Esophageal Cancer

What is Esophageal Cancer?

Esophageal cancer is a type of cancer that starts when malignant (cancer) cells form in the tissues of the esophagus. The esophagus moves food and liquid from the throat to the stomach, and its walls are made up of many layers of tissue. Esophageal cancer starts within the inner lining of the esophagus before spreading outward through the other layers as it moves.

The two most common types of esophageal cancer are adenocarcinoma and squamous cell carcinoma. They tend to develop in different parts of the esophagus and are driven by different genetic changes.

Adenocarcinoma begins in glandular cells, which produce and release fluids, such as mucus, from within the lining of the esophagus. It usually starts in the lower part of the esophagus, near the stomach.

Squamous cell carcinoma, also called epidermoid carcinoma, forms in the thin, flat cells lining the inside of the esophagus. It is most often found in the upper and middle part of the esophagus but can occur anywhere along the esophagus.

What are the Symptoms?

• Painful or difficulty swallowing (dysphagia)
• Weight loss
• Pain behind the breastbone
• Hoarseness, cough, and recurrent pneumonias
• Indigestion and heartburn (regurgitation or reflux)

What are the Risk Factors?

• Smoking and alcohol use
• Gastric reflux can increase the risk of adenocarcinoma, especially when it lasts a long time and severe symptoms occur daily.
• Other factors: Men are three times more likely than women to develop esophageal cancer, and white men are more at risk than black men in all age groups. Chances increase with age.

What are the Preventative Measures?

• Avoid smoking and alcohol use
• Weight loss (maintaining a healthy weight will also help to reduce reflux)
• Eat a nutritionally sound diet including fiber, fruits, and vegetables
• Treat reflux (GERD)

What are the Types of Preventative Treatment for Esophageal Cancer?

Chemoprevention uses drugs, vitamins or other agents to reduce the risk of cancer. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and other drugs can reduce swelling and pain.

Radiofrequency ablation can be used to treat patients with Barrett esophagus, a premalignant condition. Radio waves are employed to heat and destroy any abnormal cells that may become cancer.

Endoscopic (through an esophageal scope) resection is also a treatment for Barrett’s esophagus

What Should I Know About Screenings?

There are no standard or routine screening tests for esophageal cancer.

What Happens After Diagnosis?

After a diagnosis, tests are performed to detect if cancer cells have spread within the esophagus or to other parts of the body. Cancer can spread through nearby tissue, through vessels in the lymph system to other parts of the body or via blood vessels. The stages of esophageal cancer are categorized from Stage 0 to Stage IV, with Stage IV indicating the cancer has spread to other parts of the body. Esophageal cancer can return, known as recurrence, even after it has been treated.

What are the Types of Treatment for Esophageal Cancer?

• Surgery is the most common treatment type. Part of the esophagus may be removed in an operation called an esophagectomy.
• Endoscopic resection removes the abnormal tissue and assesses the depth of tumor invasion. If the esophageal cancer is early stage without deep penetration or if the area is premalignant, surgery may not be needed, and surveillance may be all that’s required.
• Radiation therapy using high-energy x-rays and other types of radiation to kill or stop the growth of cancer cells
• Chemotherapy using drugs to stop the growth of cancer cells
• Chemoradiation therapy combines chemotherapy and radiation therapy to increase the effects of both
• Laser therapy uses a laser beam to kill cancer cells
• Electrocoagulation uses an electric current to kill cancer cells
• Immunotherapy using substances made naturally in the body or in a laboratory setting to boost the body’s natural defenses against cancer
• Palliative: If advanced stage, the goals may shift towards patient comfort including any of the above as well as endoscopic dilations of stent placement, feeding tube placement, and control of pain.

Some content courtesy of the National Cancer Institute.