Esophagus Cancer

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About Esophagus Cancer

Overview

The esophagus is a hollow muscular tube that’s responsible for moving food from the throat to the stomach. Esophageal cancer can occur when a malignant tumor forms in the lining of the esophagus.

As the tumor grows, it can affect the deep tissues and muscle of the esophagus. A tumor can appear anywhere along the length of the esophagus, including where the esophagus and the stomach meet

Esophageal cancer is cancer that occurs in the esophagus — a long, hollow tube that runs from your throat to your stomach. Your esophagus helps move the food you swallow from the back of your throat to your stomach to be digested.

Esophageal cancer usually begins in the cells that line the inside of the esophagus. Esophageal cancer can occur anywhere along the esophagus. More men than women get esophageal cancer.

Esophageal cancer is the sixth most common cause of cancer deaths worldwide. Incidence rates vary within different geographic locations. In some regions, higher rates of esophageal cancer cases may be attributed to tobacco and alcohol use or particular nutritional habits and obesity.

Esophageal cancer occurs when cancer cells develop in the esophagus, a tube-like structure that runs from your throat to your stomach. Food goes from the mouth to the stomach through the esophagus. The cancer starts at the inner layer of the esophagus and can spread throughout the other layers of the esophagus and to other parts of the body (metastasis).

There are two main types of esophageal cancer. One type is squamous cell carcinoma. Squamous cells line the inner esophagus, and cancer developing from squamous cells can occur along the entire esophagus. The other type is called adenocarcinoma.

This is cancer that develops from gland cells. To develop adenocarcinoma of the esophagus, squamous cells that normally line the esophagus are replaced by gland cells. This typically occurs in the lower esophagus near the stomach and is believed to be largely related to acid exposure to the lower esophagus.

Symptoms

Early on there may be no symptoms. In more advanced cancers, symptoms of esophageal cancer include:

  • Difficulty or pain when swallowing
  • Weight loss
  • Pain in the chest, behind the breastbone
  • Coughing
  • Hoarseness
  • Indigestion and heartburn

Risk Factors

here are a number of factors which increase a person’s risk of developing esophageal cancer. They include:

  • Smoking or other use of tobacco
  • Heavy alcohol use
  • Gastroesophageal reflux disease (GERD), in which contents and acid from the stomach back up into the esophagus

Barrett’s esophagus, a condition that affects the lower part of the esophagus and can lead to esophageal cancer; Barrett’s esophagus may be caused by GERD. Over time, stomach acid in the esophagus can cause changes in the cells that increase risk for adenocarcinoma.

In addition, certain groups — men, the elderly, and people who are obese — are at greater risk for esophageal cancer. Risk of adenocarcinoma of the esophagus is higher in white men, but squamous cell carcinoma of the esophagus is more common in Asian men and men of color.

Diagnosed

A doctor will examine the person presenting symptoms and ask for details. They may refer the individual to a specialist.

The following diagnostic tests will be ordered:

Gastroscopy, or endoscopy: A long, thin instrument called an endoscope is passed 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 there are any tumors or abnormalities.

Biopsy: A sample of tissue may be taken if the endoscopy shows anything unusual. 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. Several x-ray pictures are taken at intervals. They will reveal whether there are any obstructions, which would be caused by a tumor.

Endoscopic ultrasound: A small ultrasound probe is attached to an endoscope and is inserted through the mouth into a targeted area. This is usually done when the doctor knows there is 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

To diagnose esophageal cancer, your doctor will review your symptoms, medical history, and examine you. In addition, he or she may order certain blood tests and X-rays.

Tests for esophageal cancer may include:

Barium swallow X-ray, in which you drink a liquid that coats your esophagus. This makes the esophagus stand out on the X-ray so that your doctor can identify certain problems.

Endoscopy: the doctor passes an endoscope, a thin, lighted tube, down your throat into your esophagus to examine it. Endoscopic ultrasound uses sound waves to provide more information about the extent of tumor involvement in nearby tissues.

Biopsy: during an endoscopy, the doctor can take cells or tissue from your esophagus. The cells are examined under a microscope for the presence of cancer.

Other tests, including computed tomography (CT) scans, positron emission tomography (PET) scan, thoracoscopy, and laparoscopy, may be performed to determine if the cancer has spread, or metastasized, outside of the esophagus. This process is called “staging.” The doctor needs this information in order to plan your treatment.

Stages

Stage 0 . Abnormal cells (not yet cancer) are found only in the layer of cells that line the esophagus.

Stage I . Cancer cells are found only in the layer of cells that line the esophagus.

Stage II . The cancer has reached the muscle layer or the outer wall of the esophagus. In addition, the cancer may have spread to 1 to 2 nearby lymph nodes (small glands that are part of the immune system).

Stage III . The cancer has reached deeper into the inner muscle layer or the connective tissue wall. It may have spread beyond the esophagus into surrounding organ and/or has spread to more lymph nodes near the esophagus.

Stage IV . This is the most advanced stage. The cancer has spread to other organs in the body and/or to lymph nodes far from the esophagus.

Treated

As with many cancers, esophageal cancer treatment has a greater chance of success if the cancer is caught early. Unfortunately, by the time esophageal cancer is diagnosed for many people, it is often already in an advanced stage (has spread throughout the esophagus and beyond).

Treatment of esophageal cancer depends on many factors, including the stage of the cancer and the overall health of the patient.

  • Surgery . Part or all of the esophagus may be removed.
  • Radiation therapy. Kills cancer cells with radiation.
  • Powerful drugs that attack cancer cells throughout the body; typically used in combination with radiation therapy and/or surgery.
  • Targeted therapy. Newer treatments that target specific aspects of a cancer to curb cancer growth and spread.
  • Helps the immune system to attack cancer cells.
  • Photodynamic therapy. Targets cancer cells with a special laser light.
  • Uses electric current to destroy cancer cells.
  • Freezes cancer cells to help shrink a tumor.

Endoscopic mucosal resection may be done to treat precancers or very small early cancers by removing the inner lining of the esophagus. Radiofrequency ablation treatment using a device that targets cancer cells with radiofrequency energy is sometimes used for early cancers.

In addition, your doctor may recommend that you take part in a clinical trial, in which new drugs or treatments are tested in patients. The success of these tests helps determine if the drugs or treatments will be approved by the Food and Drug Administration.

Stages of Esophageal Cancer Treated?

Treatment options for esophageal cancer by stage may involve the following:

Stage 0 . Options include surgery, photodynamic therapy, radiofrequency ablation, or endoscopic muscosal resection.

Stage I, II, and III . Surgery, chemotherapy, radiation

Stage IV . Chemotherapy, radiation, targeted therapy, immunotherapy; treatment for this stage focuses on “palliative” therapy. Palliative therapy is meant to relieve the pain and difficulty swallowing caused by cancer.

According to the American Cancer Society, the percentages of people who live for at least five years after being diagnosed with esophageal cancer (taking into account that some people with esophageal cancer will have other causes of death) is 43% for localized cancer to the esophagus, 23% for cancer that has spread regionally, and 5% with distant cancer spread.

Causes

ancer results from out-of-control cell growth. Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors.

Tumors can grow and interfere with body function. Those that stay in one location and do not grow bigger are generally considered benign. Malignant cancer is dangerous because it spreads.

Without treatment, malignant cancer can spread to other parts of the body, in a process known as metastasis. If cancer enters the lymphatic system, it can reach other parts of the body, including vital organs, more quickly.

  • Experts do not know exactly why esophageal cancer starts, but there appear to be some risk factors.
  • Achalasia: A type of esophageal motility disorder.
  • Age: It is more common after 60 years of age.
  • Alcohol and smoking: Either or both of these increase the risk.
  • Celiac disease: This has been linked to a higher risk of squamous cell carcinoma.
  • Diet: Consuming very little fruit and vegetables appears to increase the risk.
  • Genetic factors: Having a family member with this condition increases the risk.
  • Gastroesophageal reflux disease (GERD) and acid reflux can lead to Barrett’s esophagus, increasing 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 have a significantly higher risk.
  • Radiation therapy: When this treatment is received to the chest or head, it can increase the risk.
  • Smoking: Long-term, heavy, regular smoking is linked to esophageal cancer.

Other procedures

Other, non-surgical techniques may be used to treat esophageal cancer, including

Photodynamic therapy: A special substance is injected into the esophagus that makes the cells extra sensitive to light. With an endoscope that has a laser attached to the end, the surgeon destroys cancer cells by burning them.

Chemotherapy: This may be used before or after surgery, or both, and possibly in conjunction with radiation therapy. Chemotherapy can be used to remove the cancer, delay or prevent recurrence, slow down progression, or to relieve the symptoms of advanced cancer.

Radiation therapy: Beams of high-energy X-rays or particles or radiation are used to destroy cancer cells. Radiation therapy damages the DNA inside the tumor cells, destroying their ability to reproduce.

It can be applied externally, through external beam radiation, or internally using brachytherapy. In cases of esophageal cancer, radiation therapy is usually given in combination with chemotherapy. Radiation therapy may also be given before or after surgery.

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