Cancer of the esophagus

Leta Scott Chetister Mohr Freeman Hoose Fields Bassett Eckman died on April 12, 1985, just two days shy of her 90th birthday. The official cause of death was cancer of the esophagus. I was a junior in college at the time, and thought she died of old age. When visiting her, I mostly witnessed dementia and muscle/strength deterioration. This seemed standard enough to me for someone of her years.

For the last ten years of her life or so, I recall this debilitation more than anything else. When she entered the senior residence/nursing facility in 1972 at age 76, she was not only mobile, but also active. She treated the place more like a home than a place to “live out her final years,” as we said back then, and although she didn’t drive, she did leave pretty regularly—for meals, shopping, local family visits and trips to visit other family members. Even as the years went by, many of our visits included walks both inside and outside the facility. Now, she wasn’t always well enough to do that. Sometimes she felt lousy, and we would simply sit in one of the lounges or at a dining room table and chat. Other times she felt worse and would be in bed. Our visits were short then. Again, as a child and teenager, I believed she was just, well, old.

According to Wikipedia, the initial symptom of cancer of the esophagus is difficulty swallowing (or dysphagia) or more painful swallowing (odynophagia). There is also pain like heartburn and a husky, raspy or hoarse cough (which indicates a tumor obstructing the airway).  Since these symptoms are very similar to a viral infection—i.e. sore throat—or common for smokers, it’s not hard to believe that a person suffering from this form of cancer would not be overly concerned, especially if the symptoms regularly waned. The coughing up of blood, another symptom, would cause concern.

Esophageal cancer is relatively rare form of cancer more common in men than women, more common in African American men than other races and generally strikes those over age 60, with a median age of 67.  Tobacco smoking and heavy alcohol use increase the risk and more prominently when together than individually. Tobacco and/or alcohol account for 90% of esophageal carcinomas. Those with gastroesophageal reflux disease or acid reflux also have a higher likelihood, because of the chronic irritation of the mucosal lining.

The disease is usually diagnosed after a barium swallow and/or esophagogastroduodenoscopy (or endoscopy)—that is, a tube inserted into the throat. Physicians then take biopsies of the tumors, most of which are malignant. Treatments include radiation and chemotherapy, esophagectomy (removal of part of the esophagus) and the insertion of a stent to help the sufferer eat and swallow.

As far as I knew, my great-grandmother never had radiation or chemotherapy.

Prognosis for this type of cancer is quite poor, because most patients are not diagnosed until the disease is advanced. The five-year survival rate is less than 20%. Most die within the first year of diagnosis. This, I suspect, is because most folks think that they have a viral infection or smoker’s cough, gradually eating softer foods and liquids.

To decreased risk, the potential sufferer should taking regular aspirin, adopt a diet rich in cruciferous (broccoli, cabbage, cauliflower) green and yellow vegetables and fruits and enjoy a moderate coffee consumption.

I believe my great-grandmother was diagnosed very late and refused more than the basic treatment.