Esophageal cancer occurs when cancer cells form in the esophagus. This cancer begins in the inner layer of the esophagus and then continues to grow outward.
According to the American Cancer Society, esophageal cancer is more common among men than women and makes up about 1% of all cancers diagnosed in the United States. It is more common in other parts of the world such as India, Iran and northern China.
The esophagus is a muscular tube that connects the throat to the stomach. Typically, an adult’s esophagus is about a foot long. This tube transports food and liquid from the mouth to the stomach.
At the top and bottom of the esophagus are sphincters, which relax to let food in or out. The lower esophageal sphincter, at the bottom of the esophagus nearest the stomach, closes between meals to keep the stomach acid and digestive juices from the esophagus.
There are many layers of the esophagus.
There are two main types of esophageal cancer, squamous cell carcinoma and adenocarcinoma.
This type of esophageal cancer usually occurs in the lower third part of the esophagus. It is the most common type of cancer in the U.S., particularly with white men. Adenocarcinoma cancers start in gland cells.
Squamous cells normally line the esophagus. Because of this, squamous cell carcinoma can occur anywhere in the esophagus. However, this type of esophageal cancer is typically found in the neck and upper two-thirds of the chest cavity.
Squamous cell carcinoma makes up less than half of esophageal cancers in the U.S. but is much more common throughout the world.
Some other rare forms of cancer of the esophagus include sarcoma, lymphoma, melanoma, small cell carcinoma and choriocarcinoma.
The exact cause of esophageal cancer is not known. However, cancer is uncontrolled cell growth and these cells form a tumor, which can grow and spread into other parts of the body.
Esophageal cancer risk factors
While the cause is unknown, risk factors can increase the chances of esophageal cancer. Having one or more of these risk factors does not mean a person will get esophageal cancer. Some people may develop cancer of the esophagus without having any of the risk factors.
Risk factors include the following.
Age and gender are also risk factors as more men are likely to develop esophageal cancer than women, and the odds increase with age. Additionally, individuals with other cancers, such as lung, mouth or throat cancers, have a higher risk of developing esophageal cancer.
Cancer of the esophagus often does not present symptoms until the cancer has reached an advanced stage. Because of this, esophageal cancer is typically found because of the symptoms it produces in these later stages.
The most common symptom of cancer of the esophagus is trouble swallowing. Often mild when it starts, over time swallowing becomes more difficult as the cancer cell growth causes the opening inside the esophagus to become smaller.
As swallowing becomes a problem, people with esophageal cancer tend to lose weight.
Some people often also have chest pain, which may present as a feeling of pressure or burning in the chest. This is similar to heartburn and is often mistaken as such.
Other symptoms include, but are not limited to, a chronic cough, hiccups, vomiting and hoarseness.
In order to determine if an individual has esophageal cancer, a physician will perform an endoscopy. During this procedure a flexible tube with a small video camera at the end is passed through the throat and down the esophagus. This allows the doctor to identify areas of irritation and possible cancer.
At this point, a physician will use an endoscope to collect a sample, or biopsy, of tissue. This tissue is then examined for cancerous cells.
Other tests a physician may use to determine the extent of the esophageal cancer include a computerized tomography (CT), endoscopic ultrasound or positron emission tomography (PET). Esophageal cancer stages range from 0 to IV. The lowest stage indicates the cancer is small, while higher stages mean the cancerous cells have spread to other areas of the body.
Treatment options for esophageal cancers are based on the type of cancer as well as the extent of the cancer and the individual’s overall health. Below are some cancer of the esophagus treatment options.
This is the most common esophageal cancer treatment. If the cancer is small and isolated to the superficial layers of the esophagus, an oncologist may recommend removing the tumors and some of the surrounding tissue. This can be performed using an endoscope.
If the cancer is more advanced, it may be necessary to remove a portion of the esophagus, which is known as an esophagectomy. After the affected section has been removed, a surgeon will reconnect the remainder of the esophagus to the stomach by pulling the stomach up to meet the esophagus.
An esophagogastrectomy may be performed if the cancer has moved into the stomach and surrounding lymph nodes. A surgeon will remove part of the esophagus, stomach and the nearby lymph nodes. It may be necessary for the surgeon to use a part of the colon to reattach the esophagus to the remainder of the stomach.
As with all surgeries, complications and side effects can occur. Our oncologists will review each of these before moving forward with a treatment plan.
Chemotherapy, or chemo, is a common form of cancer treatment during which chemicals are delivered into the individual to attack cancerous cells in the body. These chemicals may be administered intravenously or by mouth.
Chemo can also be used in conjunction with radiation therapy.
Radiation therapy uses high doses of radiation to kill cancer cells or shrink tumors. The two types of radiation treatment are external and internal radiation therapies. The type and stage of the cancer will determine which form of therapy we use.
This type of treatment uses medication and treatments to boost and support the individual’s immune system to destroy the cancer cells. Immunotherapy treatment can be topical, oral, intravenous or via catheter.
A form of chemotherapy, targeted therapy marks cells with certain traits, such as a protein or abnormal chromosome, and destroys cells with that trait.
Other treatments, according to the National Institutes of Health, include laser therapy and electrocoagulation. Additionally, there may be ongoing clinical trials to treat cancer of the esophagus.