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Esophageal cancer is cancer that occurs in the esophagus — a long, hollow tube that runs from your throat to your stomach. Your esophagus carries food 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.
Esophageal cancer isn’t common in the United States. In other areas of the world, such as Asia and parts of Africa, esophageal cancer is much more common.
Symptoms
Signs and symptoms of esophageal cancer include:
· Difficulty swallowing (dysphagia)
· Weight loss without trying
· Chest pain, pressure or burning
· Worsening indigestion or heartburn
· Coughing or hoarseness
Early esophageal cancer typically causes no signs or symptoms
Causes
It’s 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.
Types of esophageal cancer
Esophageal cancer is classified according to the type of cells that are involved. The type of esophageal cancer you have helps determine your treatment options. Types of esophageal cancer include:
· Adenocarcinoma. Adenocarcinoma begins in the cells of mucus-secreting glands in the esophagus. Adenocarcinoma occurs most often in the lower portion of the esophagus. Adenocarcinoma is the most common form of esophageal cancer in the United States, and it affects primarily white men.
· Squamous cell carcinoma. The squamous cells are flat, thin cells that line the surface of the esophagus. Squamous cell carcinoma occurs most often in the middle of the esophagus. Squamous cell carcinoma is the most prevalent esophageal cancer worldwide.
· Other rare types. Rare forms of esophageal cancer include choriocarcinoma, lymphoma, melanoma, sarcoma and small cell cancer.
Risk factors
It’s thought that chronic irritation of your esophagus may contribute to the DNA changes that cause esophageal cancer. Factors that cause irritation in the cells of your esophagus and increase your risk of esophageal cancer include:
· Drinking alcohol
· Having bile reflux
· Having difficulty swallowing because of an esophageal sphincter that won’t relax (achalasia)
· Drinking very hot liquids
· Eating few fruits and vegetables
· Having gastroesophageal reflux disease (GERD)
· Being obese
· Having precancerous changes in the cells of the esophagus (Barrett’s esophagus)
· Undergoing radiation treatment to the chest or upper abdomen
· Smoking
Complications
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.
Tests and diagnosis
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.
Esophageal cancer staging
When you’re diagnosed with esophageal cancer, your doctor works to determine the extent (stage) of the cancer. Your cancer’s stage helps determine your treatment options.
Tests used in staging esophageal cancer include computerized tomography (CT) scan and positron emission tomography (PET).
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.
Treatments and drugs
What treatments you receive for esophageal cancer are based on the type of cells involved in your cancer, your cancer’s stage, your overall health and your preferences for treatment.
Surgery
Surgery to remove the cancer can be used alone or in combination with other treatments.
Esophageal cancer surgery carries a risk of serious complications, such as infection, bleeding and leakage from the area where the remaining esophagus is reattached.
Surgery to remove your esophagus can be performed as an open procedure using large incisions or with special surgical tools inserted through several small incisions in your skin (laparoscopically).
Treatments for complications
Treatments for esophageal obstruction and difficulty eating can include:
· Relieving esophageal obstruction. If your esophageal cancer has narrowed your esophagus, a surgeon may use an endoscope and special tools to place a metal tube (stent) to hold the esophagus open. Other options include surgery, radiation therapy, chemotherapy, laser therapy and photodynamic therapy.
· Providing nutrition. Your doctor may recommend a feeding tube if you’re having trouble swallowing or if you’re having esophagus surgery. A feeding tube allows nutrition to be delivered directly to your stomach or small intestine, giving your esophagus time to heal after cancer treatment.
Chemotherapy
Chemotherapy is drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically 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.
The chemotherapy side effects that you experience depend on which chemotherapy drugs you receive.
Radiation therapy
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.
Side effects of radiation to the esophagus include sunburn-like skin reactions, painful or difficult swallowing, and accidental damage to nearby organs, such as the lungs and heart.
Combined chemotherapy and radiation
Combining chemotherapy and radiation therapy may enhance the effectiveness of each treatment. Combined chemotherapy and radiation may be the only treatment you receive, or combined therapy can be used before surgery. But combining chemotherapy and radiation treatments increases the likelihood and severity of side effects.
