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1) Esophageal cancer is caused when healthy cells alter and multiply out of control which
forms a mass, most commonly known as a tumor. Esophageal cancer generates in the esophageal wall and starts at the inner layer of the esophagus and grows outward. The two known types of esophageal cancer are squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma begins in the cells that make up mucosa that lines the esophagus. It commonly develops in the upper and middle portion whereas adenocarcinoma develops in the lower portion of the esophagus and affects the glandular tissue cells called submucosa where the stomach and esophagus connect (, 2018). In the early stages of esophageal cancer, a person may not have any signs or symptoms, symptoms usually occur if the walls of the esophagus have thickened. Signs and symptoms are usually detected if the tumor(s) have grown large enough and they block the esophagus or the entry to the stomach. The most common symptom of esophageal cancer is having difficulty or pain while swallowing, other symptoms can include weight loss, heartburn or indigestion, pain in the throat behind the breastbone or sternum, hoarseness and bringing up undigested food (, 2018). The typical tests used to diagnose esophageal cancer is an endoscopy and taking a biopsy of any suspicious tissues found during the endoscopy. A positive test usually shows cancer cells in the tissues that were tested (, 2018).

2) Factors that increase the possibility of developing esophageal cancer are highest and most common in white and African American men older than 60 years old. The use of tobacco and consuming a large amount of alcohol can increase the likelihood of developing esophageal cancer. The risk also increases if esophageal cancer is present in family members, obesity and Barrette’s esophagus which is gastroesophageal reflux disease (GERD) or acid reflux. Environmental risk factors include having exposure to exhaust fumes, soot, metal dust and silica dust for a long period of time (Saurabh, 2018). According to the world atlas website most cases for esophageal cancer occur in third world countries at 81% with Malawi being the country with the highest rate with 24.2 out of 100,000 people in that country (Sawe, 2018).

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3) The organ system that is most affected by esophageal cancer is the digestive system. One of the main organs within the gastrointestinal tract is the esophagus which allows food to pass smoothly from mouth to the stomach. The most common form of esophageal cancer, adenocarcinoma, affects the submucosa is the esophagus when gastroesophageal reflux is present. Submucosa is a soft connective layer that contains mucosa-associated lymphatic vessels, lymphoid tissue, nerve endings and blood vessels (Marieb, n.d.). Squamous cell carcinoma begins in the cells that make up mucosa and lines the esophagus. Esophageal cancer affecting the submucosa can cause a structural change that results in changing the function and secretion of the mucosa and areas where there are submucosal glands. The most common side effect is painful swallowing if there is inflammation, and difficulty swallowing because the esophagus does not open wide enough with the presence of a tumor to allow for food and liquids to pass through easily. Esophageal cancer can also affect the normal function of peristalsis which is the contraction and relaxation of the muscles in the esophageal wall that assists the food in moving through the gastrointestinal tract (, 2018).

4) The next most affected organ system is the lymphatic system. The cancer spreads from the esophagus to other organs when it gets into the lymphatic system and travels through the lymph vessels. Lymphatic vessels serve as the drainage system for the body and picks up any additional tissue fluid and returns it to the blood stream. The lymph nodes serve as the bodies way of protection by removing tumor cells and bacteria by producing an immune response with lymphocytes located in the lymph nodes. Excessive fluid buildup can weaken the tissue cells function when exchange occurs. (Marieb, n.d). Once the cancer spreads to the lymphatic system, a lymphadenectomy is recommended to remove the lymph nodes to help prevent the cancer from spreading. The most common complication is known as lymphedema. When lymph nodes are removed, it leaves the lymph vessels with nowhere to go and more area for fluid to collect in the tissues causing swelling in various locations in the body (, 2018).

5) In the later stages of esophageal cancer, the location of the cancer is no longer just in the esophagus. It has metastasized to other organs in the body through the lymphatic system. The most common organ system the cancer spreads to is the respiratory system, mainly affecting the lungs function and could cause paralysis of the diaphragm (Livstone, 2018). If the lungs are not able to provide gas exchange by adding oxygen and removing the carbon dioxide from the body at the appropriate levels, this can lead to respiratory failure. If some bacteria enter the airway and gets into the lungs, the inflammation generates fluid or pus build up in the alveoli where normal functioning of gas exchange occurs (Healthline, 2018). The most common cause for this is trachea-esophageal fistulas where holes develop between the trachea and the esophagus. This allows for food and liquid to leave the esophagus and enter into the trachea and into the lungs causing pneumonia (Rodriguez, 2018).

6) A significant amount of people dies within one year of any signs or symptoms. The death rate for esophageal cancer is extremely high because it is not typically diagnosed until the disease has spread to other areas of the body. According to Elliot Livstone, fewer than 5 percent of people survive more than 5 years. With the prognosis of esophageal cancer being less than 5 years, and with most cases being fatal, the main concern of doctors is controlling severe symptoms including pain and the difficulty with swallowing (Livstone, 2018). Treatments vary depending on the stage and location of cancer present in the body. Some treatments include a surgery called an esophagectomy which will remove part of the esophagus and lymph nodes surrounding the cancer, radiation and chemotherapy and endoscopic treatments including esophageal dilation to open the narrowing of the esophagus or placing a stent to keep it open (, 2018).

7) H. pylori is a type of bacterial infection that develops in the digestive tract and is known to attack the stomach lining. Although H. pylori is not usually serious, it can cause peptic ulcers in the stomach and small intestines. In research studies it showed that H. pylori infection can decrease gastric acidity that can cause damage to the esophagus, reducing the risk of esophageal cancer and acid reflux disease. The study included 128,992 individuals during the 1960s with regular follow-ups for 5-35 years. The risk of developing esophageal cancer during the follow-up was significantly lower in H. pylori-positive subjects at 80% compared to individuals who were not a carrier of the H. pylori infection (Gastrointestinal Society, 2018). Another study found that people who had H. pylori strains carrying a gene called CagA were half as likely to get adenocarcinoma. H. pylori and CagA-positive H. pylori has become less common due to the increased development of sanitation practices and the increased use of antibiotics, increasing esophageal adenocarcinomas (ScienceDaily, 2018).

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