Esophageal Cancer
On this page:
Esophageal cancer is a disease in which malignant (cancer) cells form
in the tissues of the esophagus.
The esophagus is the hollow, muscular tube that
moves food and liquid from the throat to the stomach. The wall of the esophagus
is made up of several layers of tissue, including mucous membrane, muscle,
and connective tissue. Esophageal cancer starts at the inside lining of the
esophagus and spreads outward through the other layers as it grows.
The two most common forms of esophageal cancer
are named for the type of cells that become malignant (cancerous):
- Squamous cell carcinoma: Cancer that forms in squamous cells, the
thin, flat cells lining the esophagus. This cancer is most often found in
the upper and middle part of the esophagus, but can occur anywhere along
the esophagus. This is also called epidermoid carcinoma.
- Adenocarcinoma: Cancer that begins in glandular (secretory) cells. Glandular
cells in the lining of the esophagus produce and release fluids such as mucus.
Adenocarcinomas usually form in the lower part of the esophagus, near the
stomach.
Smoking, heavy alcohol use, and Barrettfs esophagus can affect the risk
of developing esophageal cancer.
Risk factors include the following:
- Tobacco use.
- Heavy alcohol use.
- Barrettfs esophagus: A condition in which the cells lining the lower part of
the esophagus have changed or been replaced with abnormal cells that could
lead to cancer of the esophagus. Gastric reflux (the backing up of stomach
contents into the lower section of the esophagus) may irritate the esophagus
and, over time, cause Barrettfs esophagus.
- Older age.
- Being male.
- Being African-American.
The most common signs of esophageal cancer are painful or difficult swallowing
and weight loss.
These and other symptoms may be caused by esophageal
cancer or by other conditions. A doctor should be consulted if any of the following
problems occur:
- Painful or difficult swallowing.
- Weight loss.
- Pain behind the breastbone.
- Hoarseness and cough.
- Indigestion and heartburn.
Tests that examine the esophagus are used to detect (find) and diagnose
esophageal cancer.
The following tests and procedures may be used:
- Chest x-ray: An x-ray of the organs and bones inside the chest.
An x-ray is a type of energy beam that can go through the body and onto film,
making a picture of areas inside the body.
- Barium swallow: A series of x-rays of the esophagus and stomach. The patient
drinks a liquid that contains barium (a silver-white metallic compound).
The liquid coats the esophagus and x-rays are taken. This procedure is also
called an upper GI series.
- Esophagoscopy: A procedure to look inside the esophagus to check for abnormal
areas. An esophagoscope (a thin, lighted tube) is inserted through the mouth
and down the throat into the esophagus. Tissue samples may be taken for biopsy.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope
to check for signs of cancer. The biopsy is usually done during an esophagoscopy.
Sometimes a biopsy shows changes in the esophagus that are not cancer but
may lead to cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment
options depend on the following:
- The stage of the cancer (whether it affects part of the esophagus,
involves the whole esophagus, or has spread to other places in the body).
- The size of the tumor.
- The patientfs general health.
When esophageal cancer is found very early, there
is a better chance of recovery. Esophageal cancer is often in an advanced stage
when it is diagnosed. At later stages, esophageal cancer can be treated but
rarely can be cured.
Return
to top 
After esophageal cancer has been diagnosed, tests are done to find out
if cancer cells have spread within the esophagus or to other parts of the body.
The process used to find out if cancer cells have
spread within the esophagus or to other parts of the body is called staging.
The information gathered from the staging process determines the stage of the
disease. It is important to know the stage in order to plan treatment. The
following tests and procedures may be used in the staging process:
- Bronchoscopy: A procedure to look inside the trachea and large airways
in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is
inserted through the nose or mouth into the trachea and lungs. Tissue samples
may be taken for biopsy.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a
type of energy beam that can go through the body and onto film, making a
picture of areas inside the body.
- Laryngoscopy: A procedure in which the doctor examines the larynx (voice box)
with a mirror or with a laryngoscope (a thin, lighted tube).
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas
inside the body, taken from different angles. The pictures are made by a
computer linked to an x-ray machine. A dye may be injected into a vein or
swallowed to help the organs or tissues show up more clearly. This test is
also called computed tomography, computerized tomography, or computerized
axial tomography.
- Endoscopic ultrasound (EUS): A procedure in which an endoscope (a thin, lighted
tube) is inserted into the body. The endoscope is used to bounce high-energy
sound waves (ultrasound) off internal tissues or organs and make echoes.
The echoes form a picture of body tissues called a sonogram. This procedure
is also called endosonography.
- Thoracoscopy: A surgical procedure to look at the organs inside the chest to
check for abnormal areas. An incision (cut) is made between two ribs and
a thoracoscope (a thin, lighted tube) is inserted into the chest. Tissue
samples and lymph nodes may be removed for biopsy. In some cases, this procedure
may be used to remove portions of the esophagus or lung.
- Laparoscopy: A surgical procedure to look at the organs inside the abdomen to
check for abnormal areas. An incision (cut) is made in the abdominal wall
and a laparoscope (a thin, lighted tube) is inserted into the abdomen. Tissue
samples and lymph nodes may be removed for biopsy.
- PET scan (positron emission tomography scan): A procedure to find malignant tumor
cells in the body. A small amount of radionuclide glucose (sugar) is injected
into a vein. The PET scanner rotates around the body and makes a picture
of where glucose is being used in the body. Malignant tumor cells show up
brighter in the picture because they are more active and take up more glucose
than normal cells. The use of PET for staging esophageal cancer is being
studied in clinical trials.
The following stages are used for esophageal cancer:
In stage 0, cancer is found only in the innermost
layer of cells lining the esophagus. Stage 0 is also called carcinoma in situ.
In stage I, cancer has spread beyond the innermost
layer of cells to the next layer of tissue in the wall of the esophagus.
Stage II esophageal cancer is divided into stage
IIA and stage IIB, depending on where the cancer has spread.
- Stage IIA: Cancer has spread to the layer of esophageal muscle or
to the outer wall of the esophagus.
- Stage IIB: Cancer may have spread to any of the first three layers of the esophagus
and to nearby lymph nodes.
In stage III, cancer has spread to the outer wall
of the esophagus and may have spread to tissues or lymph nodes near the esophagus.
Stage IV esophageal cancer is divided into stage
IVA and stage IVB, depending on where the cancer has spread.
- Stage IVA: Cancer has spread to nearby or distant lymph nodes.
- Stage IVB: Cancer has spread to distant lymph nodes and/or organs in other parts
of the body.
Return
to top
Treatment of stage 0 esophageal cancer (carcinoma
in situ) is usually surgery.
Treatment of stage I esophageal cancer may include
the following:
- Surgery.
- Clinical trials of chemotherapy plus radiation therapy, with or without surgery.
- Clinical trials of new therapies used before or after surgery.
Treatment of stage II esophageal cancer may include
the following:
- Surgery.
- Clinical trials of chemotherapy plus radiation therapy, with or without surgery.
- Clinical trials of new therapies used before or after surgery.
Treatment of stage III esophageal cancer may include
the following:
- Surgery.
- Clinical trials of chemotherapy plus radiation therapy, with or without surgery.
- Clinical trials of new therapies used before or after surgery.
Treatment of stage IV esophageal cancer may include
the following:
- External or internal radiation therapy as palliative therapy to
relieve symptoms and improve quality of life.
- Laser surgery or electrocoagulation as palliative therapy to relieve symptoms
and improve quality of life.
- Chemotherapy.
- Clinical trials of chemotherapy.
This summary section refers to specific treatments
under study in clinical trials, but it may not mention every new treatment
being studied.
Return
to top
There are different types of treatment for patients with esophageal cancer.
Different types of treatment are available for
patients with esophageal cancer. Some treatments are standard (the currently
used treatment), and some are being tested in clinical trials. Before starting
treatment, patients may want to think about taking part in a clinical trial.
A treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the gstandardh
treatment, the new treatment may become the standard treatment.
Choosing the most appropriate cancer treatment
is a decision that ideally involves the patient, family, and health care team.
Five types of standard treatment are used:
Surgery is the most common treatment for cancer
of the esophagus. Part of the esophagus may be removed in an operation called
an esophagectomy. The doctor will connect the remaining healthy part of the
esophagus to the stomach so the patient can still swallow. A plastic tube or
part of the intestine may be used to make the connection. Lymph nodes near
the esophagus may also be removed and viewed under a microscope to see if they
contain cancer. If the esophagus is partly blocked by the tumor, an expandable
metal stent (tube) may be placed inside the esophagus to help keep it open.
Radiation therapy is a cancer treatment that uses
high-energy x-rays or other types of radiation to kill cancer cells. There
are two types of radiation therapy. External radiation therapy uses a machine
outside the body to send radiation toward the cancer. Internal radiation therapy
uses a radioactive substance sealed in needles, seeds, wires, or catheters
that are placed directly into or near the cancer. The way the radiation therapy
is given depends on the type and stage of the cancer being treated.
A plastic tube may be inserted into the esophagus
to keep it open during radiation therapy. This is called intraluminal intubation
and dilation.
Chemotherapy is a cancer treatment that uses drugs
to stop the growth of cancer cells, either by killing the cells or by stopping
the cells from dividing. When chemotherapy is taken by mouth or injected into
a vein or muscle, the drugs enter the bloodstream and can reach cancer cells
throughout the body (systemic chemotherapy). When chemotherapy is placed directly
in the spinal column, a body cavity such as the abdomen, or an organ, the drugs
mainly affect cancer cells in those areas. The way the chemotherapy is given
depends on the type and stage of the cancer being treated.
Laser therapy is a cancer treatment that uses
a laser beam (a narrow beam of intense light) to kill cancer cells.
Electrocoagulation is the use of an electric current
to kill cancer cells.
Other types of treatment are being tested in clinical trials.
Patients have special nutritional needs during treatment for esophageal
cancer.
Many people with esophageal cancer find it hard
to eat because they have difficulty swallowing. The esophagus may be narrowed
by the tumor or as a side effect of treatment. Some patients may receive nutrients
directly into a vein. Others may need a feeding tube (a flexible plastic tube
that is passed through the nose or mouth into the stomach) until they are able
to eat on their own.
Return
to top
