What Is It?
Esophageal cancer is the abnormal growth of cells in the esophagus. The esophagus is the tube that carries food and liquid to your stomach.
There are two types of esophageal cancer:
No one knows for sure what causes esophageal cancer. However, the most significant risk factors include the following:
Other risk factors include the following:
At first, esophageal cancer may not cause any symptoms. But as it progresses, it may cause:
Other conditions can cause these symptoms. But if you have any of them, see your doctor.
Your doctor will examine you and review your medical history. He or she probably will order chest X-rays and other diagnostic tests, too. These may include the following:
People with esophageal squamous cell carcinoma have a higher risk of mouth, throat, lung, and stomach cancer. That's why you may also have tests with endoscopes inside the throat and lungs, as well as chest X-rays and CT scans.
Esophageal cancer will continue to grow until it is treated. It can spread to almost any part of the body. The chance of survival increases greatly if the disease is detected early.
While some risk factors for esophageal cancer can't be avoided, you can lower your risk of the disease:
If you suffer from chronic heartburn, your doctor may suggest an endoscopy to look for Barrett's esophagus. If you have this condition, some doctors recommend periodic exams to check for abnormalities before they develop into cancer.
After the cancer has been diagnosed, your doctor will determine how far it has advanced and assign it a "stage." The stages run from 0 to IV. The higher the stage, the further the cancer has spread. For example, in stage 0, the cancer is confined to the lining of the esophagus. In stage I, the cancer has not invaded the outer muscle layer of the esophagus.
Treatment for esophageal cancer depends on the size and location of the tumor, its stage, your symptoms, and your general health. Many different treatments and combinations of treatments may be used. The most common ones are surgery, chemotherapy and radiation therapy.
Surgically removing the tumor and surrounding tissue offers the best chance of a cure. Usually, the surgeon opens the chest or abdomen. He or she then removes, through one or two incisions, all or part of the esophagus and the nearby lymph nodes. This helps keep the cancer from spreading.
Sometimes, the upper part of the stomach is removed, too. The surgeon then uses the rest of the stomach or part of the intestine to reconnect the digestive tract, so that you can swallow. This is very intensive surgery; some patients can't tolerate it.
The surgeon may be able to modify the procedure and use minimally invasive techniques in certain patients, such as those with other serious medical conditions. Instead of one or two larger incisions, the surgeon may make several smaller ones. This may decrease the risk of some complications. But a surgeon doing this procedure must be highly skilled.
A second possible treatment is chemotherapy. This involves the use of anticancer drugs to kill cancer cells. The drugs are usually injected into a vein. Chemotherapy may be combined with radiation therapy.
Radiation therapy uses high-energy X-rays to kill cancer cells. The radiation may come from a machine outside the body (external radiation) or from radioactive material placed in or near the tumor (internal radiation).
Your doctor may suggest radiation therapy:
Before recommending a treatment, your doctors will weigh the benefits of surgery against its risks. (It can cause numerous complications.) For many people, radiation therapy alone or combined with chemotherapy may offer the same chance of survival as surgery.
Your doctor may recommend other treatments to ease symptoms. For example, he or she may put a stent (a small, wire-mesh tube) in your esophagus so the cancer doesn't block it. This will allow you to eat normally. A laser can prevent blockages and improve swallowing by reducing the size of a tumor.
If swallowing is so difficult that adequate nutrition cannot be taken by mouth, your doctor may suggest a feeding tube inserted into the stomach or intestine.
When To Call a Professional
See your doctor if you have any of these symptoms:
Most often these symptoms will not be caused by esophageal cancer, but they always require medical attention.
If you have been diagnosed with GERD, consult a gastroenterologist. He or she can determine whether you have any precancerous conditions in the lower esophagus -- and treat them. More and more specialists ablate Barrett's esophagus with an endoscope before it becomes cancerous.
The earlier the cancer is detected, the higher the survival rate. About three-quarters of patients diagnosed with stage 0 esophageal cancer live at least five years. For those with stage I disease, almost half survive five years. But most cases of esophageal cancer are diagnosed at more advanced stages.
With or without surgery, chemotherapy and radiation therapy can help improve quality of life. They can also prolong survival, even when the disease is advanced.
National Cancer Institute (NCI)
NCI Office of Communications and Education
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American Cancer Society (ACS)
Cancer Research Institute
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New York, NY 10006