Disorders of the Gastrointestinal System, 2nd Edition
10
Esophageal adenocarcinoma Esophageal adenocarcinoma is cancer affecting the esophagus cells that make mucous and fluid known as glandular cells (NCI, 2022). Esophageal adenocarcinoma is strong- ly associated with obesity and gastro- esophageal reflux disease (GERD), while an even greater risk is the addition of to- bacco use. Work-related exposures, ge- netic predisposition, ingestion of a large amount of pickled foods (more common in some Asian countries), alcohol con- sumption, and HPV infection can also predispose a patient to develop esoph- ageal cancers (Gibson, 2022). Exposures to silica dust and airborne metal have also been associated with gastrointestinal cancers. Barrett’s esophagus increases the risk of developing adenocarcinoma (NCI, 2022). Signs and symptoms ● Often not initially distinctive. ● Dysphagia and weight loss are common early symptoms; the person reports taking increasingly smaller bites of food or eating foods that are easier to swallow, inadvertently causing weight loss or malnutrition. ● Chest pain. ● Hoarseness. ● Coughing. ● Feeling that something is caught in the throat or chest. ● Esophageal bleeding can be a potentially deadly symptom of esophageal cancer and is a medical emergency. ● Black tarry stools may indicate bleeding from high in the gastrointestinal tract (ACS, 2022b).
EVIDENCE-BASED PRACTICE ALERT Current research indicates that four genetically inherited syndromes may contribute to developing esophageal cancers. Future studies will focus on using this discovery to aid in screen- ing and treatment. In addition, target- ed therapies and immunotherapy are now being used to treat some esopha- geal cancers. However, more research is needed in these areas (ACS, 2020a). Screening for esophageal cancer Regular screening for low-risk patients without symptoms is not recommended, as there is no evidence that these screen- ings lower the mortality rate or decrease risk. In addition, screening using upper GI endoscopy or other invasive procedures may cause harm if tissue damage or reac- tions to the medications provided during the procedure occur. However, patients at significantly high risk, such as those with Barrett’s esophagus, should have period- ic examinations via upper GI endoscopy (NCI, 2022). Diagnosis is confirmed by undergoing an esophagogastroduodenoscopy (en- doscopic examination of the esophagus) with at least four biopsies of suspicious ar- eas. In addition, MRI of the chest and tho - racic region, PET scans, and CT scans are used to determine disease staging (NCI, 2022). Stage III and IV diagnoses involve tumors that invade the deepest layers of the esophagus and regional lymph nodes (ACS, 2022b). Treatment usually involves a combi- nation of surgery, chemotherapy, and radiation. Esophagectomy is the surgi- cal removal of the affected areas of the esophagus as well as local or affected lymph nodes and part of the stomach.
Powered by FlippingBook