Esophageal cancer at a glance
- Esophageal cancer is the result of uncontrolled growth of cells in the esophagus, the tube that connects the throat to the stomach.
- There are two types of esophageal cancer, adenocarcinoma and squamous cell carcinoma.
- Cancer of the esophagus is more common in men than women and chances of developing it increase with age.
- There are many risk factors that can increase the chances of developing esophageal cancer including smoking, GERD (gastroesophageal reflux disease), heavy alcohol consumption, Barrett’s esophagus and more.
- Esophageal cancer treatments vary but the most common are chemotherapy, radiation therapy and surgery.
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What is esophageal cancer?
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.
How the esophagus works
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.
- Mucosa: The inside layer of the esophagus.
- Submucosa: The layer of connective tissue below the mucosa, which contains nerves and blood vessels.
- Muscularis propria: Under the submucosa is the muscularis propria that is a thick layer of muscle. This contracts to push food and drink down the throat to the stomach.
- Adventitia: The outermost layer of the esophagus formed by connective tissue.
There are two main types of esophageal cancer, squamous cell carcinoma and adenocarcinoma.
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 cell carcinoma
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.
Esophageal cancer causes
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.
- Tobacco and alcohol
- Cigarettes, chewing tobacco, cigars, pipes and the use of other tobacco products are major contributing factors to esophageal cancer. Smoking a pack of cigarettes per day doubles a person’s chances of developing adenocarcinoma, and that risk does not decrease if the person stops using tobacco.
- Heavy alcohol use also increases the risk of esophageal cancer. The more a person drinks, the higher the chances of developing cancer of the esophagus.
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- Combining alcohol and smoking increases the risk of esophageal cancer more than using either alone.
- Barrett’s esophagus
- This condition is a result of stomach acid damaging the inner lining of the esophagus causing squamous cells to be replaced with gland cells. Barrett’s esophagus may cause heartburn, however some people with Barrett’s have no symptoms.
- Most people with Barrett’s esophagus do not develop esophageal cancer, but they are at a higher risk of having adenocarcinoma of the esophagus than a person without Barrett’s.
- Diet and obesity
- A diet low in fruits and vegetables is linked to a higher risk of cancer of the esophagus. While the exact reason is not known, these foods contain many minerals and vitamins that could help prevent cancer.
- Drinking extremely hot liquids, temperatures of almost 150° F or higher, frequently may increase the risk of esophageal cancer.
- People who are obese or overweight are at a higher risk of developing adenocarcinoma of the esophagus.
- Environmental complications
- Exposure to certain chemical fumes, such as solvents used in dry cleaning, may increase the risk of cancer of the esophagus.
- Gastroesophageal reflux disease (GERD)
- GERD is a result of stomach acid and enzymes moving up into the lower part of the esophagus. Symptoms of GERD include heartburn or pain the middle of the chest.
- GERD increases the chances of a person developing adenocarcinoma of the esophagus, but GERD is very common and most people with it do not develop esophageal cancer. This condition can also cause Barrett’s esophagus.
- Physiological complications
- Conditions that affect the physical structure of the esophagus can also increase the risk of esophageal cancer. Some conditions include:
- Achalasia is a problem where the lower esophageal sphincter does not relax.
- Tylosis is a rare, inherited disease that causes small growths in the esophagus.
- Plummer-Vinson syndrome causes webs to form in the upper esophagus and is a very rare condition.
- Injury to the esophagus that heals to develop scar tissue in the esophagus can result in an increased risk of squamous cell esophageal cancer.
- Conditions that affect the physical structure of the esophagus can also increase the risk of esophageal cancer. Some conditions include:
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.
Signs & symptoms of 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.
Diagnosing esophageal cancer
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.
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Patient StoriesEsophageal cancer treatments
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.
Surgery
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
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
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.
Immunotherapy
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.
Targeted therapy
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.