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Esophageal Cancer

Esophageal cancer is a malignant (cancerous) tumor that originates in the esophagus.

Types of Esophageal Cancer

By looking at the cells under a microscope, doctors can determine which of the two types of esophageal cancer is present, including:

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

  • Squamous cell carcinoma, which occurs throughout the length of the esophagus; smoking and alcohol consumption may be causes.
  • Adenocarcinoma, which occurs just above the esophagogastric junction, where the stomach and esophagus meet. Patients with Barrett's esophagus, a complication of GERD, are at higher risk for adenocarcinoma of the esophagus.

Esophageal Cancer Symptoms

Esophageal cancer may not cause any symptoms, or symptoms may be nonspecific, such as heartburn or chest pain. If you experience the following symptoms for more than two weeks, see your gastroenterologist for a definitive diagnosis:

  • Blood in stool or vomit
  • Indigestion
  • Difficulty swallowing (dysphagia) or painful swallowing (odynophagia)
  • Weight loss (often due to an inability to swallow food)

Sometimes, esophageal cancer is found during routine endoscopic surveillance for Barrett's esophagus. Esophageal cancer progresses rapidly, so if you have Barrett's esophagus, your doctor will monitor you frequently in order to detect any cancer in the early stages.

Esophageal Cancer Diagnosis

If you think you may have esophageal cancer, you want to be diagnosed and treated by leading experts in the field. Johns Hopkins gastroenterologists are specialists in treating esophageal cancer. In fact, our doctors treat dozens of patients with esophageal cancer each year, a much higher number than many other care centers.

Johns Hopkins is one of the few centers in the country using endoscopic confocal microscopy, in which a powerful microscope is used to help diagnose a condition during an endoscopy. The endomicroscope is a long tube with a camera on the tip that provides a detailed, high-resolution image that is used to identify abnormalities, allowing physicians to detect cancer cells without a biopsy. These “smart biopsies” precisely target the abnormal area, so invasive surgery is no longer necessary.

Our comprehensive cancer center uses the most effective diagnostic tools. A successful course of treatment depends on an accurate, precise diagnosis.

Esophageal Cancer Diagnostic Procedures

A diagnosis of esophageal cancer begins with a comprehensive physical exam during which you describe your symptoms and medical history. Other diagnostic procedures include:

  • Barium contrast radiography
  • Upper endoscopy with biopsy
  • Endoscopic ultrasound
  • Screening and surveillance

Barium Contrast Radiography

Barium contrast radiography is an X-ray procedure used to evaluate dysphagia and symptoms of esophageal cancer. During the procedure, your doctor can detect early carcinomas and erosions of the mucous lining of the esophagus.

During barium contrast radiography:

  • You swallow a contrast solution called barium.
  • The barium coats your esophagus and gastrointestinal tract, making it easier to detect abnormalities.
  • An X-ray is taken.
  • During the X-ray, your doctor looks for a narrowing in the esophagus called a stricture.

Upper Endoscopy with Biopsy

A gastroenterologist will most likely perform an upper endoscopy with biopsy to help diagnose esophageal cancer. During this procedure, the lining of the esophagus is checked for abnormalities. The endomicroscope is often used to analyze the tissue during an endoscopy, avoiding the need for a more invasive biopsy.

An upper endoscopy allows your doctor to examine the lining of your esophagus, stomach and the first part of your small intestine, called the duodenum. A gastrointestinal endoscopy examines the mucous lining of your upper gastrointestinal tract. The endoscopy and biopsy are two parts of the same procedure:

  • Endoscopy refers to the use of a flexible, lighted tube called an endoscope. The endoscope is inserted into your stomach through your mouth. There is a camera at the tip of the endoscope so your doctor can see the inside of your body.
  • Biopsy means a small tissue sample is removed and sent to a pathology lab for analysis.

During an upper endoscopy:

  • You receive an anesthetic to relax your gag reflex. You may also receive pain medication and a sedative.
  • You lie on your left side, referred to as the left lateral position.
  • Your doctor inserts the endoscope through your mouth and pharynx, into the esophagus.
  • The endoscope transmits an image of the esophagus, stomach and duodenum to a monitor that helps your physician guide the endoscope through your esophagus.
  • Your physician inserts biopsy forceps into the endoscope to obtain tissue samples.

Endoscopic Ultrasound

Johns Hopkins gastroenterologists use endoscopic ultrasonography (EUS) to diagnose and stage esophageal cancer. This procedure provides high-resolution, detailed images that provide our doctors with the information they need to effectively treat esophageal cancer.

EUS uses sound wave technology to evaluate and diagnose disorders of the digestive tract. EUS allows your doctor to see the area up close and detect subtle changes in the mucous lining. High-frequency EUS is also helpful in targeting the abnormal areas so the doctor can perform a biopsy.

Screening and Surveillance

Your doctor may recommend screening and surveillance to monitor your progress.

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

  • Screening may be used for patients who do not have symptoms but are considered at-risk for developing cancer.
  • Surveillance refers to ongoing evaluation of patients who start to show symptoms or who have gastroesophageal reflux disease or Barrett's esophagus.

Chromoendoscopy is one type of screening procedure. Patients who are at increased risk for cancer may undergo this procedure. During an upper endoscopy, a specific type of stain is applied to your esophagus. The solution stains only the normal cells. Your doctor can target the unstained areas for biopsy.

Esophageal Cancer Treatment

Johns Hopkins is a leading treatment center for esophageal cancer. Our doctors see between 50 and 100 new patients each year, providing them with an unparalleled depth of experience. You will receive the best possible treatment based on your diagnosis.

Once your doctor confirms a diagnosis of esophageal cancer, he or she will also stage the disease. Staging the disease means grading the severity of the cancer. Treatment often depends on the stage. 

Learn more about esophageal cancer treatment at Johns Hopkins.

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