Esophageal Cancer Facts
The esophagus is a muscular tube measuring 20-25 cm (8-10 in) long
and 2-3 cm (0.75-1.25 in) wide that serves as a conduit for moving food
and drink from the mouth to the stomach. Two major types of esophageal cancers exist, as follows:
- Squamous cell carcinoma arises from the epithelial cells that line the esophagus.
- Adenocarcinoma arises from the esophageal glands or within a segment of Barrett's esophagus.
- Most tumors occur in the lower esophagus.
- Forty percent occur in the lowest third.
- Forty-five percent occur in the middle third.
- Fifteen percent occur in the upper third.
Risk Factors
Both types of esophageal cancer
more commonly affect men older than 60 years, but risk factors for
adenocarcinoma are different from those of squamous cell carcinoma.
- Adenocarcinoma of the esophagus is most commonly seen within a
segment of Barrett's esophagus, chronic peptic sores in the lower
esophagus. This is an acquired condition characterized by precancerous
cells that replace the normal cellular lining of the lowest portion of
the esophagus. The condition occurs as a complication of chronic reflux
of gastric contents (GERD) into the lower esophagus.
- Squamous cell carcinoma occurs more commonly in people who heavily use tobacco
and alcohol or who have previously swallowed some caustic substance,
for example lye. The disease is also more common in people who have been
diagnosed with squamous cell cancer of the head and neck.
- Men are up to 5 times more likely than women to be diagnosed with esophageal cancer.
- Among men, African Americans have the highest rate, more than 2.7 times greater than the rate for non-Hispanic white men.
- Incidence rates generally increase with age in all racial and ethnic groups.
- Cancer of the esophagus is a common cancer in developing countries of the world, where most tumors are squamous cell cancers.
- Important risk factors in developing countries include the following:
- Nutritional deficiencies related to lack of fresh fruit and vegetables
- Drinking hot beverages
- A range of chewing and smoking habits
- In the developed world, adenocarcinoma is becoming almost as common as squamous cell cancer.
Esophageal Cancer Symptoms
and Signs
- Symptoms of esophageal cancer usually do not show up until the disease has reached an advanced stage.
- The most common symptom is difficulty swallowing (dysphagia).
- Initially, swallowing solids is difficult.
- Over time, even swallowing liquids becomes difficult.
- The following symptoms may accompany cancer of the esophagus. Any of
these symptoms are indications of advanced disease and should be
considered as a sign to get medical attention.
- Weight loss
- Central chest pain
- Pain upon swallowing
- Vomiting
- Chronic cough
- Symptoms of gastrointestinal bleeding
- Black stools
- Vomiting blood or material that looks like coffee grounds
Esophageal Cancer Diagnosis
The best diagnosis is based on findings from an endoscopic examination of the esophagus.
- This study may be carried out either in a hospital or in a doctor's office.
- The doctor administers a topical anesthetic to the throat to
suppress the gag reflex. Doctors frequently give intravenous (IV)
sedation just before the procedure.
- The doctor then inserts an endoscope into the esophagus. An endoscope is a thin, flexible plastic tube that contains fiberoptic bundles.
- Using a tiny camera in the endoscope, the doctor searches the surface of the esophagus for areas of concern.
- Doctors define esophageal tumors in terms of their size and location.
- Stage I - Tumor limited to the top layers of the cell lining
- Stage II - Tumor extending deeper into muscle layers of the esophagus or into adjacent lymph nodes
- Stage III - Tumor extensively involving the wall of the esophagus, adjacent tissues, or lymph nodes
- Stage IV - Tumor involving distant parts of the body (metastases) and may involve the liver, lungs, brain, or bones
- These factors are important in determining the stage of the cancer and treatment options.
- The doctor can take biopsies to confirm whether the abnormality is a cancer and to determine its type.
- Upper gastrointestinal (GI) barium contrast studies help the doctor
to detect cancers but may fail to detect small tumors more easily seen
through endoscopy.
- Once the presence of cancer has been confirmed, the doctor tries to
determine the spread of the malignancy beyond the esophagus. Doctors may
use the following imagery:
- CT scan of the chest and abdomen
- Chest x-ray film
- Nuclear bone scans
-
Esophageal Cancer Treatment
Treatment for esophageal cancer depends on the results of tests and your underlying health.
- People with advanced heart or lung disease may not be candidates for aggressive therapy.
- In many cases, the esophageal cancer has advanced too far for any available treatment to work.
- In these cases, the doctor considers the following procedures:
- Placing a metal or plastic tube (stent) in the esophagus to allow passage of food and liquids
- Radiation therapy
- Photodynamic therapy
- Widening the esophagus or laser destruction of the esophageal tumor
- In otherwise healthy people with localized disease, surgery may offer the best chance at long-term survival.
- Surgery involves removing the diseased portion of the esophagus and connecting the remaining portion to the stomach.
- Preoperative chemotherapy and radiation often accompany surgery.
- Studies now under way will determine whether combination chemotherapy and radiation therapy without surgery is as effective as surgery in lengthening long-term survival.
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