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Your Questions About Esophageal Cancer Answered

Diagnosing and staging esophageal cancer

What are the symptoms of esophageal cancer?
One of the reasons esophageal cancer is usually diagnosed late in the spread of the disease is that it is often asymptomatic (without symptoms). However, sometimes there are noticeable symptoms in the early stages, including:

  • Mild or intermittent difficulty swallowing (sometimes called dysphagia), pain while swallowing (also known as odynophagia), or a foreign body sensation
  • Heartburn
  • Chest pain
  • Dyspepsia (indigestion)
  • Occult blood in the stool (undetectable to the eye but visible through tests or a microscope)
  • Iron-deficiency anemia
  • Unexplained weight loss

People who experience some or all of these symptoms, especially those diagnosed with a history of Barrett's esophagus, should have them checked by a doctor.

Symptoms of advanced esophageal carcinoma become apparent with tumor growth. The most common symptoms include:

  • Increasing difficulty swallowing
  • Weight loss and anorexia (due to difficulty swallowing or pain when swallowing)

How common is esophageal cancer?
Esophageal cancer is rare in the United States, with between 12,000 and 18,000 cases diagnosed annually. However, among solid-tumor cancers, incidences of esophageal cancer are the fastest growing.

What are the risk factors?
It is believed that environmental factors contribute to the development of esophageal cancer, including:

  • Alcohol intake
  • Cigarette smoking
  • Nutritional deficiencies, including iron, riboflavin, and vitamin A, although direct evidence for this link is lacking. Not having a varied diet appears to be linked to the incidence of esophageal cancer.
  • Coming from a lower socioeconomic group
  • Excessive weight (obesity)
  • Longstanding acid reflux

How is esophageal cancer staged?
Staging is done according to the TNM classification system (T stands for tumor depth of invasion, N for regional lymph node metastasis, and M for distant organ metastasis). The resulting classifications are grouped into five stages, including Stage 1, Stage IIA, Stage IIB, Stage III, Stage IV. Stage I indicates tumors that have not metastasized while Stage IV indicates metastasis. Read more about staging.

What happens after a patient is diagnosed with esophageal cancer?
An oncologist, working with other specialists, develops a treatment plan that may include surgery, chemotherapy, and radiation, or a combination of those three therapies.

At Johns Hopkins, a multi-disciplinary clinic for esophageal cancer patients brings together an oncologist, surgeon, gastroenterologist, and radiation oncologist to meet with a patient (and the patient's family) to review the patient's diagnosis and develop a treatment plan.

Chemotherapy for esophageal cancer

What is chemotherapy?
Chemotherapy is a type of cancer treatment that employs drugs that interfere with the DNA of cancer cells. It usually involves daily or weekly treatments that stretch over a period of time.

How many chemotherapy treatments can an esophageal cancer patient expect?
The number of chemotherapy treatments will depend on the patient’s overall condition and health as well as the stage of the cancer when it is diagnosed. The amount of time chemotherapy will last ranges from a few weeks to a number of months.

Radiation therapy for esophageal cancer

How many radiation treatments does someone with esophageal cancer typically need?
Radiation treatments last approximately 15 minutes a day and are typically given daily for five to six weeks. A patient is usually treated with 25 to 30 treatments (or fractions) of radiation.

Surgery for esophageal cancer

Are all stages of esophageal cancer treated with surgery?
As with most types of cancer, determining treatment, including surgery, depends on the patient and his or her circumstances. Generally, surgery (in combination with chemotherapy and often radiation as well) is done for all stages of esophageal cancer except for Stage IV. Stage IV cancers are usually treated with chemotherapy only. Surgery and radiation may be used in some cases for relief from symptoms, such as to relieve pain or help with swallowing.

How much recovery time is needed after surgery?
It will vary according to the type of surgery, but generally patients will be in the hospital for five to 10 days.

Therapeutic services for esophageal cancer

What type of post-surgery care will a patient need?
Esophageal cancer patients will probably need services to:

  • Help with learning to swallow
  • Deal with a feed tube during recovery
  • Deal with a stent, which may be placed in the esophagus during surgery

In addition, patients may work with a physical therapist to gain strength and with a dietician for advice on the effects of esophageal cancer and dietary needs.

Esophageal cancer patients at Johns Hopkins receive therapeutic services from a range of experts, including dieticians and physical therapists. They may also receive additional endoscopies for treatment or other complications and/or for surveillance.

How long does post-treatment follow up last? Should a patient expect to come to Johns Hopkins for weeks? Months?
Because the esophageal cancer experts at Johns Hopkins usually recommend that patients receive chemotherapy and radiation before therapy, pre-surgery treatment will take longer than post-treatment follow-up. Radiation and chemotherapy are usually given in courses that last anywhere from a week to several weeks.

Hopkins is an international cancer center and many of our patients come from around the country and other international sites to be treated by our specialists. As a result, we offer resources to help coordinate housing during treatment. Patients and their families can find out about all of the services Johns Hopkins offers, including housing information, on the Patient Information website.

Our specialists maintain contact with the patient’s primary care physicians to ensure continuity of care. Our goal is to understand the unique needs of each patient and provide the appropriate support to help each patient be successful during treatment.

Post-treatment follow-up generally involves regular medical appointments in the months after treatment to ensure that any treatment complications are taken care of and to check for recurrence. If there is no recurrence, the time between appointments will lengthen, though patients will need to be checked regularly to ensure there is no tumor recurrence.

What is palliative care?
Palliative (pronounced PAL-lee-uh-tiv) care focuses on the whole person and the relief of symptoms, such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, depression, and difficulty sleeping. It can help patients carry on with daily life, including tolerating medical treatments. Palliative care is appropriate at any stage of an illness and can be provided at the same time as your cancer treatment.

Clinical trials for esophageal cancer

What is a clinical trial?
A clinical trial is a type of research that uses human subjects to answer questions about drug or other medical interventions. While it can often be beneficial for patients who participate in trials, the biggest value of clinical trials are the contribution those trials make to future treatments and procedures, often offering future patients a chance at extended life, or even a cure.