On this page
- Definition of esophageal cancer
- What causes esophageal cancer?
- What are the symptoms of esophageal cancer?
- How does cancer spread?
- How is esophageal cancer staged?
- How is esophageal cancer treated?
- Maintaining nutrition in esophageal cancer
- What are the chances of recovery?
Definition of esophageal cancer
The esophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach. The wall of the esophagus is made up of several layers, including mucous membrane, muscle, and connective tissue. Esophageal cancer starts at the inside lining of the esophagus and spreads outward through the other layers as it grows.
The two most common forms of esophageal cancer are named for the type of cells that become malignant (cancerous):
- Squamous Cell Carcinoma: Cancer that forms in squamous cells, the thin, flat cells lining the esophagus. This cancer is most often found in the upper and middle part of the esophagus, but can occur anywhere along the esophagus.
- Adenocarcinoma: Cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the esophagus produce and release fluids such as mucus. Adenocarcinomas usually form in the lower part of the esophagus, near the stomach.
What causes esophageal cancer?
Risk factors include the following:
- Tobacco use
- Heavy alcohol use
- Barrett’s esophagus – A condition in which the cells lining the lower part of the esophagus have changed or been replaced with abnormal cells that could lead to adenocarcinoma of the esophagus. Gastric reflux (the backing up of stomach contents into the lower section of the esophagus) may irritate the esophagus and, over time, cause Barrett esophagus.
- Older age
- Being male
- Being African-American
What are the symptoms of esophageal cancer?
Unfortunately, the symptom of esophageal cancer often do not develop until the cancer is advanced. Common symptoms of esophageal cancer are:
- Painful or difficult swallowing
- Weight loss
- Pain behind the breastbone
- Hoarseness and cough
- Indigestion and heartburn
How is esophageal cancer diagnosed?
The following tests and procedures may be used to diagnose esophageal cancer.
- Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.
- Upper endoscopy: A procedure to look inside the esophagus to check for abnormal areas. An endoscope is inserted through the mouth or nose and down the throat into the esophagus. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy is usually done during an endoscopy. Sometimes a biopsy shows changes in the esophagus that are not cancer but may lead to cancer.
How does cancer spread?
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastases. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if esophageal cancer spreads to the liver, the cancer cells in the liver are actually esophageal cancer cells. The disease is metastatic esophageal cancer, not liver cancer.
How is esophageal cancer staged?
The process used to find out if cancer cell have spread within the esophagus or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:
- CT scan (CAT scan): The CT scan is a noninvasive x-ray that produces three-dimensional pictures of parts of the body. The person lies on a table that slides into a donut-shaped machine. The test primary is used to evaluate for metastatic lesions.
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- Endoscopic ultrasound (EUS): An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. EUS can accurately gauge the deep the tumor has invaded into the wall of the esophagus. Malignant appearing lymph nodes can also be identified by EUS. A sample of these lymph nodes can be obtained by passing a needle through the esophageal wall using the ultrasound images to guide the needle.
- Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
- Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. In some cases, this procedure may be used to remove part of the esophagus or lung.
How is esophageal cancer treated?
The appropriate treatment for esophageal cancer depends on the stage of the cancer and the patient’s over all health.
Surgery is the most common treatment for cancer of the esophagus. Part of the esophagus may be removed in an operation called an esophagectomy. The doctor will connect the remaining healthy part of the esophagus to the stomach so the patient can still swallow. A plastic tube or part of the intestine may be used to make the connection. Lymph nodes near the esophagus may also be removed and viewed under a microscope to see if they contain cancer.
Radiation therapy is a cancer treatment that uses high-energy x rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
If the esophagus is partly blocked by the tumor and the tumor is too advanced for surgery, an expandable metal stent (tube) may be placed inside the esophagus to help keep it open.
Maintaining nutrition in esophageal cancer
Many people with esophageal cancer find it hard to eat because they have trouble swallowing. The esophagus may be narrowed by the tumor or as a side effect of treatment. Some patients may receive nutrients directly into a vein. Others may need a feeding tube (PEG tube), a flexible plastic tube inserted through the skin into the stomach, until they are able to eat on their own. Occasionally, an temporary expandable plastic esophageal stent (tube) can be placed in the esophagus to allow the patient to eat normal foods while receiving chemotherapy or radiation therapy.
What are the chances of recovery?
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the cancer (whether it affects part of the esophagus, involves the whole esophagus, or has spread to other places in the body).
- The patient’s general health.
When esophageal cancer is found very early, there is a better chance of recovery. Esophageal cancer is often in an advanced stage when it is diagnosed. At later stages, esophageal cancer can be treated but rarely can be cured. Taking part in one of the clinical trials being done to improve treatment should be considered.
Reprinted with modifications from the National Cancer Institute’s website.