The difference between esophagitis and esophageal cancer.

Written by Zhai Guo Dong

Gastroenterology

Updated on September 24, 2024

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Esophagitis and esophageal cancer have essential differences. Esophagitis is merely an inflammatory disease, which is relatively common in clinical settings and often related to excessive stomach acid, acid reflux, or other physical and chemical irritants. Esophageal cancer, on the other hand, is a malignant tumor. The mechanisms of their development, as well as the differences in prognosis and treatment plans, are very significant.

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Late-stage symptoms of esophageal cancer

What are the symptoms of late-stage esophageal cancer? Because in the early stages of esophageal cancer, the symptoms are often not very obvious, which leads many people to overlook them. By the time they feel very uncomfortable and seek medical advice, the cancer is generally in the middle to late stages. One common symptom in the later stages is progressive difficulty swallowing, which is a main symptom presented by many patients at the time of consultation. However, this symptom generally occurs only when about two-thirds of the esophagus's circumference has been infiltrated by the tumor, making swallowing difficulties a late-stage symptom. Other symptoms of late-stage esophageal cancer include hoarseness if the tumor compresses the recurrent laryngeal nerve, belching if it invades the diaphragmatic nerves, and symptoms like breathing difficulties and coughing if it compresses the airway.

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The main metastatic pathways of esophageal cancer

The main metastatic pathways of esophageal cancer include firstly, hematogenous spread, which can transfer to distant organs such as bones and the lungs or liver via the bloodstream. The second pathway is via the lymphatic system, which can lead to the metastasis of regional lymph nodes and other non-regional lymph nodes. For example, cervical esophageal cancer tends to metastasize to the supraclavicular and adjacent esophageal lymph nodes; in thoracic esophageal cancer, metastases may occur in the subcarinal, upper periesophageal, and lower periesophageal lymph nodes; metastasis can also be achieved through local spread and invasion of the tumor.

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How is esophageal cancer staged?

The staging of esophageal cancer includes a preoperative clinical staging and a postoperative pathological staging. Clinical staging involves completing various systemic examinations, determining the extent of the tumor, whether there are lymph node metastases, and whether there are distant metastases to organs such as the liver and lungs. This requires thorough assessments, including esophageal endoscopic ultrasound and whole-body examinations like PET-CT, to conduct clinical staging. Postoperative pathological staging, on the other hand, is determined based on the depth of tumor invasion reached during surgery and the status of lymph node metastasis, among other factors.

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What are the precancerous lesions of esophageal cancer?

The most common precancerous lesion of esophageal cancer is Barret's esophagus, which is formed by the chronic stimulation of the esophageal epithelium by chronic reflux esophagitis. Of course, this includes some chronic esophageal ulcers and long-term leukoplakia of the esophagus. These recurrent esophageal ulcers could potentially transform into atypical hyperplasia and then further into carcinoma in situ. However, the progression from precancerous lesions to actual cancer can take a very long time, possibly many years or even over a decade. Therefore, having a precancerous lesion does not necessarily lead to esophageal cancer.

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Gastroenterology

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What are the early symptoms of esophageal cancer?

The esophagus is a tubular passage for food, extending from the patient's pharynx to the stomach, thus named the esophagus. Its function is to allow food to travel from the mouth through the esophagus to the stomach. If a tumor develops in the esophagus, early symptoms can include difficulty swallowing, a choking sensation, and inability to swallow food, which sometimes may lead to vomiting. These are early symptoms of esophageal cancer. If the condition progresses to a late stage, it can lead to a situation where not even liquids can pass, making swallowing impossible, resulting in extreme weight loss. In severe cases, the cancer may metastasize, including to lymph nodes and other organs, and may also compress surrounding organs, causing symptoms like chest tightness.