Esophageal Cancer

Related Media: Upper GI Endoscopy

Definition

The esophagus is the tube that carries food from the mouth to the stomach. Esophageal cancer (EC) is cancer that starts in this tube.

There are two main types of EC:

• Squamous cell cancer—from the cells that line the upper part of the esophagus
• Adenocarcinoma—from the cells where the esophagus meets the stomach

Esophageal Cancer

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Causes

Cancer is when cells in the body split without control or order. These cells go on to form a growth or tumor. The term cancer refers to harmful growths. These growths attack nearby tissues. They also spread to other parts of the body. It is not clear exactly what causes these problems. It’s likely a mix of genes and the environment.

The changes may be caused by irritants such as:

• Tobacco
• Alcohol
• Stomach acid from acid reflux

Risk Factors

EC is more common in men. It's also more common in people aged 50 years and older.

Your chances for EC are also higher for:

• History of gastroesophageal reflux (GERD)
• Barrett esophagus
• Smoking and other tobacco use
• Excess alcohol use —risk is greater when you combine drinking with tobacco
• Human papillomavirus (HPV) infection
• Obesity
• Damaged esophagus

Symptoms

Symptoms may not happen until later. When symptoms happen, EC may cause:

• Trouble swallowing
• Weight loss
• Lack of hunger
• Heartburn
• Pain from swallowing
• Persistent cough
• Hoarse voice

Diagnosis

The doctor will ask about your symptoms and health history. Your answers and a physical exam may point to EC. You may also have:

• Blood tests
• Imaging tests such as:
  • Upper GI endoscopy with biopsy —Examination of esophagus with a lighted scope. Tissue samples will be removed and looked at under a microscope.
  • CT scan
  • PET/CT scan

The exam and your test results will help find out the stage of cancer you have. Staging guides your treatment plan. EC is staged from 0-4. Stage 0 is a very localized cancer. Stage 4 is a spread to other parts of the body.

Treatment

Talk with your doctor about the best treatment plan for you. Options are based on the stage of your EC. You may have one or more of the following:

Surgery

Surgery may be needed. It may be the only treatment, or it may be done in combination with radiation therapy or chemotherapy. Types include:

• Esophagectomy—removes part or all of the esophagus using a scope or open incision
• Endoscopic ablation—to remove cancer using a laser

Radiation Therapy

Radiation kills cancer cells and shrink tumors. It does not cure EC. It offers brief relief of symptoms. It may also shrink the tumor. It used with chemotherapy. It may also be done after an esophagectomy.

It may be:

• External—radiation directed at the esophagus from a source outside the body
• Internal—radioactive materials are placed into the esophagus in or near the cancer cells

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms. It may given by mouth, shots, or IV. The drugs enter the bloodstream and travel throughout the body.

Chemotherapy alone will not cure EC. It is only used when the cancer has spread and can’t be cured. It is used to help shrink the tumor, ease pain, or control nausea.

Photodynamic Therapy

A mix of drugs and special lights are used to try to kill cancer cells. The cells absorb the medicine. The lights stimulate the medicine to kill the cells.

This therapy may not be useful in some people.

Prevention

To help lower your chances of EC:

• Don't smoke or use other tobacco products.
• If you smoke, talk to your doctor about ways to quit .
• Limit alcohol. This means 2 drinks or less a day for men and 1 drink or less a day for women.
• Eat a healthful diet. Eat fruits and vegetables , foods that are high in fiber. Limit dairy, processed foods, and red meat.
• Exercise regularly—Aim for 30 minutes of activity on most days of the week.
• Get medical treatment for GERD or Barrett esophagus.
• Maintain a healthy weight.

This type of cancer is often found in later stages. People who have risk factors, especially GERD or Barrett esophagus, should talk to their doctor about screening tests. Screening tests will look for cancer before symptoms appear.

References

• ASGE Technology Committee, Kantsevoy SV, Adler DG, et al. Endoscopic mucolsal resection and endoscopic submucosal dissection. Gastrointest Endosc. 2008;68(1):11-18.
• Barrett esophagus. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T115861/Barrett-esophagus. Accessed January 29, 2021.
• Esophageal and esophagogastric junction cancer. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T114816/Esophageal-and-esophagogastric-junction-cancer. Accessed January 29, 2021.
• Esophagus cancer. American Cancer Society website. Available at https://www.cancer.org/cancer/esophagus-cancer.html. Accessed January 29, 2021.
• Far AE, Aghakhani A, Hamkar R, et al. Frequency of human papillomavirus infection in oesophageal squamous cell carcinoma in Iranian patients. J Infect Dis. 2007;39(1):58-62.
• General information about esophageal cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/esophageal/patient/esophageal-treatment-pdq. Accessed January 29, 2021.
• Kato H, Nakajima M. Treatments for esophageal cancer: A review. Gen Thorac Cardiovasc Surg. 2013;61(6):330-335.
• Lightdale CJ. Endoscopic treatments for early esophageal cancer. Gastroenterol Hepatol (NY). 2007;3(12):904-906.
• Nakajima M, Kato H. Treatment options for esophageal squamous cell carcinoma. Expert Opin Pharmacother. 2013;14(10):1345-1354.
• Vignesh S, Hoffe SE, Meredith KL, et al. Endoscopic therapy of neoplasia related to Barrett's esophagus and endoscopic palliation of esophageal cancer. Cancer Control. 2013;20(2):117-129.