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Health Library : Digestive Disorders

 

Esophageal Cancer

What is esophageal cancer?

Esophageal cancer is cancer that develops in the esophagus, the muscular tube that connects the throat to the stomach. The esophagus, located just behind the trachea, is about 10 to 13 inches in length and allows food to enter the stomach for digestion. The wall of the esophagus is made up of several layers and cancers generally start from the inner layer and grow out.

The American Cancer Society estimates that 17,460 Americans will be newly diagnosed with esophageal cancer during 2012, and 15,000 deaths are expected.

What causes esophageal cancer?

No one knows exactly what causes esophageal cancer. At the top of the esophagus is a muscle, called the sphincter, that releases to let food or liquid go through. The lower part of the esophagus is connected to the stomach. Another sphincter muscle is located at this connection that opens to allow the food to enter the stomach. This muscle also works to keep food and juices from the stomach from backing into the esophagus. When these juices do back up, reflux, commonly known as heartburn, occurs.

Long-term reflux can change the cells in the lower end of the esophagus. This condition is known as Barrett's esophagus. If these cells are not treated, they are at much higher risk of developing into cancer cells.

What are the different types of esophageal cancer?

There are two main types of esophageal cancer. The most common type of esophageal cancer, known as adenocarcinoma, develops in the glandular tissue in the lower part of the esophagus, near the opening of the stomach. It occurs in just over 50 percent of cases.

The other type, called squamous cell carcinoma, grows in the cells that form the top layer of the lining of the esophagus, known as squamous cells. This type of cancer can grow anywhere along the esophagus.

Treatment for both types of esophageal cancer is similar.

What are the symptoms of esophageal cancer?

Often, there are no symptoms in the early stages of esophageal cancer. Symptoms do not appear until the disease is more advanced. The following are the most common symptoms of esophageal cancer. However, each individual may experience symptoms differently. Symptoms may include:

  • difficult or painful swallowing
    A condition known as dysphagia is the most common symptom of esophageal cancer. This gives a sensation of having food lodged in the chest, and persons with dysphagia often switch to softer foods to help with swallowing.
  • pain in the throat or back, behind the breastbone or between the shoulder blades
  • severe weight loss
    Many persons with esophageal cancer lose weight unintentionally because they are not getting enough food.
  • hoarseness or chronic cough that does not go away within two weeks
  • indigestion
  • vomiting
  • coughing up blood
  • heartburn

The symptoms of esophageal cancer may resemble other medical conditions or problems. Always consult your health care provider for a diagnosis.

There is no routine screening examination for esophageal cancer; however, persons with Barrett's esophagus should be examined often because they are at greater risk for developing the disease.

What are the risk factors for esophageal cancer?

The following factors can put an individual at greater risk for developing esophageal cancer:

  • age
    The risk increases with age. In the US, most people are diagnosed at 65 years of age or older.
  • gender
    Men have a three times greater risk of developing esophageal cancer than women.
  • tobacco use
    Using any form of tobacco, but especially smoking, raises the risk of esophageal cancer. The longer tobacco is used, the greater the risk, with the greatest risk among persons who have indulged in long-term drinking with tobacco use. Scientists believe that these substances increase each other's harmful effects, making persons who do both especially susceptible to developing the disease.
  • alcohol use
    Chronic or long-term heavy drinking, more than three alcoholic drinks per day, is another major risk factor for esophageal cancer.
  • Barrett's esophagus
    Long-term irritation from reflux, commonly known as heartburn, changes the cells at the end of the esophagus. This is a pre-cancerous condition, which raises the risk of developing adenocarcinoma of the esophagus.
  • diet
    Diets low in fruits and vegetables and certain vitamins and minerals can increase risk for this disease.
  • other irritants
    Swallowing caustic irritants such as lye and other substances can burn and destroy cells in the esophagus. The scarring and damage done to the esophagus can put a person at greater risk for developing cancer many years after ingesting the substance.
  • medical history
    Certain diseases, such as achalasia, a disease in which the bottom of the esophagus does not open to release food into the stomach, and tylosis, a rare, inherited disease, increase the risk of esophageal cancer. In addition, anyone who has had other head and neck cancers has an increased chance of developing a second cancer in this area, which includes esophageal cancer.
  • obesity
  • acid reflux
    Abnormal backward flow of stomach acid into the esophagus.

How is esophageal cancer diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for esophageal cancer may include the following:

  • chest x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • upper GI (gastrointestinal) series (Also called barium swallow.) - a diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.
    Illustration of an esophagogastroduodenoscopy procedure
    Click Image to Enlarge
  • esophagogastroduodenoscopy (Also called EGD or upper endoscopy.) - a procedure that allows the physician to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the physician to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).
  • computed tomography scan (CT or CAT scan) - diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • endoscopic ultrasound - this imaging technique uses sound waves to create a computer image of the inside of the esophagus and stomach. The endoscope is guided into the mouth and throat, then into the esophagus and the stomach. As in standard endoscopy, this allows the physician to view the inside of this area of the body, as well as insert instruments to remove a sample of tissue (biopsy).
  • thoracoscopy and laparoscopy - these methods allow the physician to examine the lymph nodes inside the chest or abdomen with a hollow, lighted tube, and remove these nodes for further testing.

Treatment for esophageal cancer:

Specific treatment for esophageal cancer will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of this disease
  • your opinion or preference

Treatment may include:

  • surgery
    Two types of surgery are commonly performed for esophageal cancer. In one type of surgery, part of the esophagus and nearby lymph nodes are removed, and the remaining portion of the esophagus is reconnected to the stomach. In the other surgery, part of the esophagus, nearby lymph nodes, and the top of the stomach are removed. The remaining portion of the esophagus is then reconnected to the stomach. Surgery may be performed after other treatment is completed.
  • chemotherapy
    Chemotherapy is the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual. Chemotherapy may be used along with radiation therapy as the primary treatment. Chemotherapy also is used to shrink the tumor prior to surgery.
  • radiation therapy
    Radiation therapy is the use of high-energy radiation to kill cancer cells and to shrink tumors. There are two ways to deliver radiation therapy, including the following:
    • external beam radiotherapy (EBRT)
      EBRT uses carefully aimed beams of X-rays to kill cancer cells. EBRT is painless and takes a few minutes to deliver. The treatment plan is developed by a doctor called a Radiation Oncologist. Special techniques such as 3D-conformal, Intensity-Modulated Radiotherapy (IMRT), and Tomotherapy are often used to minimize the dose of radiation to normal tissues to reduce side effects, while still delivering enough radiation to kill tumor cells and shrink tumors. EBRT is often used before or after surgery, in combination with chemotherapy, to reduce the likelihood of tumor recurrence. EBRT is also used to ease symptoms (palliate) such as pain, blockage, or bleeding.
    • internal radiation (brachytherapy, implant radiation) - radiation is given inside the body as close to the cancer as possible. Substances that produce radiation, called radioisotopes, may be placed directly next to the tumor in the esophagus, injected, or implanted directly into the tumor. Some of the radioactive implants are called "seeds" or "capsules." Internal radiation involves giving a higher dose of radiation in a shorter time span than with external radiation. Some internal radiation treatments stay in the body temporarily. Other internal treatments stay in the body permanently, though the radioactive substance loses its radiation within a short period of time. In some cases, both internal and external radiation therapies are used.
  • photodynamic therapy (PDT)
    Photodynamic therapy is a type of laser treatment that involves injecting photosensitizing chemicals into the bloodstream. Cells throughout the body absorb the chemicals. The chemicals collect and stay longer in the cancer cells, than in the healthy cells. At the right time, when the healthy cells surrounding the tumor may already be relatively free of the chemical, the light of a laser can be focused directly on the tumor. As the cells absorb the light, a chemical reaction destroys the cancer cells. The light is delivered through an endoscope, a small, flexible tube with a light on the end, that is inserted through the mouth or nose. PDT may be used to relieve or reduce symptoms of esophageal cancer, such as difficulty swallowing.

Sometimes, several of these treatments may be combined for treating esophageal cancer.

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