What is Esophageal Cancer?

Esophageal cancer develops in the long, hollow tube that connects the throat and stomach. It usually begins in the cells of the esophageal lining, and it can occur anywhere along the esophagus. In the United States, it more often appears in the lower part of the esophagus.

Esophageal cancer is uncommon in the United States but much more prevalent in parts of Asia and Africa. There are two main types:

• Squamous cell carcinoma: In this type, cancer develops from squamous cells that line the inner esophagus.
• Adenocarcinoma: This type of cancer develops from gland cells. Squamous cells that typically line the esophagus are replaced by gland cells – often near where the esophagus meets the stomach. Cancer then develops from these abnormal gland cells.

Baptist Health is known for advanced, superior care for patients with cancer and the diagnosis, treatment and management of esophageal cancer. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Esophageal cancer symptoms can be mild and non-specific in early stages of the disease. In more advanced cases, symptoms can include:

• Chronic coughing
• Difficulty or pain when swallowing
• Hoarseness
• Indigestion and heartburn
• Pain in the chest, behind the sternum
• Unintentional weight loss

Diagnosis

To determine if someone has esophageal cancer, we ask about medical history and do a physical exam. We also use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Biopsy: During an endoscopy, the physician may take a small piece of tissue from the esophagus and examine it under a microscope for cancer cells.

Endoscopy: During this test, a thin tube with a light and a lens is inserted in the mouth and down into the esophagus and stomach to check for inflammation, suspicious growths and other problems.

Causes

Most cases of esophageal cancer result from a mutation in cell DNA, and researchers aren’t sure of the cause. There are a number of lifestyle factors that can lead to the development of esophageal cancer, however. Some of these causes include:

• Drinking alcohol
• Frequent, long-term drinking of very hot liquids
• Obesity
• Smoking

Risk Factors

Risk factors that can contribute to esophageal cancer include:

Achalasia: This is a difficulty swallowing because the esophageal sphincter won’t relax.

Barrett’s esophagus:These are precancerous changes in the cells of the esophagus, often caused by chronic acid irritation.

Bile reflux: In this condition, bile flows upward from the small intestine into the stomach and esophagus. 

Gastroesophageal reflux disease: In GERD, acid splashes up from the stomach and can damage the lower esophageal lining.

Gender: Esophageal cancer is more common in men than women.

Radiation to the chest/upper abdomen: Previous cancer radiation treatments can damage the esophagus.

Prevention

While many risk factors cannot be controlled, there are ways you can help prevent some types of esophageal cancer:

Ask about your risk: If you have a known risk of esophageal cancer, ask your physician about periodic endoscopies.

Don’t smoke: Smoking is a known cause of most cancers.

Eat a healthy diet: Eat a diet that includes plenty of fruit and vegetables, and exercise daily.

Lose weight: People at a healthy weight are less likely to develop many types of cancer.

Reduce the amount of alcohol you drink: Frequent drinking may lead to some esophageal cancers.

Prognosis

The earlier that esophageal cancer is diagnosed, the better the outcome. Unfortunately, esophageal cancer is often diagnosed at an advanced stage because there aren’t many early signs or symptoms. If the cancer has spread to lymph nodes or organs, prognosis is poor.

Treatment and Recovery

Esophageal cancer treatment depends upon how far the condition has progressed, a person’s overall health and his or her preferences. Treatment methods may include:

Chemotherapy

Chemotherapy uses special drugs designed to kill cancer cells. Chemotherapy can be administered as a pill or injected into the bloodstream and may be given before surgery to shrink a tumor, after surgery to kill remaining cancer cells and as a means of reducing symptoms.

Radiation Therapy

This treatment uses high-energy radiation to kill cancer cells. The radiation is directed specifically to the esophagus. Most often, radiation treatments are given five days a week for several weeks.

Surgery

Surgery is meant to remove all of the esophageal cancer and a margin of healthy surrounding tissue. People with early-stage tumors can undergo removal during an endoscopy procedure. Others will need a portion – or all – of the esophagus, and sometimes part of the stomach, removed. The surgeon may also remove surrounding lymph nodes to see if the cancer has spread.

Treatments for Complications

Certain complications of esophageal cancer may require treatment, including:

Feeding tube placement: This is used to deliver nutrition directly to the stomach and small intestine if a person is having trouble swallowing or has recently undergone esophageal surgery.

Obstruction relief: If cancer has narrowed the esophagus, a surgeon can place a metal stent to hold the esophagus open. 

Complications

Esophageal cancer can recur, so follow-up care after successful treatment is important. In addition, the cancer itself and some treatments can result in complications. These include:

Bleeding: Esophageal cancer can cause mild to severe bleeding.

Pain: Advanced esophageal cancer can cause pain.

Obstruction: A tumor can make it difficult or impossible for food and liquid to pass through to the stomach.

Spread of the cancer to other areas: Esophageal cancer can spread to surrounding lymph nodes and other organs throughout the body.