Esophageal Cancer

Esophageal cancer is cancer that occurs in the esophagus — a long, hollow, muscular tube that connects your throat to your stomach. It carries food and liquid that you swallow to your stomach to be digested.

Esophageal cancer usually begins in the cells that line the inside of the esophagus. Esophageal cancer can occur anywhere along the esophagus, but in people in the United States, it occurs most often in the lower portion of the esophagus. More men than women get esophageal cancer.The most common types of esophageal cancer are squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma begins in flat cells lining the esophagus. Adenocarcinoma begins in cells that make and release mucus and other fluids. Smoking and heavy alcohol use increase the risk of esophageal squamous cell carcinoma. Gastroesophageal reflux disease and Barrett esophagus may increase the risk of esophageal adenocarcinoma.

Esophageal cancer is not common in the United States. In other areas of the world, such as Asia and parts of Africa, esophageal cancer is much more common.

Esophageal cancer is often diagnosed at an advanced stage because there are no early signs or symptoms. Your doctor uses imaging tests and a biopsy to diagnose esophageal cancer. Treatments include surgery, radiation, and chemotherapy. You might also need nutritional support, since the cancer or treatment may make it hard to swallow.

Early esophageal cancer typically causes no signs or symptoms.

Signs and symptoms of later stages of esophageal cancer include:

• Difficulty swallowing (dysphagia)
• Weight loss without trying
• Chest pain, pressure, or burning
• Worsening indigestion or heartburn
• Coughing or hoarseness

It is not clear what causes esophageal cancer. Esophageal cancer occurs when cells in your esophagus develop errors (mutations) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells form a tumor in the esophagus that can grow to invade nearby structures and spread to other parts of the body.

Risk factors for developing esophageal cancer include:

• Smoking
• Heavy alcohol drinking
• Obesity
• Eating a diet high in processed meat
• Consuming few fruits and vegetables
• Gastroesophageal reflux disease
• Barrett’s esophagus
• Drinking very hot liquids
• Advanced age
• Receiving radiation treatments to the chest or upper abdomen

Tests and procedures used to diagnose esophageal cancer include:

• Using a scope to examine your esophagus (endoscopy). During endoscopy, your doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your esophagus. Using the endoscope, your doctor examines your esophagus, looking for cancer or areas of irritation.
• Collecting a sample of tissue for testing (biopsy). Your doctor may use a special scope passed down your throat into your esophagus (endoscope) to collect a sample of suspicious tissue (biopsy). The tissue sample is sent to a laboratory to look for cancer cells.

Once you have been diagnosed with esophageal cancer, your doctor will use tests such as computerized tomography (CT) scan and positron emission tomography (PET) to determine the extent (stage) of your cancer. Staging helps determine what treatments are most appropriate for you.

The stages of esophageal cancer are:

• Stage I. This cancer occurs in the superficial layers of cells lining your esophagus.
• Stage II. The cancer has invaded deeper layers of your esophagus lining and may have spread to nearby lymph nodes.
• Stage III. The cancer has spread to the deepest layers of the wall of your esophagus and to nearby tissues or lymph nodes.
• Stage IV. The cancer has spread to other parts of your body.

As esophageal cancer advances, it can cause complications, such as:

• Obstruction of the esophagus. Cancer may make it difficult or impossible for food and liquid to pass through your esophagus.
• Pain. Advanced esophageal cancer can cause pain.
• Bleeding in the esophagus. Esophageal cancer can cause bleeding. Though bleeding is usually gradual, it can be sudden and severe at times.

If you have or have had esophageal cancer, you can take steps to manage the stress that accompanies the diagnosis:

• Learn about esophageal cancer so you can make informed decisions about your care.
• Have a schedule of follow-up tests and go to each appointment.
• Take care of yourself so that you are ready to fight cancer. This includes eating a healthy diet that includes plenty of fruits, vegetables and whole grains, exercising for at least 30 minutes most days of the week, and getting enough sleep so that you wake feeling rested.
• Accept help and support from family and friends.
• Talk with other cancer survivors or attend support groups.

After esophageal cancer is found and staged, your physician will discuss treatment options with you. The treatments will be based on your overall health and the extent and location of the cancer.

The main options for treatment of cancer of the esophagus include:

• Surgery. If your cancer is very small, confined to the superficial layers of your esophagus, and has not spread to other parts of your body, your surgeon may recommend removing the cancer and a portion of healthy tissue that surrounds it. Surgery for very early-stage cancers can be done using an endoscope passed down your throat and into your esophagus. Surgery can also be done to remove part of your esophagus and/or stomach that is affected by the cancer.
• Radiation. Radiation therapy uses high-powered energy beams to kill cancer cells. Radiation can come from a machine outside your body that aims the beams at your cancer (external beam radiation). Or radiation can be placed inside your body near the cancer (brachytherapy). Radiation therapy is most often combined with chemotherapy in people with esophageal cancer. It can be used before or after surgery. Radiation therapy is also used to relieve complications of advanced esophageal cancer, such as when a tumor grows large enough to stop food from passing to your stomach.
• Chemotherapy. Chemotherapy is drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs can be used before (neoadjuvant) or after (adjuvant) surgery in people with esophageal cancer. Chemotherapy can also be combined with radiation therapy. In people with advanced cancer that has spread beyond the esophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by the cancer. Many different chemotherapy drugs can be used to treat esophageal cancer including:
  • 5-fluorouracil (5-FU) (Adrucil)
  • Bleomycin (Blenoxane)
  • Capecitabine (Xeloda)
  • Carboplatin (Paraplatin)
  • Cisplatin (Platinol, Platinol-AQ)
  • Docetaxel (Taxotere)
  • Doxorubicin (Adriamycin)
  • Epirubicin (Ellence)
  • Irinotecan (Camptosar)
  • Methotrexate (Abitrexate, Folex, Mexate)
  • Mitomycin (Mitosol, Mutamycin)
  • Oxaliplatin (Eloxatin)
  • Paclitaxel (Taxol)
  • Topotecan (Hycamtin)
  • Vinorelbine (Navelbine)
• Targeted therapy. Targeted therapy for cancer targets the changes in cells that cause cancer. For some esophagus cancers, chemotherapy may be used along with the targeted drug trastuzumab (Herceptin). Ramacirumab (Cyramza) is targeted therapy used to treat advanced gastroesophageal cancers.