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Esophageal cancer forms in the esophagus, or the food pipe, a muscular tube that allows food to move from our mouths to the stomach.

There are two types of esophageal cancer:

• Squamous cell carcinoma, which is linked to alcohol and tobacco abuse. The occurrence of this type of cancer is diminishing.
• Adenocarcinoma, which results from gastro esophageal reflux disease (GERD). Barrett’s esophagus is a complication that arises in GERD, and it may increase your risk of developing adenocarcinoma. Adenocarcinoma is more prevalent.

Stage 4 Esophageal Cancer

Esophageal cancer is categorized into different stages, depending on the extent or spread of the cancer. In stage 4 esophageal cancer, the cancer would have spread to other organs, like the liver, kidneys, and so on. Stage 4 esophageal cancer is not considered curable, and only palliative treatment (surgery and alternate treatment options to ease the symptoms) is given at this stage. In all of the other stages of cancer, curative surgery and post and pre-operative chemotherapy and radiation is used to treat the cancer.

Symptoms

While there are minimal symptoms in the early stages of this cancer, by stage 4 one or all the listed symptoms would have manifested.

• Pain in swallowing or dysphagia (the most obvious symptom is esophageal cancer)
• Regurgitation or choking
• Chest or back pain
• Indigestion and heartburn
• Unexplained weight loss
• Hoarseness in the voice or a persistent cough that lasts more than two weeks

While most of the symptoms can also be caused by other diseases, it is prudent to visit a doctor and get tested. Early diagnosis is one of the best ways of ensuring complete reversal.

Treatment

As mentioned earlier, stage 4 esophageal cancers cannot be cured.

Hence, cancer treatment options in this stage are aimed and alleviating symptoms. Palliative treatment options include the following.

• Endoscopic dilation, where a stent is placed in the esophagus to keep it dilated to ease swallowing of food.
• Electrocoagulation or laser surgery, which is given to relieve some of the symptoms and improve overall quality of life. Destruction of the cancer cells by means of a thermal laser (through an endoscope) may provide relief from dysphagia. Laser ablation is also used to remove polyps or growths that are blocking the esophagus.
• Radiation therapy (internal and external) to improve quality of life and relieve symptoms.
• Chemotherapy is also given to relieve you of certain symptoms.
• Photodynamic therapy, where a drug is first injected in the tumor through the bloodstream, then the tumor is exposed to light. The light serves to activate the medicine so as to kill the tumor.

Apart from palliative treatment, one of the best treatment options for stage 4 esophageal cancer is participation in clinical trials. Clinical trials are studies that are conducted to evaluate the efficacy of new treatments and drugs. While you can participate in clinical trials at any stage, you should discuss this with your doctor first to choose what is best for you.

Prognosis

The esophageal cancer prognosis mainly relies on the stage in which the cancer is and the patient’s age and overall health. Stage 4 esophageal cancer prognosis is considerably poor, because in this stage the cancer has spread to other organs of the body as well.

Survival rates also depend on how far the cancer has progressed. Stage 4 esophageal cancer survival rate is less than 5%. It is advisable that patients with stage 4 esophageal cancer obtain treatment at a medical center, where they can benefit from multi-modality treatment.

References

• http://cancer.unm.edu/patients/cancer-info/types-of-cancer/esophageal-cancer/stage-iv-esophageal-cancer/
• http://lombardi.georgetown.edu/GI/Services/gastrointestinal/esophageal/treatment.html
• http://omlc.ogi.edu/pdt/ptinfo/esophca/index.html

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