The esophagus is a tube about 25 cm in length connecting the pharynx with the stomach. When a bolos (i.e. small ball) of masticated food is swallowed, it gently slides down the tube, assisted by mild waves called peristalsis. At the far end, a valve called the cardiac valve opens to allow this to pass into the stomach.
The chief disorders that occur in this region are esophageal cancer, a disease with a high mortality rate, and hiatus hernia, a mechanical disorder being diagnosed more frequently in these days of more sophisticated radiological equipment and endoscopic devices.
Esophageal Cancer Symptoms
A symptom of major importance in this canal is difficulty in swallowing. This is termed dysphagia. It sometimes occurs in simple spasms as in cardiospasm. But by far the most important and sinister reason is cancer of the esophagus.
Therefore, as a symptom it must never be overlooked, or put down to “nerves.” It must be investigated. Heartburn and discomfort in the upper abdomen may be among the few indications of a hiatus hernia.
The major problem (as with cancer in most parts of the body) is that symptoms rarely occur early. In fact, by the time they appear, the disease is so far advanced that a cure is virtually impossible.
Difficulty in swallowing is frequently the earliest symptom. Often it starts with a difficulty in being able to swallow bread and meat adequately. The patient tends to wash his or her food down with copious amounts of liquid. However, due to the considerable elasticity of the gullet, nearly 80 per cent of the circumference must be involved before there is any difficulty in the ability to swallow normally. By then the disease is invariably progressive and well on the way to ultimate destruction. In about one case in five, pain and discomfort may occur on swallowing.
Progress and diagnosis as the condition advances, malnutrition and weight loss occur. Dehydration will eventuate, and anemia may result from local ulceration, plus the fact that inadequate food essential for normal health is being ingested. Little by little, additional symptoms will take place as surrounding organs are encroached upon.
Diagnosis is usually made by endoscopic (direct vision) or X-ray examination. A special technique often called a “barium swallow” is used. The patient swallows radio-opaque barium in fluid form, and as this occurs, radiological examination is carried out. The constricted part caused by the growing cancer is usually visible.
With the wide use of the fiber-optic endoscope, it is readily possible to inspect this area under direct vision. It is also possible to take a small snipping (called a biopsy) of the abnormal lesion. This is then subjected to microscopic examination to confirm the diagnosis. However, direct inspection alone is usually accurate when carried out by an expert in this field.
Esophageal Cancer Causes
The cause is unknown. For some unexplained reason, it has a strange geographical distribution. For example, it is common in France, and in a particular province of China, where the abnormally high incidence of 67 persons per 100,000 of population is reported. It is much less frequent in the United Kingdom and in North America among the white population.
The sex ratio is also variable. For example, it affects men four times as commonly as women in America. The ratio is 2:1 in England and 8:1 in Finland. Not long ago. Lancet magazine published articles by authors who had discovered a nomadic tribe in Asia with an incredibly high rate of this form of cancer. It made all other figures pale into insignificance. Apart from living a semi-civilized life, the chief feature of their habits was the constant drinking of enormous quantities of almost boiling tea. The researchers believed the continual irritation of this in the lower part of the esophagus may have been the precipitating cause.
With esophageal cancer, 50 percent of the lesions occur in the lower part of the tube, about 40 percent in the middle third and only 10 percent in the upper section.