Esophageal Cancer

Esophageal cancer happens when cancerous cells in your esophagus multiply and create tumors. Your esophagus is the long, muscular tube that moves food from your throat to your stomach.

Types of esophageal cancer

There are two types of esophageal cancer:

• Adenocarcinoma: This is the most common type of esophageal cancer in the U.S. It develops in tissue that makes mucus to help you swallow. It usually affects the lower part of your esophagus.
• Squamous cell carcinoma: This type begins in the squamous cells that line your esophagus. It typically affects the upper and middle parts of your esophagus.

Symptoms of esophageal cancer

Difficulty swallowing is the first symptom you may notice. Other symptoms include:

• Heartburn (especially if it’s new or worsening)
• Unintentional weight loss
• Chest pain
• Chronic (persistent) cough
• Hoarseness
• Pain in your throat or back, behind your breastbone or between your shoulder blades
• Vomiting or coughing up blood

Your symptoms may take years to develop. That’s because your esophagus is flexible and can stretch to make room for large bites of food. You may not notice a change in your body until the tumor grows large enough to block your esophagus and make it hard to swallow.

Esophageal cancer causes

Healthcare providers don’t know the exact cause, but they’ve identified risk factors that increase the chance of developing this disease. For example, your age, sex and race may increase your risk. So can certain medical conditions and lifestyle factors.

Personal characteristics

Personal characteristics that may increase your risk include:

• Your age: This disease typically affects people aged 60 and older.
• Your sex: Males are more likely to have esophageal cancer.
• Your race: Your race may increase your risk for specific types of this disease. For example, people who are Black or Asian are more likely to have squamous cell esophageal cancer. People who are white typically have adenocarcinoma esophageal cancer.

Medical conditions

Having the following conditions may increase your risk:

• Barrett’s esophagus and chronic acid reflux
• Chronic heartburn
• Certain inherited disorders, like achalasia
• History of head and neck cancer
• Human papillomavirus (HPV)
• Obesity or overweight

Lifestyle

Lifestyle factors that increase your risk include:

• Long-term and/or heavy use of alcohol
• Tobacco use, including smokeless tobacco
• Long-term exposure to certain substances, like solvents used in dry cleaning, mineral spirits, paint and varnishes

How to lower your risk

You may be able to lower your risk by:

• Maintaining a weight that’s healthy for you
• Avoiding alcohol and tobacco
• Protecting yourself against HPV infections (ask your healthcare provider about getting shots that defend against the virus)
• Using protective gear if your job involves long-term exposure to solvents and other substances

Talk to your healthcare provider if you have conditions like Barrett’s esophagus or achalasia. They may recommend you have an upper endoscopy (EGD) to check for early signs of this cancer.

How doctors diagnose esophageal cancer

A healthcare provider will do a physical exam. They’ll ask about your symptoms and medical history. They may do the following tests:

• Barium swallow to check for tumors in your esophagus
• CT scan to look for cancer in your chest and abdomen (belly)
• Upper endoscopy to look at the inside of your esophagus (they may also do an endoscopic ultrasound during this test)
• Biopsy to remove a small piece of tissue to check for cancer (your provider may do this during an upper endoscopy)

Your provider will use test results and other information to classify or stage the cancer. Cancer staging systems lay the foundation for cancer treatment.

They’ll consider factors like cancer tumor location and whether it’s spread outside your esophagus. Your provider will also set tumor grades by checking whether tumor cells look and act like healthy cells. Low-grade tumors are slow-growing tumors and may be less aggressive. High-grade tumors have cells that divide very quickly and can be more aggressive.

How is esophageal cancer treated?

Surgery and other procedures to remove cancer are common treatments. Other treatments help shrink tumors before surgery and kill any cancerous cells that remain after surgery. Cancer specialists are investigating new treatment combinations to shrink large tumors. And there are treatments to ease symptoms. Specific treatments include:

• Esophagectomy: This surgery removes some or most of your esophagus and surrounding tissue. It’s a treatment for early-stage cancer.
• Endoscopic submucosal dissection (ESD): This is a minimally invasive procedure to remove precancerous or cancerous polyps or very small tumors.
• Endoscopic mucosal resection (EMR): This procedure removes tumors in the mucous lining of your esophagus.
• Endoscopic laser therapy: This treatment uses a laser to destroy cancerous tissue in your esophagus. You may have it if a tumor blocks your esophagus, so you can’t swallow.
• Photodynamic therapy (PDT): This treatment uses lasers to activate medication. This medication triggers chemical reactions that kill cancerous cells. It’s a treatment for early-stage cancer or to help manage cancer symptoms.
• Radiation therapy: You may have radiation therapy before surgery to shrink a tumor or after surgery to remove any remaining cancer cells. You may also have this treatment to ease symptoms if cancer has spread to other areas of your body.
• Chemotherapy: Oncologists may use chemotherapy along with radiation therapy before and after surgery. It’s also treatment when cancer has spread to other areas of your body. In this case, chemotherapy may support a good quality of life and help you live longer.
• Targeted therapy: Some cancerous esophagus cells carry an unusually high amount of certain proteins or genes. These help cancer cells grow. There are treatments for some of these proteins or genes that can target and kill the cancer cells.
• Immunotherapy: This treatment targets your immune system’s response to cancer cells. You may have this treatment before or after surgery, or if your cancer has spread and surgery isn’t an option.

When should I seek care?

Talk to a healthcare provider if you have issues like heartburn that don’t go away, or it’s hard to swallow food. These are common early symptoms of esophageal cancer. Early diagnosis and treatment can cure this disease.

What can I expect if I have this disease?

Esophageal cancer may come back after treatment. You may have checkups every three to six months for the first two years after you complete treatment. Later, you’ll have checkups every six to 12 months for the next three years. Checkups may involve physical exams, blood tests, imaging tests and endoscopy.

Is there a cure for esophageal cancer?

Research shows that surgery and other treatments may cure cancer that hasn’t spread from your esophagus.

What’s the survival rate?

A cancer survival rate estimates the percentage of people with certain cancers who are alive five years after their diagnoses. The National Cancer Institute (U.S.) compares the five-year survival rate of someone with cancer with that of people who don’t have a specific disease. This is the relative survival rate.

Esophageal cancer survival rates vary depending on whether you have adenocarcinoma or squamous cell carcinoma of the esophagus. The cancer stage at diagnosis also makes a difference.

The NCI classifies cancer as being localized, regional or distant:

• Localized cancer means the cancer hasn’t spread outside your esophagus
• Regional cancer is cancer in nearby lymph nodes or tissues
• Distant cancer means there’s cancer in your bones, brain, liver, lungs, distant lymph nodes or other organs far away from the esophagus

The NCI also estimates survival rates when there’s no information about cancer stage at diagnosis. The estimated five-year survival rates for someone with adenocarcinoma of the esophagus are:

• Localized cancer: 51%
• Regional cancer: 27%
• Distant cancer: 5%

The five-year relative survival rate is 15% when there’s no information about cancer stage at diagnosis.

The estimated five-year survival rates for someone with squamous cell carcinoma of the esophagus are:

• Localized cancer: 35%
• Regional cancer: 27%
• Distant cancer: 7%

The five-year relative survival rate is 15% when there’s no cancer stage information.

Cancer survival rate information can be confusing. You may feel anxious and uncertain about what the numbers mean. Try to keep in mind that these are estimates based on what other people experience. Your experience with this disease may be very different. Ask your healthcare provider what the survival rate information means in your case. They’re your best resource for information because they know you and your situation.

What’s the life expectancy for someone with esophageal cancer in remission?

There’s no clear picture of how this disease affects life expectancy. Research suggests people who are cancer-free after treatment don’t live as long as people who don’t have it. Experts think lifestyle habits that increase esophageal cancer risk, like smoking and heavy use of alcohol, can cause other serious or life-threatening diseases.

Is there anything I can do to feel better?

If you have esophageal cancer, you may need surgery to remove your esophagus along with other cancer treatments. You may also need treatment to ease symptoms. There are programs to help you manage the challenges that living with this disease can bring:

• Cancer rehabilitation: Cancer treatment can be hard on your body. Cancer rehabilitation is treatment that supports you before, during and after treatment.
• Palliative care: This is additional support you may receive along with cancer treatment. It helps you manage symptoms and treatment side effects, as well as add comfort and emotional support.
• Cancer survivorship: Cancer survivorship helps you live as long as you can with the best possible quality of life.