Esophageal Cancer
Esophageal cancer is a type of cancer that occurs in the esophagus, a long tube that runs from the throat to the stomach.
It is more common in men than in women and is the sixth most common cause of cancer deaths worldwide. Esophageal cancer is more common in certain regions, where it may be linked to tobacco and alcohol use, specific nutritional habits, or obesity.
Types
Esophageal cancer is classified according to the type of cells that are involved. The two main types of esophageal cancer are:
- Adenocarcinoma: this type of cancer 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: this type of cancer occurs in the squamous cells, which are flat, thin cells that line the surface of the esophagus. Squamous cell carcinoma occurs most often in the upper and middle portions of the esophagus. Squamous cell carcinoma is the most prevalent esophageal cancer worldwide.
Other rare types of esophageal cancer include small cell carcinoma, sarcoma, lymphoma, melanoma, and choriocarcinoma.
Symptoms
Symptoms of esophageal cancer include:
- Difficulty swallowing (dysphagia).
- Weight loss without trying.
- Chest pain, pressure, or burning.
- Worsening indigestion or heartburn.
- Coughing or hoarseness.
- Difficulty and pain when swallowing, especially when eating meat, bread, or raw vegetables.
- Vomiting.
- Choking on food frequently.
- Pain behind the breastbone or in the throat.
Evaluation
To diagnose esophageal cancer, a doctor will perform a physical exam and may also use tests to confirm diagnosis and to determine the stage and grade of the cancer.
- Endoscopy: a thin, flexible tube with a light and camera on the end is inserted through the mouth to examine the inside of the esophagus.
- Biopsy: a small tissue sample is taken from the esophagus and examined under a microscope to check for cancer cells.
- CT scan: a series of detailed pictures of the inside of the body taken from different angles for staging of the tumor.
- PET scan to look for spread of the cancer for staging purposes.
- Endoscopic ultrasound for staging to determine the depth of tumor growth and spread to lymph nodes.
Staging
The stage of esophageal cancer describes how advanced the cancer is. The TNM system is used to describe the stage of esophageal cancer. T stands for the size and depth of the primary tumor, N stands for the involvement of the lymph nodes, and M stands for the presence of metastasis (spread to other parts of the body). There are 4 stages of esophageal cancer: stages I through IV.
Grade: the grade of esophageal cancer describes how much cancer cells look like normal cells under a microscope. Cancer cells that look similar to normal cells are called “differentiated,” while cancer cells that look very different from normal cells are called “poorly differentiated.”
Treatment
Treatment for esophageal cancer depends on the stage of the cancer and the person’s overall health. Treatment options may include endoscopy, surgery, chemotherapy, radiation therapy, or a combination of these. The goal of treatment is to remove or kill the cancer cells and to help the person return to normal activities as soon as possible.
Endoscopic mucosal resection (EMR is a option for very early stage esophageal cancers). This procedure removes the cancerous tissue using an endoscope (a thin, flexible tube with a light and camera) that is inserted through the mouth and into the esophagus. If the tumor has progressed past the very early stage, surgery is performed to remove the tumor.
Advanced tumors need neoadjuvant therapy before surgery or chemotherapy and radiation alone. Neoadjuvant therapy is a type of treatment that is given before the main treatment, such as surgery. It is often used for esophageal cancer when the cancer is at a more advanced stage and may not be able to be completely removed with surgery alone. Neoadjuvant therapy is given with the goal of shrinking the tumor, making it easier to remove surgically and potentially increasing the chances of a successful outcome. It may also be used to reduce the risk of the cancer spreading to other parts of the body during surgery. It is typically given for a few weeks or months before surgery.
FAQs
Esophageal cancer can be caused by a variety of factors, including chronic acid reflux, Barrett’s esophagus, smoking, excessive alcohol consumption, and certain genetic conditions.
Symptoms of esophageal cancer can include difficulty swallowing, chest pain, heartburn, weight loss, and coughing or hoarseness.
Esophageal cancer is typically diagnosed by performing an upper endoscopy and obtaining a biopsy of the esophagus. Other tests such as endoscopic ultrasound, CT and PET scans may be used to stage the cancer.
Treatment options for esophageal cancer can include surgery, radiation therapy, and chemotherapy. The choice of treatment will depend on the stage of the cancer and the overall health of the patient.
The long-term prognosis for esophageal cancer depends on the stage of the cancer at the time of diagnosis and the patient’s overall health. The earlier the cancer is detected, the better the prognosis.
Esophageal cancer can lead to complications such as difficulty swallowing, malnutrition, and spread of cancer to other parts of the body.
Certain lifestyle changes, such as maintaining a healthy diet, avoiding smoking and excessive alcohol consumption, and being aware of the symptoms of esophageal cancer, may help to reduce the risk of developing the disease.
The chance of a cure depends on the stage of the cancer at the time of diagnosis and the patient’s overall health. The earlier the cancer is detected, the better the chance of a cure.
Early detection of esophageal cancer can be difficult, as symptoms may not appear until the cancer has progressed. Regular screenings and monitoring are important for people at high risk of the disease. The most common form of esophageal cancer develops from a precancerous condition called Barrett’s esophagus which is a complication of long-standing acid reflux. Screening of patients with acid reflux for Barrett’s esophagus and Surveillance by periodic endoscopy of those with Barrett’s, provides the best chance for early detection of cancerous change.
Risk factors for esophageal cancer include age, being male, smoking, excessive alcohol consumption, chronic acid reflux, Barrett’s esophagus, and certain genetic conditions such as Tyrosinemia type 1, Plummer-Vinson syndrome.
Esophageal cancer is relatively rare, but the incidence rates have been increasing in recent years. It is more common in men than in women, and is most commonly diagnosed in people over the age of 50.
Yes, esophageal cancer can spread to other parts of the body, such as the lymph nodes, lungs, liver, and bones. This is known as metastasis.
Treatment options for esophageal cancer can include surgery, radiation therapy, and chemotherapy. The choice of treatment will depend on the stage of the cancer, the location and size of the tumor, and the overall health of the patient. In some cases radiation therapy or chemotherapy alone may be used but it is best to consult with a specialist.
Obesity has been linked to an increased risk of esophageal cancer, as it is a risk factor for acid reflux and Barrett’s esophagus, both of which can lead to esophageal cancer.