Difficulties to swallow (medically termed “dysphagia”), rapid weight loss and chest pain (central chest area) are the most common esophagus cancer symptoms.
Because of the proximity of the esophagus to the bronchial airways and trachea the tumor might irritate these structures and lead to a chronic cough or hoarseness. In about 5% of cases there could even be a breakdown of tissue between the trachea and the esophagus and a tracheoesophageal fistula could develop.
This is a high risk situation as food enters through this connection into the lungs and leads to aspiration pneumonia. If a major blood vessel is corroded by the cancer, there can be sudden hemoptysis (=blood vomiting), which is an emergency and needs to be dealt with immediately by endoscopy and cauterization or injection of vasopressin by intravascular catheterization.
Who comes down with esophageal cancer? Typically it is a man aged 55 to 65 who has a long history of cigarette smoking and possibly heavy alcohol abuse as well (this constellation leads to a potentiated risk).
Trouble swallowing may suddenly happen, but often there was a history of some problems with swallowing for 3 to 6 months before. In the case of bone metastases, there is tenderness of the bones wherever the metastases are found on a bone scan later. Sometimes there are neurological symptoms such as “Horner’s” syndrome where a metastatic lymph gland in the lower cervical region affects the sympathetic branch on the same side where the metastatic lesion is located. As a result the eye lid droops, the pupil cannot dilate and is pin-sized and the affected side of the face has stopped producing sweat on the affected side.
References:
1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Chapter 25. Cancer of the esophagus.
2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Cancer of the esophagus.
3. D Sharma J Indian Med Assoc 1999 Sep;97(9): 360-364.
4. MJ Roth et al. Cancer Res 2001 May 15;61(10):4098-4104.
5. K Schumacher et al. Cancer Res 2001 May 15;61(10):3932-3936.
6. M Tachibana et al. Virchows Arch 2001 Apr;438(4):350-356.
7. SJ Spechler et al. JAMA 2001 May 9;285(18):2331-2338.
