What to know about esophageal cancer
This cancer is rare in the United States but more common in Asia and parts of Africa. In 2015, esophageal cancer made up 1 percent of new diagnoses of cancer and 2.6 percent of deaths from cancer. It mostly occurs in individuals who are at least 55 years of age.
The two main subtypes of esophageal cancer are:
- Squamous cell carcinoma: This arises from the cells lining the upper part of the esophagus.
- Adenocarcinoma of the esophagus: This occurs due to changes in the glandular cells that exist at the junction of the esophagus and the stomach.
Rarer types include:
The treatment, symptoms, and prognosis are similar for both main types of esophageal cancer.
In this article, we look at the symptoms, causes, and treatments of esophageal cancer.
The esophagus is the tube connecting the throat to the stomach. A growth or tumor in this tube can make swallowing and eating difficult.
People often experience no symptoms during the initial stages of this cancer.
The majority of esophageal cancer diagnoses occur when the cancer has advanced.
When symptoms are present, they may include:
- Dysphagia: As the tumor narrows the passage in the esophagus, pushing food through becomes harder. This is usually the first noticeable symptom.
- Vomiting: A person vomits food after it gets stuck in the esophagus.
- Weight loss: Dramatic and sudden weight loss might occur.
- A cough: This becomes more common when trying to swallow. Sometimes, the individual wmay cough up blood.
- Voice changes: The voice may become hoarse.
- Pain and discomfort: These occur in the throat.
- Acid reflux: This can happen if cancer affects the lower part of the esophagus.
- Chest pain: This relates to acid reflux.
Cancer results from out-of-control cell growth. The disease harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors.
Tumors may grow and interfere with function. Some are benign and stay in one location without growing any bigger. Malignant cancer is dangerous as, without treatment, it can spread to other parts of the body, or metastasize.
If cancer enters the lymphatic system, it can reach other parts of the body more quickly, including vital organs.
The cause of esophageal cancer is not clear, but certain factors increase the risk.
- Achalasia: This is a type of esophageal motility disorder.
- Age: Esophageal cancer is more common after 60 years of age.
- Alcohol and smoking: Either or both of these increase the risk.
- Celiac disease: This may increase the risk of squamous cell carcinoma.
- Diet: Not consuming enough fruits and vegetables appears to increase the risk.
- Genetic factors: Having a family member with this condition increases the risk.
- Gastroesophageal reflux disease (GERD): Both this disease and its main symptom, acid reflux, can lead to Barrett's esophagus. Barrett's esophagus increases the risk of future malignancy.
- Human papillomavirus (HPV): HPV is a contagious, sexually transmitted virus.
- Long-term exposure to chemicals or irritants: These include soot, metal dust, exhaust fumes, lye, and silica dust.
- Sex: Males have a higher risk.
- Obesity: It is more common in people with obesity.
- Other cancers: Those who have had head and neck cancers in the past have a significantly higher risk of esophageal cancer§.
- Radiation therapy: When a doctor administers this treatment to the chest or head, they might increase the risk.
Radiation therapy shrinks or kills the tumor.
The methods a doctor will use for treating esophageal cancer depend on several factors, including:
- the cellular type of cancer
- the stage
- the general health and age of the person with esophageal cancer
- the presence of other diseases
Treatment options include:
The person may need help to consume food and drink in the following ways:
- If the person cannot swallow, a surgeon may insert a stent to keep the esophagus clear.
- A nasogastric tube, which a surgeon passes through the nose, may be necessary to assist feeding while treatment proceeds on tumor.
- A gastrostomy is a feeding hole in the skin that provides direct access to the stomach.
Treatment aims either to take out the whole tumor and any other cancerous cells or prevent the tumor from getting any bigger. To achieve this, a doctor may recommend surgery, chemotherapy, or both.
The following surgical interventions can help people with esophageal cancer:
- Esophagectomy: This procedure removes part of the esophagus. The surgeon removes the section of esophagus that contains the tumor and reconnects the remaining part to the stomach. Sometimes, they use a small section of the large intestine to help connect the esophagus and the stomach.
- Esophagogastrectomy: In this procedure, the surgeon removes the part of the esophagus with the tumor, as well as parts of the stomach and nearby lymph nodes. If the surgeon cannot connect the stomach and esophagus afterward, they may use a small part of the large intestine to do so.
Other, non-surgical techniques that support the treatment of esophageal cancer, including
- Photodynamic therapy: The doctor injects a special substance into the esophagus that makes the cells extra sensitive to light. With an endoscope that has a laser at the end, the surgeon destroys cancer cells by burning them.
- Chemotherapy: This may take place before or after surgery, or both, and possibly in conjunction with radiation therapy. Chemotherapy can help remove the cancer, delay or prevent recurrence, slow down progression, or relieve the symptoms of advanced cancer.
- Radiation therapy: Beams of high-energy X-rays, particles, or radiation destroy cancer cells. Radiation therapy damages the DNA inside the tumor cells, destroying their ability to reproduce. A doctor can apply radiation therapy externally, through external beam radiation, or internally, using brachytherapy.
People with esophageal cancer usually receive radiation therapy in combination with chemotherapy. Cancer doctors may request radiation therapy before or after surgery.
An endoscope can help diagnose the location and size of a tumor.
A doctor will examine the person presenting symptoms and ask for details. They may refer the individual to a specialist.
The doctor will order the following diagnostic tests:
- Gastroscopy, or endoscopy: The doctor passes a long, thin instrument called an endoscope through the mouth, into the esophagus, and toward the stomach. The endoscope has a light and camera at the end. The doctor sees the images on a screen and determines whether the presence of any tumors or abnormalities.
- Biopsy: The doctor may take a sample of tissue if the endoscopy shows unusual results. A pathologist then examines the sample under a microscope. They can determine whether or not there are any cancerous cells.
- Barium swallow test: The patient drinks a liquid containing barium. Barium shows up on x-rays. A technician takes several x-ray pictures at intervals. They will reveal wany obstructions that a tumor would cause.
- Endoscopic ultrasound: A small ultrasound probe fixes to an endoscope. The doctor then inserts it through the mouth into a targeted area. This usually takes place once the doctor has confirmed the cancer but wants to have a better look at the tumor on a monitor. This type of test may show whether the cancer has spread into nearby tissue.
- Other imaging scans: A CT scan can help determine the spread of the cancer.
Esophageal cancer develops in five stages, each of which highlight the spread and severity of the cancer:
- Stage 0: This stage refers to cells that have shown signs of cancerous activity without becoming cancerous.
- Stage 1: Cancer has formed in the wall of the esophagus. The location of the tumor may not be obvious.
- Stage 2: The cancer has spread to the muscular or connective tissue of the esophagus and one or two lymph nodes.
- Stage 3: The cancer has spread to the muscular or connective tissue of the esophagus, possibly as well as the diaphragm, the sac around the heart, or the protective tissue around the lungs, and between 3 and 6 lymph nodes.
- Stage 4: Cancer has spread to distant sites in the body.
The stage of a cancer will dictate how a doctor treats that cancer and the likelihood of successful treatment.
In 2014, the most recent year in which researchers collected data, the outlook for esophageal cancer was that 19.2 percent of people survived for five years after diagnosis.
The outlook depends strongly on the stage of the cancer. If cancer has not spread from the esophagus, the survival rate increases to 43 percent. If the disease has spread to surrounding organs, the survival rate drops to 23 percent. Once the cancer reaches distant sites, the survival rate can be as low as 5 percent.
If you experience any symptoms at all, contact a doctor.
While these figures are an estimate, they indicate a low overall survival rate and therefore highlight the severity of esophageal cancer.