Definition
Esophageal cancer occurs when cancer cells develop in the esophagus, a tube-like structure that runs from your throat to your stomach. Food goes from the mouth to the stomach through the esophagus. The cancer starts at the inner layer of the esophagus and can spread throughout the other layers of the esophagus and to other parts of the body (metastasis).
There are two main types of esophageal cancer. One type is squamous cell carcinoma. Squamous cells line the inner esophagus, and cancer developing from squamous cells can occur along the entire esophagus. The other type is called adenocarcinoma. This is cancer that develops from gland cells. To develop adenocarcinoma of the esophagus, squamous cells that normally line the esophagus are replaced by gland cells. This typically occurs in the lower esophagus near the stomach and is believed to be primarily related to acid exposure to the lower esophagus.
Esophageal carcinoma is the third most common gastrointestinal malignancy worldwide and is largely unresponsive to therapy. Blacks have an increased risk for esophageal squamous cell carcinoma (ESCC).
Symptoms
There may be no symptoms in the early stages of esophageal cancer. However, in more advanced cancers, symptoms can include:
- Difficulty or pain when swallowing
- Weight loss
- Pain in the chest, behind the breastbone
- Coughing
- Hoarseness
- Indigestion and heartburn
Risk Factors
There are a number of factors that increase a person’s risk of developing esophageal cancer:
- Smoking or other use of tobacco
- Heavy alcohol use
- Gastroesophageal reflux disease (GERD), in which contents and acid from the stomach back up into the esophagus
- Barrett’s esophagus, a condition that affects the lower part of the esophagus and can lead to esophageal cancer; Barrett’s esophagus may be caused by GERD. Over time, stomach acid in the esophagus can cause cell changes that increase risk for adenocarcinoma.
In addition, certain groups — men, the elderly, and people who are obese — are at greater risk for esophageal cancer. Risk of adenocarcinoma of the esophagus is higher in white men, but squamous cell carcinoma of the esophagus is more common in men of color.
Diagnosis
To diagnose esophageal cancer, your doctor will review your symptoms, medical history, and examine you. In addition, they may order certain blood tests and X-rays including Barium swallow X-ray, Endoscopy, Biopsy. Other tests, including computed tomography (CT) scans, positron emission tomography (PET) scan, thoracoscopy, and laparoscopy, may be performed to determine if the cancer has spread, or metastasized, outside of the esophagus. This process is called “staging.” Your doctor will need this information in order to plan your treatment.
Treatment
Esophageal cancer treatment has a greater chance of success if the cancer is caught early. Unfortunately, by the time esophageal cancer is diagnosed for many people, it is often already in an advanced stage (has spread throughout the esophagus and beyond).
Treatment of esophageal cancer depends on many factors, including the stage of your cancer and your overall health. Typical treatments include:
- Surgery. Part or all of the esophagus may be removed.
- Radiation therapy. Kills cancer cells with radiation.
- Chemotherapy. Powerful drugs that attack cancer cells throughout the body; typically used in combination with radiation therapy and/or surgery.
- Targeted therapy. Newer treatments that target specific aspects of a cancer to curb cancer growth and spread.
- Immunotherapy. Helps the immune system to attack cancer cells.
- Photodynamic therapy. Targets cancer cells with a special laser light.
- Electrocoagulation. Uses electric current to destroy cancer cells.
- Cryotherapy. Freezes cancer cells to help shrink a tumor.
Other treatments:
- Endoscopic mucosal resection may be done to treat precancers or very small early cancers by removing the inner lining of the esophagus.
- Radiofrequency ablation treatment using a device that targets cancer cells with radiofrequency energy is sometimes used for early cancers.
- In addition, your doctor may recommend that you take part in a clinical trial, in which new drugs or treatments are tested in patients.