum There is role of Neoadjuvant therapy in locally advance rectal cancer.Surgery is the treatment of choice if cancer is resectable

  • Hepato-Biliary GI Cancer

It include cancer of the liver, gallbladder, bile duct and pancreas. Patient have symptom of right sided pain abdomen with jaundice. CECT abdomen along with MRCP is helpful to delineate biliary anatomy

  • Symptoms of GI Cancer

Vomitting

It occur when there is obstruction in the gastrointestinal tract. Obstruction distal to the bile duct opening causes billious vomitting. Obstruction proximal to it causes non-billious vomitting.Primary stomach cancer or small bowel cancer casues vomitting due to intrinsic mass which compromise the lumen. Gallbladder mass can cause external compression over the duodenum and antro-pyloric region resulting in gastric outlet obstruction

Dysphagia

Early and Common symptom of esophagus cancer. In patients with esophagus cancer patients have initial dysphagia to solid foods and gradually progress to liquid. This progressive dysphagia is indicative of any progressive mass lesion in the esophagus which is compomising the esophagus lumen and causing dysphagia

Jaundice

It occur when there is obstruction in the Common bile duct. Most common symptom of hepato-biliary gastrointestinal cancer symptom.This obstruction can be intrinsic due to bile duct cancer. It may be extrinsic due to external compression such as Gallbladder mass or pancreatic head mass causing external compression over the CBD. patient present with features of obstructive jaundice such as pale colored stool, dark urine and pruritus

It is passage of black tarrish colored stool. Melena indicate slow bleed in the GI tract. This bleed can originate at any site along the GI tract. Cancer stomach and peri-ampullary cancer and right sided colon cancer have a tendency to bleed. Sometimes patient have occult bleed and present with feature of anemia such as weakness/tiredness

Hematochezia

It is the passage of fresh blood per rectum. symptom of lower gastrointestinal tract cancer that is colo-rectal cancer

Anorexia and Weight Loss

These are common symptoms of any malignancy in our body

Dr Amit Jain MS MCh (GI Surgery) is Best Gastro Doctor in Delhi Noida Ghaziabad Indrapuram. Call us at 7351088686 for your queries. 

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Acute Corrosive Esophagus Injury

The incidence of corrosive esophagus injury has decreased. Mostly it is accidental and seen in children. Suicidal ingestion is seen in adults. It is of two types acid and alkali. Alkali because of its adhesive property causes esophagus injury. Acid ingestion causes mainly gastric injury

  • First-aid management of Acute Corrosive esophagus injury

First step is ABC that is airway breathing circulation maintenance. If required tracheostomy should be done. Patient should be kept nil per mouth. No attempt should be done to put a ryles tube. Intravenous fluid should be started, Vitals should be monitored. No role of upper GI endoscopy at acute corrosive esophagus injury. X-ray Chest and abdomen should be done to look for pneumo-mediastinum and gas under diaphragam. If the patient condition remain stable should be allowed liquids one he is able to swallow saliva comfortably

  • Corrosive Esophagus InjuryRole of Upper GI Endoscopy in Acute Corrosive Esophagus Injury

It is a controversial issue. Some suggest that it should be done while other does not recommed upper GI endoscopy in acute injury. Upper GI endoscopy helps in grading the severity of injury. It does not change the management plan

  • Role of Surgery in Acute Corrosive Esophagus Injury

If patient general condition is good, vitals are stable and there is difficulty in swallowing after 7-10 days of ingestion then feeding jejunostomy can be done to start nutrition
If patient condition deteriorates CECT chest and abdomen should be done for esophagus and stomach or other organ perforation or necrosis. If present then damage control surgery should be done. No attempt to restore the bowel continuity should be done at this critical condition of the patient

Best Gastroenterologist in Delhi Noida Ghaziabad India. Call us at 7351088686 for your queries. Visit our facebook page Dr Amit Jain LaparoscopicGastrointestinal Cancer & Bariatric Surgeon for GI Surgery

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Hiatus Hernia: Undervalued Cause of Acid Reflux

Diaphragam is a muscular wall which separates chest cavity from abdomen cavity. Hiatus is an opening in the diaphragam through which esophagus enters from thorax into the abdomen. A hiatus hernia occur when stomach most commonly or other abdomen organs enters into thorax through this opening.

  • Types of Hiatus Hernia

There are two types of hiatus hernia one is sliding and other is paraesophageal. In sliding hernia GE junction migrates into the thorax.In Paraesophageal hernia GE junction remains stable, stomach most commonly or other abdomen organs rolls into the thorax through side of esophagus

Hiatus Hernia
Hiatus Hernia

Symptoms

Most commonly patient present with features of acid reflux such as heartburn. Heartburn is defined as pressure sensation localized to epigastric and retrosternal area which does not radiate to back.As the disease become more severe patient complain of regurgitation of digested food. Dysphagia occur due to mechanical obstruction to food.Patient may complain of chest pain

Diagnosis

Upper GI Endoscopy is first step to rule out other disorders whose symptoms mimics with hiatus hernia. It also grades the esophagus injury severity due to acid reflux. Esophagus manometery and Esophagogram are other investigations which are also done. CECT chest and upper abdomen is helpful in large paraesophagus hernia for management

Medical Treatment

Proton pump inhibitors and life style modification are first step. Pantoprazole will reduce the heartburn. Weight reduction is important. Eat small but frequent meal. Do not lie immediately after food intake

Surgical Management

Failed medical therapy, Large hiatus defect, Herniation of other abdomen organs are indications for surgery. The standard surgical procedure is reduction of hernia contents with repair of hiatus and fundoplication. It is done Laparoscopically

Dr Amit Jain MS MCh (GI Surgery) Senior Consultant Max Hospital Patparganj Delhi & Vaishali Ghaziabad is best Laparosopic Surgeon for Laparoscopic Fundoplication Surgery. Call us at 7351088686 for your queries

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