The esophagus is a long, muscular tube that runs from the throat to the stomach. The esophagus is made up of several layers of muscle that contract to help move food down the tube and into the stomach. A special muscle called the esophageal sphincter acts as a valve, opening to allow food and liquids to pass from the esophagus into the stomach.
What is esophageal cancer?
Esophageal cancer results when abnormal cells grow out of control in esophageal tissue. Eventually the cells form a mass called a tumor. There are two main types of esophageal cancer:
- Squamous cell carcinoma begins in the cells (called squamous cells) that line the esophagus. This cancer usually affects the upper and middle part of the esophagus.
- Adenocarcinoma develops in the tissue that produces mucus that aids in swallowing. It generally occurs in the lower part of the esophagus.
What are the symptoms of esophageal cancer?
Esophageal cancer may have no obvious symptoms in its early stages. The symptom people notice first is difficulty swallowing. As the tumor grows, it narrows the opening of the esophagus, making swallowing difficult and/or painful. Other symptoms of esophageal cancer can include:
- Pain in the throat or back, behind the breastbone, or between the shoulder blades
- Vomiting or coughing up blood
- Heartburn
- Hoarseness or chronic cough
- Significant weight loss
What causes esophageal cancer?
The exact cause of esophageal cancer is not known, but there are several risk factors for the disease. Risk factors for esophageal cancer include:
- Older age. Esophageal cancer occurs more often in people older than 60 years than in those aged 60 or younger.
- Male gender. Men are three times more likely to develop the disease than women.
- African descent. Esophageal cancer is far more common in African American men than in other races.
- Tobacco use. This includes smoking and using smokeless tobacco.
- Alcohol use. Chronic and/or heavy use of alcohol increases the risk of esophageal cancer.
- Barrett’s esophagus and chronic acid reflux. Barrett’s esophagus is a change in the cells at the lower end of the esophagus that occurs from chronic untreated acid reflux. Even without Barrett’s esophagus, people with long-term heartburn have a higher risk of esophageal cancer.
- Human papilloma virus. In areas of the world that have a high incidence of esophageal cancer (such as Asia and South Africa), infection with human papilloma virus (HPV) carries an increased risk for developing esophageal cancer. HPV is a common virus that can cause tissue changes in the vocal cords and mouth, and on the hands, feet and sex organs.
- Other disorders. Other conditions have been linked to esophageal cancer. These include achalasia, an uncommon disease that causes difficulty swallowing, and tylosis, a rare, inherited disorder in which excess skin grows on the palms of the hands and the soles of the feet.
- Occupational exposure to certain chemicals. People exposed to dry cleaning solvents chronically are at higher risk for esophageal cancer.
- History of cancer. People who have had cancer of the neck or head have a greater risk for esophageal cancer.
How common is esophageal cancer?
Esophageal cancer is not common, although it ranks among the 10 most common cancers in the world. About 14,000 Americans are diagnosed with esophageal cancer each year.
How is esophageal cancer diagnosed?
The doctor will ask you about your medical history, including your current symptoms. After a physical examination, the doctor might order certain tests that can help in diagnosing and assessing esophageal cancer.
- Barium swallow uses a special series of X-rays to visualize the esophagus. The patient drinks a liquid containing barium, which makes the esophagus easier to see on the X-ray.
- Esophagoscopy is a procedure that allows the doctor to look at the inside of the esophagus using a thin, lighted tube called an endoscope. For the test, the endoscope is passed through the mouth and down the throat into the esophagus. The endoscopy can also be used to relieve obstruction. The doctor can insert a balloon to dilate an obstructed esophagus.
- Biopsy. During the esophagoscopy, the doctor may remove a small piece of tissue to examine under a microscope to see if there are any cancer cells.
- Esophageal endoscopic ultrasound uses sound waves to create images of internal structures. In this procedure, the ultrasound is performed through the esophagoscope.
- Computed tomography (CT) is often used to evaluate the extent of the tumor spread to the chest and abdomen.
A newer diagnostic tool, called fluorescence tissue spectroscopy, allows doctors to distinguish between normal and abnormal cells without removing the tissue from the body, as in a biopsy. This procedure, performed during endoscopy, evaluates the cells’ reaction to light energy.
How is esophageal cancer staged?
Most cancers are grouped by stage, a description of the cancer that aids in planning treatment. The stage of a cancer is based on the location and size of the tumor; the involvement, if any, of the lymph nodes; and the degree that the cancer has spread, if at all, to other tissue and organs. Stages of esophageal cancer include:
- Stage 0 is very early cancer, also called carcinoma in situ. In this stage, the cancer has not spread below the lining of the esophagus.
- Stage I cancer has moved deeper into the esophagus, but has not entered the muscular wall and has not spread to lymph nodes or other nearby organs.
- Stage IIA and IIB cancer may have spread to nearby lymph nodes, but has not spread to nearby organs.
- Stage III cancer has spread outside the esophagus and into the lymph nodes, but it has not spread to other organs.
- Stage IV cancer has spread to other organs.
- Recurrent cancer has returned after treatment, either in the esophagus or in another part of the body.
Staging tests include endoscopic ultrasound, mediastinoscopy (visualization of the mediastinum —the space inside the central part of the chest—using a scope fitted with a light source), and positron emission tomography (PET) scanning (a measurement of glucose uptake by cells; cancer cells take up glucose more rapidly).
In addition to staging the cancer, tumors may also be graded. Grading is a way of rating a tumor based on how much its cells look and act like normal cells. Tumor grading can also tell the doctor how fast the tumor is growing. Tumors with almost normal-looking cells that grow slowly are called low-grade tumors. Tumors with very abnormal-looking cells that divide rapidly are called high-grade tumors. High-grade tumors are more likely to spread than low-grade tumors.
How is esophageal cancer treated?
The approach to treatment depends on the stage and grade of the cancer. Treatment options that may be used for esophageal cancer include:
- Surgery is the most common treatment for esophageal cancer. Surgery may be done to remove all or most of the esophagus, as well as some tissue around it, in a procedure called esophagectomy. If the esophagus is removed, the doctor may reposition the stomach (moving it up into the chest), or replace the esophagus with a plastic tube or piece of intestine to preserve function. The doctor may also remove lymph nodes around the esophagus and look at them under a microscope to see if they contain cancer.
Surgery can cure cancer in some patients who have no spread of the tumor beyond the esophagus. Unfortunately, less than 25% of esophageal cancers are discovered this early. Therefore, surgery is often offered to ease symptoms.
Esophageal cancer surgery often requires extended hospitalizations. Some surgeons are now doing the procedures using minimally invasive techniques.
Complications include: stomach emptying problems, narrowing where the surgery was performed and heartburn.
- Radiation therapy is a way of treating disease using radiation (high-energy rays) or radioactive substances. It is used to kill or damage cancer cells, often by aiming a beam of radiation at the tumor. The radiation destroys the cancer cells by interfering with their growth and division. Radiation can be used alone, before surgery to shrink tumors, or after surgery to kill any cancer cells that may remain. During radiation treatments for esophageal cancer, a plastic tube is sometimes inserted into the esophagus to keep it open. This is called intraluminal intubation and dilation.
Radiation therapy isn’t considered a cure, but it can be very useful in relieving difficulty swallowing.
- Chemotherapy uses medicines to kill or stop the growth of cancer cells. Some chemotherapy drugs are taken as pills and some are placed directly into the bloodstream through a vein (intravenous). Chemotherapy drugs travel through the bloodstream and can kill cells throughout the body. For esophageal cancer, chemotherapy is sometimes used before surgery to help shrink the tumor.
Chemotherapy can be given to control symptoms (palliative), before surgery to shrink the tumor, or can be used in conjunction with radiation.
- Endoscopic laser therapy. As the tumor grows, it may cause a blockage in the esophagus. Lasers can be used to cut a hole in the blockage and improve swallowing.
- Photodynamic therapy (PDT) uses photoactive drugs (drugs activated by non-thermal light) that are absorbed by cancer cells, thus destroying the cancer cells. This treatment may be used to help ease the symptoms of esophageal cancer, particularly difficulty swallowing.
People with esophageal cancer may participate in clinical trials. Clinical trials are research programs conducted with patients to evaluate new medical treatments, drugs or devices. New uses for chemotherapy and radiation therapy are being tested in clinical trials.
Treatment by stage
Surgery is the treatment of choice for stage 0 and stage I. Radiation therapy also may be used.
Stage IIA and stage IIB are generally treated with a combination of chemotherapy and radiation therapy. Surgery may be used to help treat symptoms.
Chemotherapy and radiation therapy may be used to provide some symptom relief for patients with stage III and stage IV esophageal cancer.
What is the outlook for people with esophageal cancer?
The chance of recovery depends on the stage of the cancer and the person’s general health. If caught early, esophageal cancer can often be successfully treated. Unfortunately, esophageal cancer usually is not discovered until it has progressed to an advanced stage, when treatment is less successful.
Can esophageal cancer be prevented?
Although esophageal cancer cannot be prevented, controlling the risk factors, such as tobacco and alcohol use, may help reduce the risk of developing the disease.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 9/1/2008…#14253
