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Esophageal Cancer

Esophageal cancer is a fatal cancer that has one of the lowest survival rates of cancers. The incidence trends differ based on the tumour anatomy and anatomic site.

In Canada, EAC rates have increased by a third in the last 20 years. This may be due to the rising prevalence of obesity and gastroesophageal acid reflux Canadian National Railway Interstitial Lung Disease. During this time, ESCC rates decreased.

Background

A rare type of canadian national railway throat cancer, esophageal carcinoma (EAC) has one of the fastest growing incidence rates and the lowest survival rates of any common malignancy in the Western world. EAC rates have increased by two-fold since the early 1990s in Canada. Squamous cell cancer of the esophagus have decreased, as a result of the increase in obesity and gastroesophageal reflux disease.

The prognosis for esophageal carcinoma is poor but the 5-year survival rate has been improving slightly over the last two decades. This could be due to the improved ability to identify and treat a rapidly growing tumour as well as the availability of modern therapies such as chemotherapy and radiation therapy, and improvements in the selection of patients and treatment planning.

The rates of incidence and trends for EAC and ESCC differ by tumour morphology and anatomical location, as well as the type of cancer. In Canada the incidence rates of ESCC decreased while those of EAC doubled between 1986-2006. The projected incidence rates suggest that the incidence rates of EAC will continue to increase and those of ESCC will decline and a wide range of individual provinces having both decreases and increases.

The prognosis for esophageal cancer is influenced by a variety of aspects, including the degree (how similar the cells are to normal tissue) and the area of the cancer. A pathologist determines the severity of a tumour by examining the cells under microscope.

Methods

Adenocarcinoma and squamous-cell carcinoma are the two most prevalent types of esophageal cancer. While the incidence rates in Canada remain low (compared with those in the United States, Australia, New Zealand and northern Europe), they have risen over the past 20 years. The rate of increase varies according to tumour morphology and the location. For example, rates of EAC doubled, and those for canadian national railway interstitial lung disease ESCC decreased between 1986 and 2006.

The five-year survival rates for esophageal cancer are low and decrease with the age. About 15% of those diagnosed have a younger age than 45. Men are three to four time more likely to be affected.

A pathologist examines cancerous cells with microscopes to determine the severity of the tumor. This is determined by how different the cancerous cells appear compared to normal ones. The higher the grade the more likely it is that the cancer will develop and spread. Your health care team uses the grading system to determine which treatment is best for your specific situation. The grade of the tumour can also help your health team plan the follow-up care. In general, those who have a tumour of a lower grade are monitored less often than those who have a high grade tumor.

Results

The rate of survival for esophageal cancer is among the lowest of all cancers. In Canada the five-year rate of survival was 13% in the year 2006 compared to 18 percent for the general population (Table 1). Survival rates decline with age and sex at diagnosis however, they remain relatively stable in the upper and middle segments of the esophagus. Table 2 shows that squamous cell carcinomas of the esophagus decreased for both women and men since the beginning of the 1990s. Drinking alcohol and smoking cigarettes increase cancer risk in ESCC. This is the reason for 90 percent of cases. Thus, lower rates of smoking and the prevalence of gastroesophageal reflux canadian national railway interstitial lung disease could be the reasons behind this decline (45).

The prevalence of adenocarcinoma as well as squamous cell carcinoma of the lower esophagus have opposing trends in Canada and the United States, with EAC rates increasing and ESCC decreasing between 1986 and 2006. The changes that were observed up to 2026 were projected using the standard cancer projection model Nordpred (23) and further categorized based on tumor morphology, and anatomical locations. The projections showed increases between 40 and 50 percent for esophageal carcinoma and a decrease of 30% to 50% for squamous cells cancer of the upper, middle and lower sections of the esophagus. The rise in EAC incidence could be due to higher rates of obesity and gastroesophageal respiratory disease, while decreases in ESCC could be due to less use of tobacco.

Conclusions

The five-year survival rate for esophageal carcinoma is still low, but it has improved slightly since the 1990s. This is due to the more precise diagnosis of esophageal cancers using ultrasonography of the esophageal region and preresection staging done by thoracoscopy and laparoscopy, with the biopsy of the celiac axis or a lesser curvature. The increase is mainly restricted to those who are between 45 and 70 years old. In this group the rate of EAC has doubled. ESCC however, on the other on the other hand, has decreased in both women and men.

Smoking levels may have declined, which could explain the decrease in ESCC. Due to the low survival rates of esophageal cancer, efforts should be made to reduce risk factors and develop more effective treatment strategies.

All stage 0 and 1 esophageal cancers could be resectable, and so are most stage 3 cancers that have not progressed to the trachea (windpipe), an aorta (large canadian national railway blood cancer vessel that is derived from the heart) or spine. However, canadian National railway All most patients with advanced cancers that have spread to these vital structures or distant lymph nodes and organs are not candidates for surgery. They should be treated with chemotherapy, either with or without radiation therapy. Esophageal carcinomas of stage 4 are not suitable to be treated surgically however they can be treated with drugs that stop cancer cell growth or prevent it from spreading.