Description

Esophageal cancer is a growth of cells that begins in the esophagus. The esophagus is a long, hollow tube that extends from the throat to the stomach. Your esophagus helps move swallowed food from the back of the throat to the stomach to be digested.

Esophageal cancer usually begins in the cells that line the inside of the esophagus. Esophageal cancer can occur anywhere along the esophagus.

Esophageal cancer is more common in men. Risk factors include alcohol consumption and smoking.

Esophageal cancer treatment often involves surgery to remove the cancer. Other treatments may include chemotherapy, radiation, or a combination of the two. Targeted therapy, immunotherapy, and may also be used.

Symptoms

Esophageal cancer may not cause early signs or symptoms. The symptoms of esophageal cancer tends to occur when the disease is advanced.

The signs and symptoms of esophageal cancer include:

  • Difficulty swallowing.
  • Chest pain, pressure or burning.
  • Cough or hoarseness.
  • The loss of weight without trying.
  • The worsening indigestion or heartburn.

When to see a doctor

Make an appointment with your doctor or other health care professional if you have any symptoms that worry you.

Causes

Esophageal cancer occurs when the cells lining the esophagus to develop changes in their DNA. A cell's DNA contains the instructions that tell the cell what to do. In healthy cells, the DNA contains the instructions to grow and multiply at a set rate. The instructions that tell cells to die at a set time. In cancer cells, changes in DNA to give different instructions. The changes, to tell the cancer cells to make many more cells quickly. Cancer cells can continue living when healthy cells would die. This makes too many cells.

The cancer cells may form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. At the time, cancer cells can break off and spread to other parts of the body. When cancer spreads, it is called metastatic cancer.

Types of esophageal cancer

Esophageal cancer is classified according to the type of cells that are involved. The type of esophageal cancer you have helps determine your treatment options. Types of esophageal cancer include:

  • The Adenocarcinoma. Adenocarcinoma begins in cells of the glands of the esophagus. These glands produce mucus. Adenocarcinoma occurs most often in the lower part of the esophagus. Adenocarcinoma is the most common type of esophageal cancer in the united States. It mainly affects the white men.
  • The squamous cell carcinoma. Squamous cell carcinoma begins in the flat, thin cells that line the surface of the esophagus. Squamous cell carcinoma occurs more frequently in the upper and middle parts of the esophagus. Squamous cell carcinoma is the most common esophageal cancer in the world.
  • Other rare types. Some rare forms of esophageal cancer include small cell carcinoma, sarcoma, lymphoma, melanoma and choriocarcinoma.

Risk factors

Risk factors for esophageal cancer include the conditions and the habits that can cause irritation in the esophagus. Risk factors may include:

  • A constant habit of drinking very hot liquids.
  • The bile reflux.
  • Difficulty swallowing due to a muscle in the esophagus does not relax, a condition known as achalasia.
  • The consumption of alcohol.
  • Gastroesophageal reflux disease, also called GERD.
  • Not eating enough fruits and vegetables.
  • Obesity.
  • Precancerous changes in the cells of the esophagus called Barrett's esophagus.
  • Radiation treatment to the chest or upper abdomen.
  • The habit of smoking.

Complications

As the esophageal cancer progresses, it can cause complications. Complications can include:

  • An obstruction in the esophagus. The cancer can make it difficult for food and liquid to pass through the esophagus.
  • Bleeding in the esophagus. Cancer of the esophagus can cause bleeding. Though the bleeding is usually gradual, can be sudden and severe, sometimes.
  • Pain. Advanced cancer of the esophagus can cause pain.

Prevention

There is No sure way to prevent cancer of the esophagus, but you can reduce your risk if you:

Ask about the screening of esophageal cancer

Screening tests for cancer of the esophagus may be an option for people with Barrett's esophagus. Barrett's esophagus is a precancerous condition caused by chronic acid reflux. Increases the risk of cancer of the esophagus.

If you have Barrett's esophagus, ask your health care professional about the detection. Detection typically involves tests to observe the inside of the esophagus for signs of cancer.

Drink alcohol only in moderation, if at all

If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink per day for women and up to two drinks per day for men.

Eat more fruits and vegetables

Choose a healthy diet with a variety of fruits and vegetables. Food sources of vitamins and nutrients are best. Avoid taking large doses of vitamins in pill form, as they may be harmful.

Exercise most days of the week

Try to do at least 30 minutes of exercise most days of the week. If you haven't been active lately, ask your health care professional if you feel well and start slowly.

Maintain a healthy weight

If your weight is healthy, work to maintain that weight. If you need to lose weight, consult with a health care professional about the healthy ways to lose your weight. Eating fewer calories, and gradually increase the amount of exercise.

Stop smoking

Talk with your health care team about the strategies and aids that can help you stop smoking. Options include nicotine replacement products, medications and support groups. If you've never smoked, don't start.

Diagnosis

Esophageal cancer diagnosis often begins with imaging tests to look for in the esophagus. A thin, flexible tube with a camera can be passed through the throat to see the esophagus. A tissue sample may be taken for laboratory testing.

Barium swallow study

A barium swallow study is a test that uses X-rays to look for in the digestive system. May show changes in the esophagus, such as a growth that could be cancerous. Before the test, you drink a white liquid called barium. The barium coats the esophagus and makes it easier to see on x-rays. If something troubling is located in the barium study, your health care team may recommend to have an endoscopy to check it out.

Upper endoscopy

Endoscopy is a test to look at the upper part of the digestive system. It uses a long, flexible tube with a camera on one end, called an endoscope, to see the inside of the body. To see the inside of the esophagus, a professional of the health passes the endoscope through the throat and the esophagus. The health care professional for signs of cancer.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. To obtain the tissue sample, a professional of the health passes of special cutting tools through the endoscope. The healthcare provider uses the tools to remove a very small amount of tissue from the inside of the esophagus. The tissue sample is sent to a lab to look for cancer cells.

The determination of the extent of the cancer

After an esophageal cancer diagnosis, you may do other tests to see if the cancer has spread. These tests can help your health care team figure out the extent of your cancer, called the stage. Cancer staging tests often involve testing image. Tests to detect signs of cancer in the lymph nodes or other parts of your body. Your healthcare team uses the stage of the cancer, the results of the test to help you to create your treatment plan.

Imaging tests may include bronchoscopy, endoscopy, ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography scans, also called PET. Not each of the tests is appropriate for each person. Talk with your healthcare provider about which tests you will need.

The stages of esophageal cancer in the range of 0 to 4. A stage 0 esophageal cancer is small and only on the inner surface of the esophagus. As the cancer grows and grows more in the esophagus, the stages get more. A stage 4 esophageal cancer has grown beyond the esophagus, or has spread to lymph nodes or to other parts of the body.

Treatment

The treatment for small cancers of the esophagus usually begins with surgery to remove the cancer. If the cancer grows or spreads to other parts of the body, treatment can begin with the chemotherapy and the radiation in its place. Your health care team takes into account many factors when creating a treatment plan. These factors include your general health, the type and stage of your cancer, and your preferences.

Surgery

The surgery to remove the cancer can be used alone or in combination with other treatments.

The procedures used for the esophageal cancer may include:

  • Removing the cancer from the inside of the esophagus. Endoscopic resection is a procedure to remove the cancer and some healthy tissue around it. The procedure is performed through a long, flexible tube, called an endoscope. The tube passes through the throat and the esophagus. Special tools are passed through the endoscope to remove the cancer. This procedure may be an option if the cancer is very small and has not spread.
  • The extraction of the cancer and part of the esophagus. Esophagectomy is surgery to remove part of the esophagus. During esophagectomy, the surgeon removes the part of the esophagus that contains the cancer and some nearby lymph nodes. The surgeon may also remove some of the upper part of the stomach. When the surgery involves the removal of some of the esophagus and some of the stomach is called a esophagogastrectomy. The rest of the esophagus is reconnected to the stomach. Usually this is done by pulling the stomach up to meet the rest of the esophagus. If necessary, a part of the colon is used to help join the two.

Esophageal cancer surgery carries a risk of serious complications. These complications may include infection and bleeding. There is also a risk of leakage of the area where the remaining esophagus is reattached to the stomach.

The surgery to remove the esophagus can be performed as an open procedure through large incisions. The surgery can also be performed laparoscopically in special surgical instruments are inserted through small incisions in the skin. How the surgery is performed depends on your individual situation and how your surgeon wants to get closer to him.

Chemotherapy

Chemotherapy treats the cancer with strong medications. Chemotherapy drugs are typically used before or after surgery in patients with esophageal cancer. Chemotherapy may be combined with radiation therapy.

In people with advanced cancer that has spread beyond the esophagus, chemotherapy can be used alone to help relieve the symptoms caused by the cancer.

Side effects of chemotherapy depend on the drugs you receive. Common side effects include fatigue, nausea and vomiting, diarrhea and loss of appetite.

Radiation therapy

Radiation therapy treats cancer with powerful rays of energy. The energy can come from X-rays, protons or other sources. For esophageal cancer, radiation therapy is most often done with a procedure called external-beam radiation. During this treatment, you will lie on a table while a machine moves around you. The machine directs radiation to precise points on your body. The radiation can also be placed inside your body near the cancer. This type of radiation therapy called brachytherapy, is less common.

Radiation therapy is often combined with chemotherapy in people with cancer of the esophagus. Radiation therapy is also used to relieve the complications of advanced esophageal cancer. This may include the treatment of a cancer grows large enough to let food pass into your stomach.

Side effects of the radiation in the esophagus include sunburn-like skin reactions, pain or difficulty when swallowing, and damage to nearby organs, such as lungs and the heart.

Combined chemotherapy and radiation therapy

The combination of chemotherapy and radiation therapy may improve the efficacy of each treatment. Combined chemotherapy and radiation may be the only treatment you receive, or combination therapy may be used before surgery. But the combination of chemotherapy and radiation treatments increases the likelihood and severity of side effects.

Targeted drug therapy

Targeted therapy for cancer is a treatment that uses drugs that attack specific chemicals in cancer cells. By blocking these chemicals, specific treatments can cause cancer cells to die.

For esophageal cancer, targeted therapy may be combined with chemotherapy for advanced cancer that cannot be removed with surgery or the cancer returning after treatment.

Some targeted therapies only work in the people that the cancer cells have been certain changes in the DNA. Cancer cells can be analyzed in a laboratory to see if these medications can help.

Immunotherapy

Immunotherapy for cancer is a treatment with a medication that helps the body's immune system destroys the cancer cells. The immune system fights diseases by attacking the germs and other cells that should not be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the cells of the immune system find and kill cancer cells.

For esophageal cancer, immunotherapy is sometimes used before or after surgery. It can also be used for advanced cancer that cannot be removed with surgery or the cancer returning after treatment.

Treatments for complications

Cancer of the esophagus sometimes grows large enough to limit the esophagus. It can cause difficulty swallowing. The treatments for this complication can include:

  • The relief of obstruction esophageal. If the esophageal cancer has been reduced by the esophagus, a surgeon may use an endoscope and special tools to insert a metal tube called a stent. The stent contains the esophagus open. Other options include surgery, radiation therapy, chemotherapy, laser therapy and photodynamic therapy.
  • Provide nutrition. Your health care professional may recommend a feeding tube if you are having trouble swallowing, or if you are having surgery of the esophagus. A feeding tube allows nutrition to be delivered directly to your stomach or small intestine. This gives your esophagus time to heal after cancer treatment.

Palliative care

Palliative care is a special type of health care that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve the pain and other symptoms. A health care team that may include doctors, nurses and other specially trained health professionals providing palliative care. The care team's goal is to improve the quality of life for you and your family.

Palliative care specialists work with you, your family and your care team. They provide an extra layer of support, while you have cancer treatment. You can have palliative care at the same time that you are getting strong cancer treatments, such as surgery, chemotherapy or radiation therapy.

The use of palliative care with other appropriate treatments can help people with cancer feel better and live longer.

Alternative medicine

Complementary and alternative for esophageal cancer treatments can't cure the cancer of the esophagus. But these treatments can be combined with your health care team care to help relieve pain and other symptoms.

The options may include:

  • Acupuncture.
  • Guided imagery.
  • Hypnosis.
  • The massage.
  • Relaxation techniques.

Ask your health care team if these options are safe for you.

Coping and support

With time, you will find what helps you to deal with the uncertainty and distress of a cancer diagnosis. Until then, you may find that it helps to:

Learn enough about esophageal cancer to make decisions about your care

Ask your health care team about your cancer, including your test results, treatment options, and, if you like, your prognosis. As you learn more about cancer of the esophagus, may be more confident in making treatment decisions.

Keep friends and family close

Keep your close relationships strong can help you deal with the cancer of the esophagus. Friends and family can provide the practical support that you may need, such as help to take care of your house if you're in the hospital. And that you can serve as emotional support when you feel overwhelmed by the fact of having cancer.

Find someone to talk to

Find someone who is willing to listen to you talk about your hopes and fears. This can be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group may also be useful.

Ask your health care team about support groups in your area. Other sources of information are the National Cancer Institute and the American Cancer Society.

Preparing for your appointment

Make an appointment with a doctor or other health care professional if you have any symptoms that worry you.

If your healthcare provider thinks you might have cancer of the esophagus, you may be referred to a doctor who specializes in the treatment of diseases and conditions of the digestive system, called a gastroenterologist. If a diagnosis of cancer, you may also be referred to a doctor who specializes in the treatment of cancer is called an oncologist.

Because appointments can be brief, it is a good idea to be prepared. Here's some information to help you prepare.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do in advance, such as restrict your diet.
  • Write down your symptoms, including those that do not seem to be related to the reason for which you scheduled the appointment.
  • Write down key personal information, including major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you are taking and the dose.
  • Have a family member or friend. Sometimes it can be very difficult to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
  • Write questions to ask their health care team.

Your time with your health care team is limited, so preparing a list of questions can help you make the most of their time together. A list of questions from most important to least important in case time runs out. For cancer of the esophagus, some basic questions to ask include:

  • Where is my cancer of the esophagus?
  • How advanced is my cancer?
  • Can you explain the pathology report to me?
  • What other tests do I need?
  • What are my treatment options?
  • What are the possible side effects of each treatment option?
  • There is a treatment option which you think is the best?
  • What would you recommend to a friend or family member in my situation?
  • You should see a specialist?
  • Are there brochures or other printed material that I can take with me? What sites do you recommend?
  • What is going to determine whether I should plan for a follow-up visit?

Do not hesitate to ask other questions.

What to expect from your doctor

Be prepared to answer questions, such as:

  • When did your symptoms begin?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Esophageal cancer