Esophageal Cancer

What Is It?

Esophageal cancer is the abnormal growth of cells in the esophagus, the tube that carries food and drink from your throat to your stomach. There are two types of esophageal cancer:

• Squamous cell carcinoma starts in the cells that line the esophagus. This type of esophageal cancer can occur anywhere in the esophagus.
• Adenocarcinoma starts in the lower portion of the esophagus near the opening to the stomach. It starts when cells in the lining transform into glandular type cells, a condition called Barrett's esophagus.

Esophageal cancer is common in Asia, Africa and Latin America, but less common in the United States. However, the number of cases of adenocarcinoma of the esophagus is increasing faster than almost all other cancers in the United States. No one is certain what causes esophageal cancer, but risk factors include the following:

• Age — Most people who develop esophageal cancer are over 50.
• Sex — Both types of esophageal cancer occur about three times more often in men than women.
• Race — Squamous cell esophageal cancer is three times more common among African-Americans than whites. However, Caucasians have a higher incidence of adenocarcinomas of the lower esophagus than African-Americans.
• Tobacco use — Tobacco consumed in any form increases the risk of esophageal cancer. The longer you smoke and the more you smoke each day, the greater the risk. This is primarily true for squamous cell esophageal cancer.
• Alcohol consumption — Chronic or excessive consumption of alcohol, especially when combined with tobacco use, increases the risk. Again, this is primarily true for squamous cell esophageal cancer.
• Barrett's esophagus — Irritation caused by chronic acid reflux is believed to cause the cells at the bottom of the esophagus to transform into glandular cells similar to cells in the stomach lining. These glandular cells are more likely to become cancerous. This is the strongest known risk factor for cancer of the lower esophagus, adenocarcinoma.
• Chemical irritation — Damage to the esophagus from swallowing lye, most often during childhood, or from prior radiation increases the risk of esophageal cancer. Chemical irritation also can occur in a condition called achalasia, where part of the esophagus is dilated (expanded) and collects partially digested foods.
• Diet — A diet low in fruits and vegetables and certain minerals and vitamins has been associated with a higher risk of esophageal cancer. Nitrates in foods and fungal toxins from pickled vegetables also have been associated with esophageal cancer.
• Medical conditions — Two conditions are associated with a higher risk of esophageal cancers: Plummer-Vinson, also called Paterson-Kelly syndrome, and tylosis.

Symptoms

Early esophageal cancer may not cause any symptoms. As the cancer progresses, it usually causes one or more of the following symptoms:

• Difficult or painful swallowing or difficulty swallowing only solid foods (called dysphagia or odynophagia)
• Pain in the chest or between the shoulder blades
• Frequent heartburn or acid reflux
• Severe weight loss
• Hoarseness or chronic cough
• Vomiting
• Coughing up blood

Other conditions can cause these symptoms. If you experience any of these, you should see your doctor. If you have chest pain or vomit blood, seek medical attention immediately.

Diagnosis

In addition to examining you and reviewing your medical history, your doctor probably will order chest X-rays and other diagnostic tests. These may include the following:

• Routine laboratory studies — Basic blood tests can help determine if you have been losing blood and whether your organs (kidneys, liver, etc.) are functioning normally. These tests can help your doctor determine what further studies are needed and the severity of the condition.
• Barium swallow — Also known as an esophagram, this test is an X-ray of the esophagus. You drink a liquid containing barium, which coats the interior of your esophagus and makes it easier to see blockages or changes in the shape of the esophageal tube on X-rays.
• Esophagoscopy — The doctor inserts a thin, lighted tube called an endoscope into your esophagus. At the end of the endoscope is a small video camera. With this tool, the doctor can look for problems in your esophagus, and collect tissue samples for examination. Often, you will be given a sedative or pain medicine to minimize your discomfort.
• Computed tomography (CT) scan — X-ray pictures taken from different angles provide a three-dimensional picture of your internal organs. This test looks for any masses or blockages and is especially useful for determining the extent of cancer and its spread, which can help guide decisions about treatment.
• Endoscopic ultrasound — This new test uses a tiny ultrasound machine at the end of a tube that is inserted into the esophagus to create pictures with sound waves. This test may be better than CT scans at determining how far cancer has grown into the esophagus and surrounding tissue and lymph nodes. This information is especially important in deciding about surgery and planning the surgery.

People with squamous cell carcinoma of the esophagus are at higher risk of cancers of the mouth, throat, lungs and stomach. For this reason, you probably also will have tests with endoscopes inside the throat and lungs as well as chest X-rays and chest CT scans.

Expected Duration

If it is not detected, esophageal cancer will continue to grow and can spread to almost any part of the body. The chance of survival increases greatly if the disease is detected early.

How long treatment lasts depends on such factors as your age and general health, how advanced the cancer is, and how well your body responds to treatment. Treatments can take several months to complete. If surgery is done, the recovery period typically lasts at least three to four weeks and can be longer.

Prevention

While some risk factors for esophageal cancer can't be avoided, you can take steps to decrease your risk:

• Don't use tobacco in any form. If you smoke or use smokeless tobacco, get the help you need to stop.
• Never consume anything that may damage your digestive tract.
• If you drink alcohol, drink in moderation. Most experts recommend that women have no more than one drink a day and that men have no more than two drinks a day.
• If you suffer from heartburn, discuss with your doctor how to avoid heartburn and ways to treat it, if necessary.

If you suffer from chronic reflux or heartburn symptoms, an esophagoscopy may be done to look for Barrett's esophagus. If you have Barrett's esophagus, some doctors recommend periodic exams or biopsies to look for abnormalities before they develop into cancer.

Treatment

Treatment for esophageal cancer depends on the size and location of your tumor, your symptoms and your general health. Many different treatments and combinations of treatments may be used. Your team of specialists may include a surgeon, a gastroenterologist (a specialist in diagnosing and treating disorders of the digestive system), a medical oncologist (a specialist in treating cancer) and a radiation oncologist (a specialist in using radiation to treat cancer). Other testing may also be required before treatments begin to determine how well your heart and kidneys are functioning.

Here are the key treatments for esophageal cancer:

• Surgery — Removing the tumor and affected tissue offers the best chance to cure esophageal cancer. Usually, the surgeon removes all or a portion of the esophagus and the neighboring lymph nodes to prevent the cancer from spreading. Sometimes, the upper part of the stomach also is removed. The surgeon then uses the remaining portion of the stomach or a part of the intestine to reconnect the digestive tract, so that you can swallow.
• Chemotherapy — Anticancer drugs may be administered, usually intravenously (into a vein), to kill cancer cells. Chemotherapy may be combined with radiation therapy.
• Radiation therapy — This treatment uses high-energy rays to kill cancer cells. The radiation may come from a machine outside the body (external radiation) or from radioactive elements placed in or near the tumor (internal radiation). Radiation therapy may be done instead of surgery, either alone or in combination with chemotherapy, especially if the size or location of the tumor makes surgery difficult. Radiation therapy may be combined with chemotherapy to shrink the tumor before performing surgery. If the tumor can't be removed by surgery or destroyed by radiation therapy, radiation may help to ease pain and make swallowing easier.

In making a decisions about what treatment to recommend, your cancer team will weigh the benefits of surgery against the risks of this serious operation, which has many potential complications. For many people, radiation therapy alone or in combination with chemotherapy may offer the same chance of survival as surgery. In addition, there are other options to improve symptoms, including:

• A stent (small wire mesh) placed into the esophagus
• A laser to reduce the size of a tumor, which can prevent blockage and improve swallowing
• A simpler surgery, in which feeding tubes are inserted into the stomach or intestine for nutrition and to avoid swallowing problems.

When To Call A Professional

See your doctor if you experience any characteristic symptoms of esophageal cancer, such as difficulty swallowing, weight loss or vomiting. If you have chest pain or vomit blood, seek medical attention immediately.

Prognosis

Once cancer has been diagnosed, your doctor will conduct tests to determine what stage your cancer has reached. The stages are labeled 0 to IV. The higher the stage number, the further the cancer has spread. For example, in stage 0, the cancer is confined to the superficial lining of the esophagus. In stage I, the cancer has not invaded the outer muscle layer of the esophagus.

Surgery to remove the tumor offers the best chance for cure. If the disease is caught early, the five-year survival rate is much higher — 75% for patients diagnosed in stage 0 and 50% for those diagnosed in stage I. Most esophageal cancer is diagnosed at the more advanced stages when the five-year survival is only about 15% to 20%. With or without surgery, chemotherapy and radiation therapy can help to improve the quality of life and prolong survival, even in advanced stages.

Additional Info

National Cancer Institute (NCI)

U.S. National Institutes of Health

Public Inquiries Office

Building 31, Room 10A03

31 Center Drive, MSC 8322

Bethesda, MD 20892-2580

Phone: (301) 435-3848

Toll-Free: (800) 422-6237

TTY: (800) 332-8615

E-Mail: cancergovstaff@mail.nih.gov

http://www.nci.nih.gov/

American Cancer Society (ACS)

1599 Clifton Road, NE

Atlanta, GA 30329-4251

Toll-Free: (800) 227-2345

http://www.cancer.org/

Cancer Research Institute

681 Fifth Ave.

New York, NY 10022

Toll-Free: (800) 992-2623

E-Mail: info@cancerresearch.org

http://www.cancerresearch.org/