Esophagus Cancer … Diagnosis and Treatment Middle East

Esophageal cancer is one of the most prevalent cancers in the world, the sixth leading cause of cancer death, but many people are not aware of its seriousness. The symptoms that can help early detection are often ignored and, as a result, always diagnosed at an advanced stage, so only about 15% of people diagnosed with esophageal cancer survive five years more later.
Esophageal cancer begins in the cells lining the esophagus and occurs anywhere. Incidence rates vary by geographic region, in some cases due to smoking and alcohol consumption, certain dietary habits and obesity. Men are more likely than women to develop cancer of the esophagus.

– Reasons
Esophageal cancer has no clear and specific cause, and it is certainly caused by mutations in the DNA of cells that develop and divide involuntarily, forming tumors in the esophagus can proliferate to scan nearby structures and spread to other parts of the body.
According to the Mayo Clinic, chronic irritation of the esophagus may contribute to these changes that cause esophageal cancer, as well as a combination of factors that cause this irritation and increase the risk of cancer of the esophagus, including:
Gastroesophageal reflux disease (GERD)
Smoking
* Precancerous changes of the esophagus cells (Barrett's esophagus) will be identified later.
* Obesity
* Drinking alcohol
* Biliary reflux
* Difficulty swallowing because of the sphincter muscle of the esophagus that does not calm down (can not relax)
* Get used to drinking too hot liquids
* Do not eat enough fruits and vegetables
* Undergo radiation therapy in the chest or upper abdomen

– diagnostic
* First: notice the symptoms, difficulty swallowing – weight loss – chest pain – exacerbated indigestion or heartburn to the stomach – coughing or hoarseness – bleeding from the esophagus. Early cancer of the esophagus usually shows no sign.
Second: endoscopy and biopsy, with the help of a gastroscope to search for tumor or irritation sites, and then take a sample of the suspect tissue and examine it in the laboratory to detect the cells cancerous.
Third: Cytospong technology, developed in the oncology unit of the Medical Research Council of the University of Cambridge. This technique provides a simple and safe way to capture abnormal cells in the lining of the esophagus.
Cytosponge is a Medtronic device used once to collect cells from the lining of the esophagus. It consists of a small network of sponges, about 30 mm in diameter, inside a gelatinous capsule attached to a wire. The patient swallows the capsule with water and melts the gelatin coating as soon as it reaches the stomach. After about five minutes, pull the string to retrieve the sponges. Once recovered, the network combines abrasive cells along the esophagus. The collected cells are analyzed to detect the biomarker of the BE Barrett esophagus.
Professor Rebecca Fitzgerald of the Cancer Unit of the Cancer Research Center at the University of Cambridge says that this sponge contains about half a million cells and that she groups together a group of cells the most representative and complete laparoscopy in the esophagus, with an accuracy of 80 to 90%. Cytospong has been tested in more than 1,000 people and more than 94% of patients who have swallowed sponges have not reported any serious side effects. Sponge technology costs less than $ 100, while traditional endoscopy costs about $ 900 a year. Procedure. The British Cancer Society for Cancer Research said the test results were very encouraging.

– "Barrett's esophagus"
Esophageal cancer is often preceded by changes in the cells of the lining of the esophagus, called Barrett's esophagus, whose form changes and develops abnormally. The cause of these cellular changes is the reflux of the bile acid – the return of gastric juice to the top (esophagus). And esophageal cancer 1 to 5 people in 100 have a "Barrett's esophagus", a form of cancer that can be difficult to treat, especially if it is not detected early enough.
Professor Fitzgerald explains that the problem of Barrett's esophagus is that it looks normal and that it can reach up to 10 cm in the esophagus. A map of mutations has been established in the patient with this condition and revealed that in this extension there are many variations between normal and abnormal cells.
* The Barrett's esophagus may be an indicator of adenocarcinoma-type esophageal cancer – the most common type of esophageal cancer in Canada.
* Identifying people with Barrett's esophagus helps monitor the disease and, if necessary, receive treatment to eliminate abnormal cells and reduce the risk of esophageal cancer.
* Endoscopy and biopsy, two traditional methods of diagnosing the disease, an expensive and inconvenient procedure for patients, requires anesthesia and involves certain risks. Although cytospong is a small network of sponges in a soluble gelatin capsule, it can be safely administered in primary care to collect oesophageal cells for analysis. It can detect cancer of the esophagus at an early stage and avoids biopsies and various tests.
* Saitospong is characterized by sensitivity sensitivity and good privacy to detect the presence of Barrett's esophagus.
* The use of cytospong with biometric index analysis can improve the detection rate of people with BE through a less severe test for endoscopic patients and less expensive.

– treatment
The type of treatment depends on the stage of the cancer, the type of cancer cells and the general health of the patient. includes
* Surgery, whether to remove cancer alone or to remove some of the esophagus or to remove some of the esophagus with the upper part of the stomach.
Chemotherapy, whether it is given before or after surgery, in case of advanced cancer.
* Radiotherapy, that it is administered outside the body or inside the body near the area affected by cancer (intensive treatment).

– Genetical therapy
Researchers at the University of Cambridge have discovered in a study published in the 2016 Journal of the National Cancer Institute that drug-based treatments can help up to 15% of the 8,500 people diagnosed with diabetes. an esophageal cancer in the UK every year. Thanks to advances in DNA research, researchers are better able to identify genes related to the disease, but the fact that gene function is often unknown is that it is difficult to develop a treatment based on discovery.
What is this new gene? The results of the Cambridge study showed that the TRIM44 gene plays a key role in the development of esophageal cancer and also revealed how the gene had been synthesized. This research also reveals that overactivity (when multiple copies occur) increases the activity of the mTOR gene, which regulates cell growth and division – processes that become uncontrolled in the case of cancer.
Professor Rebecca Fitzgerald praised the effectiveness of gene targeting therapies and highlighted the success of Herceptin treatment in treating breast cancer and stomach cancer and hoped that new treatments for cancer of the esophagus would be discovered within five years, provided that there are already a number of drugs targeting mTOR. ).
Researchers have already discovered that when tumors are treated in mice with a gene (TRIM44) with inhibitors (mTOR), their size decreases. Interestingly, these same experiments were conducted with human breast cancer cells and gave the same results, suggesting that these findings can also be applied to other types of cancer.

– Mutations in the genome
Professor Fitzgerald and her colleagues examined a complete set of genomes for analyzing Barrett's esophagus samples from 23 patients, as well as 73 samples taken over a three-year period in a patient with Barrett's esophagus. I found models of mutations in the genome, in which a small fragment of DNA could be replaced by another, for example from C to T, which provides a "fingerprint" for the causes of cancer . Similar work has already been done on lung cancer, where it has been shown that cigarettes leave their imprint in the DNA of the individual. The Cambridge team discovered that fingerprints were due to lesions of the lining of the esophagus due to a spray of stomach acid on its walls. The same fingerprints can be observed in both esophageal cancer and in Barrett's esophagus (Barrett's esophagus), suggesting that these changes occur very early in the disease.
Even in areas of Barrett's esophagus without cancer, the researchers found a large number of mutations in the tissues – an average of 12,000 mutations (compared to an average of 18,000 mutations in the case of cancer). cancer). It is likely that many of them were "waiting for changes", genetic mutations occurred throughout the process, but were not already involved in cancer.
Scientists know very little about how to go from pre-cancer to cancer – this is especially the case in esophageal cancer. The esophagus and Barrett's cancer share many mutations, which allows researchers to better understand the important mutations that lead to the transmission of the disease to a form of fatal cancer.