Terminal stage of Esophageal cancer

Cancer of the esophagus — the long tube that helps food move from your oral cavity to your stomach — is one of the deadliest types of cancer due to the fact that once it is diagnosed, this cancer has often significantly progressed and almost always spread to nearby organs and tissues. The very anatomical characteristics of the esophagus allow the tumor to grow and be noticed once it is large enough to block the passage of food.

Esophageal cancer: Stages

The staging system is of major importance for any type of cancer, including esophageal cancer. In order to precisely determine the stage of the esophageal cancer, medical experts take into consideration several factors such as histological type and grade of the tumor, spread of the cancer to regional/distant lymph nodes or nearby organs, the extent of infiltration of the esophageal wall etc. Staging is what determines the future therapy and also predicts the outcome of the disease (prognosis).

The tumor per se is diagnosed with the assistance of several tests and exams. Initially, a patient usually undergoes an upper gastrointestinal endoscopy (a tube with a camera that allows the doctor to get a closer look). This approach is capable of visualizing the inner surface of the esophagus and easily detects the tumor.

During the procedure, doctors take samples of the suspicious tissue and send them for pathohistological examination. Upper gastrointestinal endoscopy is also a powerful tool for the diagnosis of Barret's esophagus, which is a precancerous condition, eventually progressing into invasive esophageal cancer.

Apart from an endoscopy, once the tumor is histologically confirmed, patients will undergo a CT scan, MRI scan, or even PET scans. These imaging techniques provide your medical team with the information they need about the size of the tumor and also detect the extent of its infiltration. The techniques additionally identify enlarged lymph nodes and metastases.

By visualizing the organ, the tumor, and evaluating the extent of the disease doctors make decision regarding the treatment of esophageal cancer.

In the early stages, the tumor is small and restricted to the wall of the esophagus. Later, it penetrates all the layers of the esophagus, infiltrates the nearby organs and regional lymph nodes while dissemination of cancer cells leads to metastatic lesions in the lungs, bones and other organs.

TNM classification is definitely the basis for staging esophageal cancers. This abbreviation stands for tumor (T), lymph node involvement (N) and the presence or absence of metastases (M).

As for T part of TNM classification, there are several options. T0 stands for no evidence of the primary tumor while T1-4 confirm the presence of the tumor and its spread through the esophageal layers. There is also Tis (carcinoma in situ) which is actually a non-invasive esophageal cancer limited to the surface of the organ (the mucosa).

When it comes to node involvement, the classification recognizes two states, N1 when the cancer has spread to regional lymph nodes and N0 when nodal involvement is ruled out.

And finally, the presence of metastases (in which the cancer spreads to other parts of the body) is classified as M1, while M0 stands for absence of cancer cell dissemination.

There are 5 stages of esophageal cancer.

• In stage 0, the cancer is restricted to the epithelium layer and the rest of the esophageal wall is cancer-free. So, the tumor remains inside the organ sparing regional lymph nodes and distant organs.
• In the first stage of the disease the esophageal cancer grows further, infiltrating the lamina propria but still remaining inside the organ, not affecting the lymph nodes.
• Further progression of the disease (stage II esophageal cancer) is characterized by infiltration of the muscular layer and cancerous spread beyond the esophagus itself. Nearby lymph nodes are affected in most cases but there is no further dissemination of cancer cells.
• In stage III of esophageal cancer, the cancer infiltrates the nearby organs and tissues along with regional lymph nodes. Fortunately, there are no cancer cells in the lungs, bones or other distant organs but the tumor is practically inoperable and the prognosis is not very good.

The final Stage of Esophageal Cancer

The final stage of esophageal cancer — or stage IV of the disease — occurs when the tumor is located not only inside the esophagus and nearby organs but is also confirmed in other organs of the body, where clumps of cancer cells form metastases of various sizes.

The five-year rate of survival in these patients is no greater than 2.8 %, since dissemination does not respond well to any of the available treatments. What is more, patients in the terminal stage of esophagus cancer are anorexic, lose their appetite, and subsequently lose their strength against the disease and develop a whole variety of different complications.

Even though it sounds horrible, the terminal stage of esophageal cancer is actually an introduction into an inevitable lethal outcome. Depending on the affected organs, patients may deal with severe pain (bone metastases), swallowing difficulties, or a complete inability to swallow solids or liquids (obstruction of the esophagus by the tumor), or they experience respiratory problems (lung metastases). Sometimes the cancer infiltrates the nearby large blood vessels and is blamed for rapid death due to exsanguination (blood loss). A hoarse voice, frequent hiccups, and throat pain are several more symptoms these patients have to deal with.

All in all, the terminal stage of esophageal cancer, after all treatment avenues have been explored, is hard to withstand and requires plenty of supportive palliative care. Such patients are treated palliatively, where the goal of the treatment is to alleviate the symptoms of the disease, which are in the majority of cases practically unbearable. Relieving suffering and pain is the goal at this stage of esophageal cancer.