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Esophageal Cancer

Overview

Esophageal cancer is an illness where harmful and carcinogenic cells form in the tissues of the throat. Smoking, heavy liquor use, and Barrett&#39;s esophagus can increase the risk of esophageal disease. Signs of esophageal cancer include weight loss and agonizing or troublesome gulping<a href="#accordion">[1]</a>.

Esophagus is a long, hollow cylinder that runs from the throat to the stomach. It directs the chewed food through muscle contractions and relaxations from the back of the throat to the stomach to be processed<a href="#accordion">[2]</a>.&nbsp;Esophageal cancer generally starts in the cells that surround the esophagus. The growth of cancerous cells in the esophagus can happen in any region of the esophagus. This cancer is more common in men compared to women. Being the 6th most frequent reason for disease-related deaths around the world, esophageal cancer has an extremely high fatality rate.&nbsp;

Interestingly, the incidence rates fluctuate in various geographic areas and higher cases of esophageal cancer might be credited to tobacco and liquor use, or specific dietary propensities and weight<a href="#accordion">[2]</a>.&nbsp;

<div>&nbsp;</div>

Esophageal cancer can not only be categorized exclusively by its degree but also based on the cells involved. The two most prevalent types of esophageal cancer are squamous cell carcinoma and adenocarcinoma. Different types, including sarcoma, small cell carcinoma, and lymphoma, are generally a rarity<a href="#accordion">[3]</a>.&nbsp;

&nbsp;

<ul>
	<li>Squamous Cell Carcinoma</li>
</ul>

This sort of esophageal cancer influences the squamous cells, the leveled cells found on the lining of the esophagus. Squamous cell carcinoma tends to structure in various and random segments of the esophagus; however, it most frequently occurs in the upper and middle area, which is situated in the neck and the upper two-thirds of the chest. Although squamous cell carcinoma was once the leading type of esophageal cancer in most countries; currently thanks to the recent advancements and innovations in cancer therapies it represents less than fifty percent of all diagnoses. Nonetheless, it is the most common type of esophageal cancer worldwide.

Esophageal squamous cell carcinoma&#39;s origins have been linked reliably to hereditary changes and unprecedented genetic modifications that encourage the cells of the esophagus to develop and multiply extensively and rapidly. While the specific reason for this hereditary transformation remains obscure, specialists accept that it very well might be connected to the overconsumption of liquor or heavy tobacco utilization. While there is no authoritative method for forestalling this harm, avoiding and resisting the urge to use and smoke tobacco and controlling one&#39;s extreme liquor use can assist with lessening the possibility of squamous cell carcinoma of the esophagus.&nbsp;

&nbsp;

<ul>
	<li>Adenocarcinoma</li>
</ul>

Adenocarcinoma is another popular and common type of esophageal cancer in many parts of the world. For adenocarcinoma of the esophagus to develop completely and properly, gland cells responsible for creating mucus and other bodily fluids would typically supplant a region of the squamous cells that under normal circumstances line the esophagus. This change is prevalent in people with Barrett&#39;s esophagus, a medical complication of gastrointestinal reflux disease that transforms the cells in the esophagus to become like the cells lining the digestive system. In this manner, having Barrett&#39;s esophagus might put a person at a more serious risk of getting diagnosed with esophageal cancer. But one should not lose complete hope as having Barrett&#39;s esophagus does not confirm or guarantee a cancer diagnosis.

&nbsp;

Specialists suggest that a person is more prone to developing esophageal adenocarcinoma because of overexposure to stomach acid, and the malignancy is most frequently situated in the lower third (distal) part of the esophagus. Usually, adenocarcinoma develops at the gastroesophageal junction (GEJ), the intersecting region of the stomach and the esophagus.&nbsp; Cancers in the initial two inches of the stomach (cardia) can also be categorized with esophageal cancers as they generally have comparative attributes and are subsequently treated in that capacity.&nbsp;

Similar to the case of squamous cell carcinoma, the specific reasons for esophageal adenocarcinoma are unclear at this point. Although, certain factors, including chronic indigestion, acid reflux, and obesity, have been associated with a growing probability of fostering this threatening malignancy.&nbsp;

To lessen the risk of developing esophageal adenocarcinoma, people must abide by general well-being practices including eating a fair, nutritious, and vital supplements-centered diet and ensuring fewer weight fluctuations.&nbsp;

<div>&nbsp;</div>

Signs And Symptoms

The common signs and symptoms of esophageal cancer are:

<ul>
	<li>Difficulty swallowing (dysphagia)</li>
	<li>Pain while swallowing, even water (odynophagia)</li>
	<li>Unexplained weight loss</li>
	<li>Cough&nbsp;</li>
	<li>Hoarseness</li>
	<li><a href="https://www.merisehat.pk/disease/heart-burn-58" target="_blank">Heartburn </a>or indigestion</li>
	<li>Pain or pressure in the chest</li>
</ul>

<div>&nbsp;</div>

Causes

As is the case with most cancers, the exact and accurate cause is rather ambiguous. However, recent studies and persistent research have narrowed them down to genes, lifestyle choices, and medical history. All these factors could contribute to a potential esophageal cancer diagnosis.&nbsp;

Most cancers affect the composition of an individual&rsquo;s cells and directly impact the DNA. DNA is an important component of the human body as it controls the rate of proliferation, growth, and death of vital bodily cells. Genes are necessary and imperative to steady and control the daily division of cells and ensure a cell completes its functions before terminating. Such genes are known as tumor suppressor genes<a href="#accordion">[4]</a>.&nbsp;

Esophageal cancers, like other types of cancers, develop due to acquired or inherited DNA mutations that create an unnatural imbalance of oncogenes and tumor suppressor genes. Because of the absence of a manager to regulate the growth of cells, they tend to spread rather rapidly. Thus, cancer metastasizes.&nbsp;

&nbsp;

Some of the identified DNA mutations are explained below:&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Howel-Evans Syndrome</h5>
	</li>
</ul>

The Howel-Evans syndrome is defined as tylosis with esophageal cancer. This is a rare yet concerning dominant autosomal trait associated with the evident hyperkeratosis of the palms and soles, coagulation of skin tissue, and obvious signs of dermal fissuring. Scientists have associated the disorder with the hereditary and characteristic mutation of a specific DNA composition known as the RHBDF2 gene. Individuals with changes in this gene are more vulnerable and susceptible to the possible development and diagnosis of squamous cell variety of Esophageal Cancer<a href="#accordion">[4]</a>.

&nbsp;

<ul>
	<li>
	<h5>Bloom Syndrome</h5>
	</li>
</ul>

The bloom syndrome has been linked to modifications of the BLM gene. The gene in question has been associated with vital bodily functions, such as synthesizing a critical protein that balances the fickle nature of DNA during cell division. The absence of this key and principal protein can lead to DNA damage rendering it unfit for other cell functions, thereby, leading to esophageal cancer.

Individuals who have been clinically diagnosed with Bloom syndrome have to be monitored diligently due to their inherent syndrome increasing the growing concerns of producing squamous cells that could in effect lead to esophageal cancer, as well as Acute myeloid leukemia (AML), Acute lymphocytic leukemia (ALL), and different cancers that impact the lymph framework. Because it has been recognized as a recessive condition, for it to persevere, the unusual and rare gene is typically inherited from both biological parents, rather than just one<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Fanconi <a href="https://www.merisehat.pk/disease/anemia" target="_blank">Anemia</a></h5>
	</li>
</ul>

Fanconi anemia, like its counterparts, has been an intriguing subject of research for countless years. This is attributed to its rarity and infrequency, considering the disorder&rsquo;s atypical genetic modifications that prohibit and restrain the healing of previously damaged and altered DNA<a href="#accordion">[5]</a>. These genetic mutations are observed in specific and unique FANC genes which have been discovered to be phylogenetically unrelated, but their unnatural compositional changes can prompt a higher risk of numerous cancers including AML and squamous cell cancer of the esophagus<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Familial <a href="https://www.merisehat.pk/disease/barretts-esophagus" target="_blank">Barrett&rsquo;s Esophagus</a></h5>
	</li>
</ul>

Familial Barrett&#39;s Esophagus is a syndrome that is defined by several different families with Barrett&#39;s esophagus, adenocarcinoma of the esophagus, and GEJ<a href="#accordion">[4]</a>. This rare syndrome is an acquired condition that has rudimentary notions related to the existence of complicated and chronic pathologic acid and biliary gastro-esophagal reflux. However, genetic factors may also play a significant role in most diagnoses. The specific genetic compositions associated with this syndrome have yet to be elucidated.&nbsp;

<div>&nbsp;</div>

Diagnosis

Once symptoms are persistently observed, an individual should immediately schedule an appointment with an oncologist to confirm their suspicions. If the healthcare professional finds any indication of a possibility of esophageal cancer then they may be inclined to recommend certain procedures and tests to determine the presence of cancer. Diagnosis of esophageal cancer is quite prolonged as it has been segmented into two categories:

&nbsp;

<h5>Tests To Confirm The Initial Hypothesis</h5>

These include:&nbsp;

&nbsp;

1. Barium Swallow Study

Barium Swallow Study or the Upper Gastrointestinal (GI) Series, is a particular test that is used to determine and examine the organs lying within the initial parts of the digestive system i.e. the esophagus, the stomach, and the initial segment of the small intestine (the duodenum). The patient will be instructed to swallow a metallic liquid called barium, which will coat the walls of the esophagus and illuminate any abnormalities and possible progressions of cancer when observed under an X-ray<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

2. Endoscopy

An endoscopy is performed by the designated healthcare consultant. The doctor, to provide effective and accurate results, will take the assistance of a scope to examine the critical parts or the entire length of the esophagus. They will guide the scope through the oral cavity and gently proceed along the length of the esophagus or the areas that may be prone and susceptible to the development of cancerous or malignant cell growth. Throughout the process, the doctor can differentiate between healthy and visibly scarred segments of the esophagus as the view is displayed on a screen. However, to confirm the suspicion, any region that may seem questionable is examined more proficiently. A minuscule tissue sample (biopsy) might be retrieved for lab assessment<a href="#accordion">[2]</a>. The presence of modified and distorted malignant cells in the sample is indicative of cancer.

An endoscopy could also be suggested by the doctor due to factors such as age, history of bleeding, unexplained weight loss, or trouble eating and swallowing.&nbsp;

&nbsp;

3. Biopsy

If a region is suspected to be a prospective ground for cancerous growth, the general physician or the oncologist would highly suggest examining a sample of cells from the affected region for lab testing. This procedure is called a biopsy. Once sent to the lab, the cells are observed and tested for malignant growth or precancerous modifications that can either indicate the existence of cancerous growth or alert medical professionals to the possibility of cancer in the near future. A biopsy can be carried out in one of the many ways depending on the invasiveness of the procedure<a href="#accordion">[8]</a>:

&nbsp;

<ul>
	<li>Punch Biopsy: Samples from the skin&rsquo;s top layers are removed via holes punched in the skin using surgical instruments. A scalpel may also be used to obtain samples.&nbsp;</li>
	<li>Excisional Biopsy: In this form of the biopsy, the medical services provider will surgically remove small samples of tissue to analyze cells for cancer. The patient will be under anesthesia to ensure less discomfort.&nbsp;</li>
	<li>Perioperative Biopsy: This is referred to as the accidental diagnosis where a biopsy is carried out during a surgical procedure for non-cancer-related issues. The tissue under concern is immediately sent to the laboratory to confirm its nature. The lump or malignant growth may be removed while the patient is under anesthesia, but prior consent is needed.</li>
</ul>

&nbsp;

The doctor according to their preference, and after monitoring the situation, will determine the ideal type of biopsy. Even though brush biopsies are easy and convenient, a scalpel biopsy is still required to confirm the results of a brush biopsy. Some doctors have even considered other options, such as biopsies conducted through laser.

&nbsp;

<h5>Tests To Gauge The Spread Of Cancer</h5>

Proving and recognizing the presence of cancerous growth in the body will not suffice, a doctor will then be obliged to carry out further assessments to estimate and visualize the extent and spread of cancer, to devise treatment plans accordingly. If cancer has metastasized and spread to other parts of the body, the patient is said to have entered staging. These extensive and supplementary procedures allow doctors to successfully identify the stage the patient is at. Staging is carried out through the following comprehensive tests and procedures:

&nbsp;

1. Endoscopic Ultrasound (EUS)

A technique wherein an endoscope is directed into the body, through either the mouth or the rectum. Doctors prefer guiding the endoscope through the mouth for malignant esophageal growth. An endoscope is a tube-like instrument with a light and a focal point for better and clearer evaluation of the tissues. A gentle probe-like structure is fixed at the rear end of an endoscope that ricochets high-energy sound waves (ultrasound) off the inner tissues or organs to produce echoes. These echoes then help form an image of body tissues called a sonogram. A biopsy may likewise be carried out for extra caution; this is called an endosonography<a href="#accordion">[1]</a>.

&nbsp;

2. CT Scan

This procedure involves a&nbsp; collection of pictures of various regions inside the body, like the chest, abdominal cavity, and pelvis, captured from various holistic points. The photos are taken by a PC connected to an X-ray machine. To offer more clarity and visibility some technicians may inject a&nbsp; medically safe synthetic color, or instruct the individual to gulp the liquid. The procedure is also known as computed tomography, computerized tomography, or computerized axial tomography<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

3. Magnetic Resonance Imaging (MRI)

Specialists may also recommend other more elaborate imaging tests such as MRIs that rely on magnetic resonance computerized through preset algorithms and displayed on a screen.&nbsp; It provides an image of all concerning parts that may have been affected by cancer<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

4. Positron Emission Tomography (PET) Scan

This is a specialized method to track down threatening cancer cells in the body. An inconsequential quantity of radioactive glucose (sugar) is inserted into the patient&#39;s vein. The PET scanner captures an image of each segment, part, and region where glucose is being utilized in the body. Malignant growth cells appear more vividly in the image since they are more dynamic and more porous to glucose than ordinary cells. A PET scan and CT scan might be suggested simultaneously. This is known as PET-CT<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

5. Thoracoscopy

This is a slightly more invasive method, but it is equally important as it allows specialists to view the organs for irregular growth. A precise incision between two ribs serves as an entry point for the thoracoscope (a narrow, attenuated, tube-like instrument with a light and a focal lens attached for the survey). It might likewise have a device to extract tissue or lymph node samples, which are then observed under a microscope for indications of the cancerous disease. This procedure may also be used to remove infected parts of the esophagus or lung<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

6. Laparoscopy

A laparoscopy comprises an invasive surgical method that examines internal parts and organs to ensure there are no indications of malignant growth. Like thoracoscopy, a laparoscopic procedure will commence with a scalpel making tiny incisions close to the walls and surroundings of the abdomen. After this, a laparoscope is inserted within the newly constructed cavity to explore the inner organs. But laparoscopy is not an exclusive procedure and different instruments might also be used through the initial or other entry points to carry out respective procedures. For example, extraction of organs or taking tissue tests to be sent to the lab for confirmation of metastasis<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

7. Ultrasound

This is an extremely common and prevalent test involving high-energy sound waves (ultrasound) that rebound off inner tissues or organs, like those in the neck, and consequently, display the corresponding reverberations. The reverberations form an image of body tissues called a sonogram. The image can be printed afterward for a closer examination<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

<h5>Stages</h5>

The standard diagnostic procedure of esophageal cancer also helps in identifying the progression of stages. Esophageal cancer can spread via tissues or through the lymph system<a href="#accordion">[1]</a>. The staging of cancer is identified through the Roman numerals, starting from 0 and ending at IV<a href="#accordion">[9]</a>. If chronologically aligned, the staging consists of:

&nbsp;

<ul>
	<li>Stage 0: Doctors may have noticed irregular cell division or abnormal cell growth in the lining of the esophagus, but at this stage, it does not necessarily equate to cancer.&nbsp;</li>
</ul>

&nbsp;

<ul>
	<li>Stage I: When examined, the layer of cells coating the esophagus has been confirmed as cancer cells.</li>
</ul>

&nbsp;

<ul>
	<li>Stage II: This is when staging becomes more apparent as cancer has advanced to thicker layers, such as the muscle layers or the esophageal lining. The stage can increase the growing concern as it might indicate the spread of cancer to localized lymph nodes that are integral parts of the immune system.</li>
</ul>

&nbsp;

<ul>
	<li>Stage III: Cancer&rsquo;s escalation has hastened; the doctors have identified buried regions of more secure inner muscle layers or parts of the walls of connective tissues. Staging of this extent might suggest the spread of cancer beyond regions of the esophagus, especially close organs or other lymph nodes that are near the esophagus.</li>
</ul>

&nbsp;

<ul>
	<li>Stage IV: The final advancement of staging deepens the severity of cancer. Stage IV is typically associated with the vast and expanded reach of cancer, where the malignant growth has impacted organs and lymph nodes that are considerably further away from the esophagus or the initial point of growth.</li>
</ul>

&nbsp;

Cancer, although pervasive, is an ambiguous domain in medicine that is constantly being researched and reviewed. The staging criteria and system within oncology are fundamentally changing; therefore, they can determine the course or treatment options for patients.

<div>&nbsp;</div>

Treatment

Due to medical advancements, individuals are welcomed with a vast archive of treatment choices that range from local mucosal resection or ablation therapy to esophagectomy, chemotherapy, and radiation treatment.

Suggested therapy is principally contingent on the stage, cancer area, and patients&#39; clinical eligibility for being offered a specific restorative methodology. The stage groupings portrayed till now within the medical fraternity are exceptionally helpful for both dictating prognosis and directing treatment. But there remains room for improvement where patients can be classified significantly more essentially while thinking about treatment.

While considering therapy for individuals diagnosed with malignant growth, especially esophageal cancer patients, the system is at first determined by whether the patients are in the initial stages of indication of distant metastases<a href="#accordion">[10]</a>.&nbsp;The overall treatment guidelines that are followed regardless may include the following:

&nbsp;

<ul>
	<li>
	<h5>Surgery</h5>
	</li>
</ul>

Surgery is perhaps the most widely recognized therapy for esophageal cancers. The invasive medical procedure is selected to remove and separate some or much of the esophagus, as well as some tissue around it, in a technique called esophagectomy. If cancer spreads and has a risk of advancing to further stages, the esophagus is removed and the specialist might reposition the stomach (moving it up into the chest), or compensate with a segment of the digestive tract to save capability. The specialist may likewise eliminate lymph nodes around the esophagus and examine them for cancer cells under a microscope<a href="#accordion">[11]</a>.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Radiation Therapy</h5>
	</li>
</ul>

Radiation therapy is an approach to treating illness with the help of radiation (high-energy beams) or radioactive substances<a href="#accordion">[11]</a>. It is potent and vigorous enough to kill or harm malignant growth and tumors through the standard process of directing a radiation emission at cancer. The radiation annihilates the cancer cells by obstructing their development and division<a href="#accordion">[1]</a>.&nbsp;Radiation can be preferred as the sole treatment and can be applied before medical procedures to shrivel growths, or after medical procedures to kill any cancer cells that might remain. During radiation therapies for esophageal cancer, a stent (little cylinder) is embedded into the esophagus to prevent it from collapsing. This is called intraluminal intubation and dilatios<a href="#accordion">[1]</a>.

&nbsp;

<ul>
	<li>
	<h5>Chemotherapy</h5>
	</li>
</ul>

Chemotherapy is characterized as a procedure involving prescriptions to kill or stop the development of cancer cells<a href="#accordion">[11]</a>. Some chemotherapy drugs are taken as pills and some are taken intravenously, i.e., into the vein. Chemotherapy drugs travel through the circulation system and can eradicate cancer cells all over the body. For esophageal cancer, chemotherapy is seldom eased into treatment before a medical procedure.

&nbsp;

<ul>
	<li>
	<h5>Endoscopic Submucosal Dissection (EDS) Or Endoscopic Mucosal Resection (EMR)</h5>
	</li>
</ul>

Endoscopic submucosal dissection (EDS) or endoscopic mucosal resection (EMR) are techniques to manage the early growth and initial stages of a tumor. The growths might be taken out endoscopically, without eliminating significant portions of the esophagus<a href="#accordion">[11]</a>.

&nbsp;

<ul>
	<li>
	<h5>Endoscopic Laser Therapy</h5>
	</li>
</ul>

Endoscopic laser therapy may prove to be productive in situations that require further assistance in preventing the development of advanced cancers that can potentially obstruct the esophagus and disrupt swallowing. A supplementary component of palliative care involves lasers that are used for making cuts and incisions in the blockage to improve gulping and permit the patient to eat<a href="#accordion">[11]</a>.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Photodynamic Therapy</h5>
	</li>
</ul>

Photodynamic treatment (PDT) is a unique procedure that relies on photoactive medications that comprise drugs stimulated by non-thermal light to be consumed by malignant growth cells. Thus, obliterating the cancer cells. This therapy might be suggested to assist with facilitating the debilitating symptoms of esophageal cancer, especially difficulties in consuming food or deglutition<a href="#accordion">[11]</a>.

It should be noted that conclusive information from randomized preliminaries to direct the therapy of esophageal disease is inadequate for the majority of clinical circumstances. Results likewise by and large are generally poor with numerous treatment techniques, so laying out the ideal treatment for various clinical circumstances stays an area of dynamic exploration<a href="#accordion">[12]</a>.

The NCCN rules mirror the absence of conclusive proof and frequently permit a range of likely medicines for the overwhelming majority of clinical circumstances. Considering the commonly insufficient prognosis and the potential morbidity related to treatment, multidisciplinary assessment by medical procedures, clinical oncology, and radiation oncology ought to be considered for all patients before a therapy methodology is started. Treatment that fails to adhere to rules should presumably just be utilized concerning clinical preliminaries<a href="#accordion">[10]</a>.

<div>&nbsp;</div>

Esophageal cancer is a complicated and tedious illness that if ignored or not treated according to its stage can worsen and cause multiple complications. Some possible complications include the following<a href="#accordion">[2]</a>:

&nbsp;

<ul>
	<li>Obstruction In Esophagus: Unprecedented and unavoidable obstructions within the esophagus. The escalation of tumors can decrease the esophageal cavity and increase the possibility of friction. This is extremely painful and causes a great deal of discomfort during deglutition.&nbsp;</li>
</ul>

&nbsp;

<ul>
	<li>Uncontrollable Pain: Most patients fighting and battling advanced stages of cancer describe it to be exhausting, as chronic pain overwhelms them. Different stages of esophageal cancer and other underlying health conditions may determine the degree and severity of pain.&nbsp;</li>
</ul>

&nbsp;

<ul>
	<li>Bleeding In Esophagus: Risky and fickle growth of malignant tumors and the rampant division of cancer cells within the esophagus may raise the risk of bleeding. While bleeding is normally gradual, it can occur at any given time.</li>
</ul>

&nbsp;

To ensure advanced stages of esophageal cancers do not leave irreparable damage to the individual, it is extremely important to update and remain in constant communication with a licensed and specialized doctor who would be able to tend to the complication and health concerns more professionally.

<div>&nbsp;</div>

Risk factors of esophageal cancers differ slightly considering the type of cancer, whether squamous cell carcinoma or esophageal adenocarcinoma. Moreover, numerous research studies have indicated the adverse effect of inadequate nutrition, compromised immunity, reliance on non-medicated drugs, excessive smoking of tobacco, and frequent consumption of alcohol to be prominent factors that increase the probability of an individual developing esophageal cancer<a href="#accordion">[13]</a>.

There have also been affirmative case studies that corroborate the theoretical connection of esophageal cancers to genetics. Hereditary autosomal dominant conditions such as Tylosis have increased the risk of an individual being diagnosed with squamous cell carcinoma<a href="#accordion">[14]</a>.&nbsp;

However, recent developments have elaborated the contributions of other factors which may make an individual more susceptible to developing esophageal adenocarcinomas. This includes obesity, which may increase the risk of GERD and stimulate hormones that can activate inflammatory markers<a href="#accordion">[14]</a>.

<div>&nbsp;</div>

The prevention of esophageal cancer is rather theoretical as there is no scientific guarantee. But the following acts may decrease the possibility and ward off the development of advanced stages<a href="#accordion">[15]</a>:

<ul>
	<li>Immediately stop or avoid smoking tobacco</li>
	<li>Limit alcohol consumption to a bare minimum</li>
	<li>Incorporate a considerable dose of vegetables and fruits into the diet</li>
	<li>Participate in regular physical activity to maintain a healthy weight</li>
	<li>Seek immediate medical attention for chronic <a href="https://www.merisehat.pk/disease/heart-burn-58" target="_blank">heartburn </a>and reflux</li>
</ul>

<div>&nbsp;</div>

There has been recent research that indicates the relationship between TM4SF1 support esophageal squamous cell carcinoma metastasis by the involvement of integrin &alpha;6. Transmembrane-4 L-six member-1 (TM4SF1) belongs to the L6 family and serves as an indicative transducer to direct cancer cell actions and escalation. It should be noted that the capability and component of TM4SF1 in esophageal squamous cell carcinoma (ESCC) metastasis is still ambiguous. It was observed that TM4SF1 expression is expanded and decidedly related to clinical TNM stage, N classification, differentiation, tumor growth, and unfortunate prognosis in ESCC patients. Strangely, it is exhibited that TM4SF1 advances ESCC cell bonding, spreading, relocation, and invasion; however, not cell multiplication, in a laminin-dependent way by communicating with integrin &alpha;6<a href="#accordion">[16]</a>.&nbsp;

&nbsp;

Key Points

<ul>
	<li>Esophageal Cancer is the accumulation of malignant cells in the esophagus and neighboring lymph nodes due to the rampant division of cells.</li>
	<li>There are two types of esophageal cancers: squamous cell carcinoma and esophageal adenocarcinoma. Stages of esophageal cancer have been numbered from 0 to Stage IV.</li>
	<li>Diagnosis involves identifying the presence of cancer and its extent. It can be done through imaging tests such as CT scans, PET scans, MRIs, endoscopic ultrasounds, and invasive methods such as laparoscopy and thoracoscopy.</li>
	<li>Treatment options range from surgery to radiation therapy, chemotherapy, endoscopic laser therapy, and photodynamic therapy.</li>
	<li>Risk factors have been outlined as genetics, obesity, excessive consumption of alcohol, drugs, and tobacco.</li>
</ul>

<div>&nbsp;</div>

[1] National Cancer Institute (NCI). (2021, November 18). Esophageal Cancer Treatment (Adult) (PDQ®)–Patient Version.

[2] Berry, M. F. (2014). Esophageal cancer: staging system and guidelines for staging and treatment. Journal of Thoracic Disease, 6 Suppl 3(Suppl 3), S289–S297.

[3] Cleveland Clinic. (2019, August 22). Esophageal Cancer.

[4] D'Amico, T. A. (2008). Surgery for esophageal cancer. Gastrointestinal cancer research: GCR, 2(4 Suppl), S6–S9.

[5] Ek, W. E., Levine, D. M., D'Amato, M., Pedersen, N. L., Magnusson, P. K., Bresso, F., . . . Clinic, M. (2013). Germline genetic contributions to risk for esophageal adenocarcinoma, Barrett's esophagus, and gastroesophageal reflux. Journal of the National Cancer Institute, 105(22), 1711–1718.

[6] John Hopkins Medicine. (2022). Esophageal Cancer.

[7] Mayo Clinic Staff. (2022, April 19). Esophageal Cancer.

[8] Mofit Cancer Center. (2022, August 8). Types of Esophageal Cancer.

[9] Olson, T. S. (2022, June 16). Clinical manifestations and diagnosis of Fanconi anemia.

[10] Oze, I., Matsuo, K., Ito, H., Wakai, K., Nagata, C., Mizoue, T., . . . Japan, R. G. (2012). Cigarette smoking and esophageal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Japanese journal of clinical oncology, 42(1), 63–73

[11] Ratini, M. (2022, January 20). Esophageal Cancer.

[12] Sicong, H., Xin, H., Jiajia, L., Siwei, W., Jiaxin, W., Tiantian, Z., . . . Qinglei, H. (2022). TM4SF1 promotes esophageal squamous cell carcinoma metastasis by interacting with integrin α6. Cell Death & Disease, 13 (609).

[13] Spechler, S. J. (2021, October 19). Barrett's esophagus: Epidemiology, clinical manifestations, and diagnosis.

[14] The American Cancer Society. (2020, March 20). What Causes Esophageal Cancer?

[15] The National Health Service (NHS). (2021, August 10). Biopsy: How it is Performed.

[16] Velleuer, E., & Dietrich, R. (2014). Fanconi anemia: young patients at high risk for squamous cell carcinoma. Molecular and cellular pediatrics, 1(1), 9.