Esophageal cancer

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 29, 2016
StartDiseasesEsophageal cancer

Esophageal cancer accounts for approximately one percent of all cancers diagnosed in the United States. Men are three times more likely to develop esophageal cancer than women. Overall, the average American male has a one in 125 chance of developing esophageal cancer. That rate drops to one in 435 for women. The average five-year survival rate for individuals with all stages of esophageal cancer is approximately 20 percent.

Contents

Definition & Facts

Esophageal cancer affects the hollow, tube-like structure responsible for carrying food from your mouth to your stomach. The esophagus is situated between the trachea and the spine. The cancer usually attacks the cells lining the esophagus. It typically starts in the inner mucosa layer of the lining and works its way outward to the muscle.

There are two primary types of esophageal cancer defined by the types of cells that are affected. The first type is called squamous-cell carcinoma, and it can occur at any point along the length of the esophagus. The second type, adenocarcinoma, starts in gland cells that are not part of the esophageal lining. This kind of cancer typically occurs in the lower part of the esophagus where it joins the stomach.

Symptoms & Complaints

In its early stages, esophageal cancer may not cause any signs or symptoms. As the condition progresses, the individual may complain of persistent coughing or hoarseness, unintentional weight loss, difficulty swallowing, and chest pain or worsening heartburn. Individuals who experience these symptoms should consult their health care provider, especially if they have any of the following risk factors:

In advanced cases, the tumors may obstruct the esophagus so much that it is impossible to take food or liquids by mouth. There is also a risk of sudden, severe bleeding in the esophagus. Esophageal cancer can also cause severe pain in advanced stages.

Causes

Like any other type of cancer, esophageal cancer is the result of genetic mutations that occur in the cellular DNA. These changes cause cells to divide and grow uncontrollably. These abnormal cells develop into a tumor that can grow and spread to other parts of the body. Esophageal cancer is staged according to how far it has spread into surrounding tissues and organs:

  • Stage 0—Precancerous cells are found in the lining the esophagus.
  • Stage I—Actual cancerous cells are found in the lining of the esophagus.
  • Stage II—The cancer has spread to the outer muscle wall of the esophagus. It may also have spread to a couple of nearby lymph nodes.
  • Stage III—The cancer has spread to the connective tissue wall or deep into the inner muscle layer. It may also have reached other organs and numerous lymph nodes.
  • Stage IV—The cancer has metastasized to multiple organs and far away lymph nodes.

While it is unclear exactly what triggers these cellular mutations, one theory suggests that it could be the result of chronic irritation, such as that caused by acid reflux.

Diagnosis & Tests

The most common test used to diagnose esophageal cancer is an endoscopy. During this procedure, an endoscope is passed down the throat and into the esophagus. An endoscope is a hollow tube with a small camera attached to the end. The camera allows the doctor to view the lining of the esophagus to identify any tumors or areas showing chronic irritation. During the endoscopy, the doctor will collect samples of any abnormal-looking cells for biopsy. A lab will examine the cells further to determine if they are actually cancerous.

Another test used to diagnose disorders of the esophagus is the barium swallow study where the patient drinks a liquid to coat the esophagus to make it stand out more on an X-ray. This test is particularly useful in ruling out structural abnormalities of the esophagus. Once a diagnosis of esophageal cancer is confirmed, the doctor will use CT scans, PET scans, and other tests to determine if the cancer has spread outside of the esophagus.

Treatment & Therapy

Treatments for esophageal cancer vary depending on the stage and type of cells involved. Front-line treatment typically involves surgery to remove small tumors or even part of the esophagus and stomach. Surgery does carry significant risks, including bleeding, infection, and leaking at the site where the esophagus is reattached. Surgery may be used as a stand-alone treatment or in conjunction with other therapies.

Chemotherapy uses powerful drugs to attack and kill cancer cells. The side effects of chemotherapy can vary depending on the specific drugs used. Radiation is often used in combination with chemotherapy to treat esophageal cancer. Radiation uses energy beams to shrink tumors and kill cancer cells. Radiation therapy has numerous side effects, including potential damage to nearby organs and burn-like skin reactions. Although using radiation and chemotherapy together can increase the effectiveness of each treatment, it can also intensify the likelihood and severity of side effects.

Patients with esophageal cancer may also have to undergo procedures to deal with complications from the cancer. This may include relieving esophageal obstructions by inserting stents to keep the esophagus open or inserting a feeding tube through the abdomen to provide nutrition if the individual is unable to take food or liquids by mouth.

Prevention & Prophylaxis

To reduce their risk of developing esophageal cancer, a person should take the following steps:

  • Stop smoking. Individuals having trouble quitting on their own should speak to their health care provider about medications, counseling, and other smoking cessation strategies.
  • Limit alcohol to no more than two drinks a day for men and one drink a day for women.
  • Strive to maintain a healthy weight.
  • Eat a diet that includes a wide variety of colorful fruits and vegetables.