The oesophagus (gullet) is the hollow muscular tube that carries food from the mouth down into the stomach. Oesophageal cancer is a malignant cancer that affects the tissues lining the oesophagus. It can occur in any part of the oesophagus. Treatment for oesophageal cancer aims at destroying these cancerous cells. Surgery is the most common treatment for oesophageal cancer.
Oesophageal cancer surgery aims at curing cancer by surgically removing the whole (total oesophagectomy) or part of the oesophagus (oesophagectomy) and the surrounding tissue that is affected. The left-out oesophagus is then reattached to the stomach after pulling it into the chest. When whole of oesophagus is removed the whole stomach is pulled up in the chest and is used to replace oesophagus. Sometimes a portion of the large intestine is cut and surgically attached to replace the oesophagus. To reduce the risk of recurrence of cancer lymph nodes from the surrounding area are also removed (lymphadenectomy). In case the cancer spreads to the stomach, upper part of the stomach is removed along with part of affected oesophagus (oesophago-gastrectomy).
Surgery for oesophageal cancer can be done by either an open approach or by a minimally invasive approach using laparoscopy (minimally invasive oesophagectomy). But in certain cases it sometimes becomes necessary to switch from minimally invasive to open approach depending on the situation. The type of the approach depends on the situation and is decided by the surgeon.
In an open approach a large incision is made on the neck, chest or tummy depending on the location of the cancer and the required procedure is done. In laparoscopic approach the surgery is done in two parts. First the portion of the affected oesophagus is removed laparoscopically through 3-4 small incisions in the chest. The surgeon can view the image on the monitor provided by the camera on the laparoscope inserted through one small hole in the chest during the surgery. The stomach is then reattached to the oesophagus either through a large incision or by laparoscopy. Laparoscopic approach is less invasive and thus leads to less pain and fewer complications.
The major complications of the surgery may include pneumonia and leaking of digestive fluids at the place where the stomach is attached to the remaining oesophagus. Surgery in severe cases of oesophageal cancer is mostly done after chemotherapy and radiation therapy.
Stomach cancer, also called gastric cancer, develops due to abnormal growth and multiplication of the cells lining the inner layer of the stomach. Cancer is the uncontrolled growth of abnormal cells. The accumulation of these extra cells forms a mass of tissue called tumour.
According to the type of tissue in which the cancer originates stomach cancers are classified as
- Adenocarcinoma: It is the most common type of stomach cancer which develops from the cells in the mucosa, the innermost lining of the stomach.
- Lymphomas: These are the cancers which develop in the lymphatic tissue.
- Sarcomas: These are cancers which start in the muscle or connective tissue of the stomach wall.
- Carcinoid cancers: These are cancers which start in neuroendocrine cells in the gastrointestinal tract.
The exact cause of stomach cancer is not known, however certain factors such as advancing age, gender, family history, H. pylori infection, diet, smoking, and certain medical conditions may increase your risk of developing stomach cancer.
In the early stages of stomach cancer, you may have indigestion and stomach discomfort, a bloated feeling after eating, mild nausea, loss of appetite, and heartburn. As the cancer grows you may have weight loss, vomiting blood, blood in the stool, lumpiness in the stomach, tiredness and anaemia.
Your doctor can often detect stomach cancer by asking you several questions about the symptoms you are experiencing and performing a thorough physical examination. Certain tests may be ordered and could assist in determining the diagnosis and may include:
- Barium X-rays: These are diagnostic x-rays in which barium is used to diagnose tumours or other abnormal areas. You are asked to drink a liquid that contains barium while X-rays are taken. The barium coats the walls of the oesophagus and stomach and makes the abnormalities visible more clearly.
- Endoscopy: An endoscopy is a procedure in which a long thin flexible tube with a tiny camera is used to examine the lining of the oesophagus, stomach, and duodenum. Endoscopy may be done to help identify inflammation of stomach (gastritis), ulcers, and tumours.
- Biopsy: A small sample of tissue is removed and examined under the microscope to look for abnormal cells.
Stomach cancer may be treated with chemotherapy, radiotherapy, and surgery. Surgery to remove part or all of the stomach is called gastrectomy.