Esophageal Cancer

Background

Esophageal cancer begins in the esophagus, the muscular tube that connects the throat and stomach. If cancer spreads outside the esophagus, it often moves into the lymph nodes. Approximately 11,000 to 13,000 new cases of esophageal cancer are diagnosed each year in the United States. Esophageal cancer is more common in men than in women. Early esophageal cancer typically has no signs or symptoms.

The two common types of esophageal cancer include:

Squamous cell carcinoma begins in thin, flat cells usually lining the upper and middle part of the esophagus.
Adenocarcinoma begins in the glandular (secretory) cells that make and release mucus and other fluids in the lower part of the esophagus. There is an association with this type of esophageal cancer and chronic GERD (gastroesophageal reflux disease)/Barrett's esophagus.

Symptoms

Signs and symptoms of esophageal cancer may include:

Anemia (iron deficiency from cancer bleeding)
Difficulty swallowing
Weight loss (non-intentional)
Chest pain
Fatigue

Risk Factors

Factors that increase the risk of esophageal cancer include:

Alcohol and tobacco
Bile reflux
Chemical injury (previous lye ingestion)
Difficulty swallowing caused by incomplete relaxation of the lower esophageal sphincter (achalasia)
Drinking very hot liquids
Eating a diet low in fruits and vegetables
Eating foods preserved in lye
Gastroesophageal reflux disease (GERD)
Obesity
Precancerous changes in the cells of the esophagus related to chronic GERD (Barrett's esophagus)
Radiation treatment to the chest or upper abdomen

Staging

Determining the stage of esophageal cancer helps to decide treatment options. There are several tests used to determine the stage the cancer has reached, including upper endoscopy (EGD), endoscopic ultrasound (EUS), computerized tomography (CT), and positron emission tomography (PET).

Stage I: Cancer occurs only in the superficial layers of the esophagus without invasion into the deeper muscle layers or surrounding lymph nodes.

Stage II: Cancer has invaded deeper layers of the esophagus lining and may have spread to nearby lymph nodes.

Stage III: Cancer has spread to the deepest layers of the wall of the esophagus and to nearby tissues or lymph nodes.

Stage IV: Cancer has spread to other parts of the body.

Treatment

The treatments you receive for esophageal cancer are based on the type of cells present, the stage, your overall health and preferences for treatment.

Surgery
Surgery to remove the cancer can be used alone or in combination with other treatments. Operations used to treat esophageal cancer include:

Esophagectomy, a surgery used to remove a portion of the esophagus. This involves the removal of the portion of the esophagus that contains the tumor, along with nearby lymph nodes. The remaining esophagus is reconnected to the stomach. Usually, this is done by pulling the stomach up to meet the remaining esophagus. In some situations, a portion of the colon is placed in between the remaining esophagus and stomach.
Esophagogastrectomy, a surgery used to remove a portion of the esophagus and the upper portion of the stomach. This involves the removal of esophagus, nearby lymph nodes and the upper part of the stomach. The remainder of the stomach is then pulled up and reattached to the esophagus. If necessary, part of the colon is placed in between the remaining esophagus and stomach.

Chemotherapy
Chemotherapy drugs are typically used before or after surgery in people with esophageal cancer, depending upon its stage. Chemotherapy can also be combined with radiation therapy. In people with advanced cancer that has spread to other parts of the body (metastatic disease), chemotherapy may be used alone as palliation (i.e., not meant to be curative) to help relieve signs and symptoms caused by the cancer.

Radiation therapy
Radiation can come from a machine placed outside the body that aims beams at the cancer (external beam radiation), or placed inside the body, near the cancer (brachytherapy).

Radiation therapy is most often combined with chemotherapy in people with esophageal cancer. It can be used before or after surgery. Radiation therapy is also used for palliation (i.e., not meant to be curative) to relieve complications of advanced esophageal cancer, when a tumor grows large enough to stop food from passing to the stomach.

Clinical trials
The National Cancer Institute provides more detailed information about bile duct cancers and available clinical trials.

References
National Cancer Institute, Mayo Clinic, Cancer Treatment Centers of America.