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Esophageal Cancer

Esophageal Cancer: What You Need to Know

father and son using a laptop
  • Esophageal cancer is a type of throat cancer that develops inside the esophagus, the tube that connects the throat to the stomach.
  • Esophageal cancer symptoms often don’t become noticeable until they have reached an advanced stage.
  • The most common symptom of esophageal cancer is trouble swallowing; specifically, a feeling that food is lodged in the chest which gradually worsens over time.
  • Esophageal cancer is linked to Barrett’s esophagus, a condition that arises from chronic acid reflux.
  • Four out of five esophageal cancer cases occur in men. While it is not a common cancer, incidences of certain types of esophageal cancer are on the rise in the United States.

What is esophageal cancer?

Esophageal cancer develops in the esophagus, which is the tube that connects your throat to your stomach. Tumors arise in the mucosa, which is the inner lining of the esophagus.

There are two types of esophageal cancer, each with different risk factors:

Adenocarcinoma

Cancers that start in gland cells at the bottom of the esophagus are called adenocarcinomas. This type of cancer is the most common esophageal cancer. It usually occurs closer to the stomach. Chronic acid reflux, gastroesophageal reflux disease (GERD), Barrett’s esophagus and chronic heartburn can increase your risk of developing adenocarcinoma esophageal cancer.

Squamous cell carcinoma

This type of esophageal cancer arises from squamous cells that are primarily in the upper esophagus. Squamous cell tumors are associated with heavy alcohol consumption, smoking and organ transplants.

What causes esophageal cancer?

Factors that can increase your risk of esophageal cancer include:

  • Smoking
  • Heavy alcohol consumption
  • Chronic heartburn or acid reflux
  • Gastroesophageal reflux disease (GERD)
  • Barrett’s esophagus, a condition that sometimes develops in people with GERD
  • Achalasia, a rare disorder of muscles in the lower esophagus

What are the symptoms of esophageal cancer?

Most esophageal cancer symptoms aren’t noticeable until the cancer is in an advanced stage when it may be hard to treat. Symptoms of esophageal cancer may be caused by other, more common conditions. It is important to receive an accurate diagnosis from a physician if you suspect you may be at risk.

Trouble Swallowing

The most common symptom of esophageal cancer is trouble swallowing, especially a feeling of food stuck in the chest. With some patients, choking on food also occurs. These symptoms gradually worsen over time, with an increase in pain when swallowing, as your esophagus narrows from the growing cancer.

If you have recently changed your eating habits to avoid trouble swallowing—such as taking smaller bites, eating softer food or avoiding solid food entirely—you may benefit from a screening evaluation with your doctor.

Chronic Chest Pain

If you suffer from chronic heartburn or gastroesophageal reflux disease (GERD), you’re already familiar with a pain that feels like burning in the middle of your chest. That painful sensation may become more noticeable when esophageal cancer develops. Esophageal cancer may also cause chest pain a few seconds after swallowing, when food or liquid reaches the site of the tumor in the esophagus.

Weight Loss Without Trying

Roughly 50 percent of people with esophageal cancer experience unexplained weight loss. This can be due to eating less due to swallowing problems or a decreased appetite due to the cancer.

Persistent Coughing or Hoarseness

Developing a hoarse, scratchy voice or a cough that doesn’t go away can also indicate the presence of esophageal cancer.

How is esophageal cancer diagnosed?

Endoscopic view of early adenocarcinoma in Barrett’s esophagus
Endoscopic view of early-stage cancer in Barrett’s esophagus (click to enlarge)

Esophageal cancer is often not diagnosed until it reaches advanced stages, so accuracy in the diagnosis and staging process is especially crucial for the best possible outcome. A gastroenterologist (a doctor who specializes in diseases of the digestive system) may be the first provider to recognize the signs of esophageal cancer. If you experience any symptoms of esophageal cancer, it is important to seek treatment early when the cancer is treatable.

There are several types of tests to diagnose esophageal cancer. The most common tests are:

  • Endoscopy with biopsy: Sometimes called an esophagogastroduodenoscopy or EGD, this is the most common test a doctor will perform to test for esophageal cancer. A doctor uses an endoscope (a flexible tube with an attached camera that allows your doctor to see inside your body) to take tissue samples from abnormal areas (this is also called a biopsy).
  • Endoscopic ultrasonography: If your biopsy results reveal cancer, you doctor may order an endoscopic ultrasound (EUS). This is one of the most accurate imaging procedures for detecting esophageal cancer. EUS combines two procedures to see within your esophagus:
    • Endoscopy, during which your doctor inserts a thin, lighted tube into your body
    • Ultrasound, which uses high-frequency sound waves to obtain detailed images
  • PET scan: A PET scan, or positron emission tomography, technology is used to determine if the cancer has spread to areas beyond the esophagus. A PET scan uses radioactive dye to highlight parts of your body during scanning, so a doctor can see potentially cancerous areas to treat.

Other types of testing, which are less common, include:

  • Barium swallow: A barium swallow, also called an esophagram, is an X-ray procedure in which you drink a barium-based solution while a doctor watches how it passes through your esophagus.
  • Video fluoroscopic swallowing exam: This test, also called a VFSE, is similar to a barium swallow. A doctor records a digital movie of your esophagus while you swallow. Learn more about fluoroscopy.
  • Endoscopic confocal microscopy: This technology uses laser technology to provide immediate results without a biopsy or pathology. Learn more about confocal microscopy for esophageal cancer diagnosis.
  • CT scan: A CT scan, or computed tomography scan, is an imaging test that’s commonly used after cancer is diagnosed. It allows doctors to see how locally advanced the tumor is or whether it has spread beyond the esophagus.

How is esophageal cancer treated?

Technique for transhiatal esophagectomy; A: removal of the esophagus; B: translocation of the stomach
Technique for transhiatal esophagectomy; A: removal of the esophagus; B: translocation of the stomach (click to enlarge)

Treatment for esophageal cancer is individualized to each patient’s unique needs. Treatment options include:

  • Radiation therapy: The use of X-rays, gamma rays and charged particles to fight cancer
  • Chemotherapy: The use of anticancer drugs to treat cancerous cells
  • Surgery: The use of an operation to remove the cancerous tissue from the body

Combined Treatment for Esophageal Cancer

Most treatment plans for esophageal cancer involve a combined approach, which is when you receive a mix of radiation, chemotherapy or surgical treatments, instead of just one type of treatment.

  • Neoadjuvant therapy is a combination of therapy (usually radiation and chemotherapy) that aims to shrink tumors and prevent their reoccurrence before surgery.
  • Treating with chemotherapy and radiation together halts the spread of microscopic tumors that have developed beyond the original tumor site.
  • Research also shows patients recover more quickly from radiation and chemotherapy when they are performed before surgery rather than after.

When developing the most effective treatment plan for your unique case, your doctors will consider many factors including:

  • The stage of your cancer when it is discovered
  • Your overall health and nutrition levels
  • The location of the tumor site
  • Your personal preferences for different treatment options

How can I prevent esophageal cancer?

The most effective ways to prevent esophageal cancer involve choices that are good for your overall health:

  • Avoid tobacco and alcohol
  • Eat a healthy diet
  • Maintain a healthy weight
  • Seek treatment for reflux and heartburn
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