Esophageal Cancer

Overview

What is esophageal cancer?

Esophageal cancer is the 10th most common cancer in the world. It starts in the tissues in your esophagus, the long muscular tube that moves food from your throat to your stomach. Tumors caused by esophageal cancer may not cause noticeable symptoms until the cancer has spread.

Healthcare providers treat early-stage esophageal cancer with surgery to remove the tumors or ease symptoms. They may use treatments such as chemotherapy, radiation therapy and immunotherapy to treat more advanced or later-stage esophageal cancer. When they can’t cure the cancer, they focus on helping people live longer, easing symptoms and maintaining quality of life. Medical researchers are working on treatments that will help people with esophageal cancer live longer.

How does esophageal cancer affect my body?

Esophageal cancer happens when cancerous cells in your esophageal tissue begin to multiply, eventually creating a tumor. Esophageal cancer is aggressive, but many people don’t notice symptoms until after the cancer has spread. That’s because your esophagus stretches to make room for big things, like large bites of food. As the tumor grows, it starts to block your esophagus’ opening. You may have trouble swallowing or notice that it hurts to swallow.

There are two types of esophageal cancer:

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

Is there a cure for esophageal cancer?

Sometimes, healthcare providers can do surgery to remove small tumors. Unfortunately, only 25% of people with this cancer receive a diagnosis before the cancer spreads.

Who’s affected by esophageal cancer?

Esophageal cancer affects about 4 in 100,000 people in the U.S. It typically affects men and people designated male at birth (DMAB) who are age 60 or older. It’s more common in men and people DMAB than in women and people designated female at birth (DFAB). People who are Black and people who are Asian with this condition usually have squamous cell esophageal cancer. People who are white are more likely to have adenocarcinoma esophageal cancer.

Symptoms and Causes

What are esophageal cancer symptoms?

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

How quickly does esophageal cancer progress (get worse)?

Esophageal cancer typically grows very rapidly. Your esophagus is very flexible and expands around the tumor as it grows. This is why people often don’t have symptoms until the cancer has spread.

What’s the main cause of esophageal cancer?

Healthcare providers don’t know the exact cause, but they’ve identified risk factors that increase the chance of developing esophageal cancer, including:

  • Tobacco use: This includes smoking and using smokeless tobacco.
  • Alcohol use: Chronic and/or heavy use of alcohol increases the risk of esophageal cancer.
  • Obesity: Being overweight or having obesity may cause inflammation in your esophagus that could become cancer.
  • Barrett’s esophagus and chronic acid reflux: Barrett’s esophagus is a change in the cells at the lower end of your 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 papillomavirus (HPV): HPV is a common virus that can cause tissue changes in your vocal cords and mouth and on your hands, feet and genitals.
  • History of cancer: People who’ve had cancer of the neck or head have a greater risk for esophageal cancer.
  • Other disorders: Esophageal cancer is linked to some rare and/or inherited conditions. One is achalasia, an uncommon disease that makes it hard for you to swallow. Another disorder is tylosis, a rare, inherited disorder in which excess skin grows on the palms of your hands and the soles of your feet.
  • Occupational exposure to certain chemicals: People exposed to dry cleaning solvents over a long time are at higher risk of developing esophageal cancer.

Diagnosis and Tests

How do healthcare providers diagnose esophageal cancer?

A healthcare provider will ask questions about your symptoms and medical history. They may do the following tests to diagnose the condition:

  • Barium swallow: Healthcare providers look at your esophagus through a series of X-rays. It’s called a barium swallow because people drink a liquid with barium. Barium makes it easier for healthcare providers to see your esophagus on the X-ray.
  • Computed tomography (CT) scan: This test helps healthcare providers determine if tumors have spread to your chest and abdomen (belly).
  • Esophagogastroduodenoscopy (EGD): Healthcare providers use a thin flexible tube called an endoscope to look at the inside of your esophagus.
  • Esophageal endoscopic ultrasound: Sound waves create images of the inside of your esophagus. Healthcare providers may do this test as part of an EGD.
  • Biopsy: During the EGD, healthcare providers may remove a small piece of tissue to examine under a microscope to see if there are any cancer cells.

Healthcare providers use what they learn in diagnosis to classify or stage esophageal cancer. Cancer staging systems lay the foundation for cancer treatment.

When healthcare providers stage esophageal cancer, they look at factors such as cancer tumor location and depth, if it has spread to nearby lymph nodes and if the cancer has spread to other distant tissues or organs.

They also establish tumor grades. Tumor grades tell your provider 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.

Management and Treatment

How do healthcare providers treat esophageal cancer?

Esophageal cancer treatment depends on the cancer stage and grade. Treatment options include:

  • Surgery: An esophagectomy is the most common treatment for early-stage esophageal cancer. It involves removing some or most of your esophagus and surrounding tissue. Surgeons create a new esophagus by pulling up part of your stomach into your chest and neck.
  • Radiation therapy: Radiation kills or damages cancer cells by aiming a radiation beam at the tumor. Healthcare providers may use radiation as adjuvant therapy before or after surgery.
  • Chemotherapy: Chemotherapy kills cancer cells or stops them from growing.
  • Endoscopic submucosal dissection (ESD): Surgeons may use ESD to treat very early-stage esophageal cancer.
  • Endoscopic mucosal resection (EMR): Surgeons use this procedure to remove tumors in the mucous lining of your esophagus.
  • Endoscopic laser therapy: This treatment eases symptoms when tumors may block your esophagus, making it hard for you to swallow.
  • Photodynamic therapy (PDT): Photodynamic therapy destroys tumors with drugs called photosensitizers. Light activates these drugs and creates a chemical reaction that kills cancer.
  • Targeted therapy: Some esophageal cancer cells carry an unusually high amount of the HER2 protein. This protein helps cancer cells grow. In targeted therapy, healthcare providers treat esophageal cancer with drugs targeting HER2 proteins.
  • Immunotherapy: This treatment involves immune checkpoint inhibitors. These drugs help restore your immune system’s response to esophageal cancer cells.

Prevention

How do I reduce my risk of developing esophageal cancer?

You may be able to reduce your risk by eating well so you’re at a weight that’s right for you and that you can maintain. You may also reduce your risk by avoiding activities such as using tobacco, frequently drinking lots of alcohol or working around certain solvents. Having an HPV infection is a risk factor for esophageal cancer. Ask your healthcare provider if you should receive the HPV vaccine.

There isn’t a recommended way to screen for esophageal cancer. But if you have Barrett’s esophagus or certain other conditions, your healthcare provider may recommend screening. Your healthcare provider may do an EGD to do this screening. If your healthcare provider recommends screening, they’ll let you know how often you should have screening.

Outlook / Prognosis

What can I expect if I have esophageal cancer?

That depends on factors like your overall health and if you received a diagnosis before the tumor spread. Healthcare providers often successfully treat early-stage esophageal cancer. About 46% of people treated for early-stage esophageal cancer are alive five years after diagnosis.

Healthcare providers may not be able to destroy the cancer, especially if it’s already spread. They can provide treatment to help you live well as long as you’re able, maintain quality of life and ease symptoms. They may recommend palliative care that can help you live comfortably and without pain.

Living With

How do I take care of myself?

Esophageal cancer surgery may have significant side effects like nausea and vomiting or heartburn. You may need help to manage these side effects. Many people treated for esophageal cancer have the following issues:

  • Difficulty eating: Esophageal cancer makes you lose weight because you can’t swallow food or it hurts to swallow food. Treatment may remove the cancer, but you still may have trouble swallowing. If that’s your situation, ask your healthcare provider for suggestions such as eating smaller meals or drinking nutritional supplements.
  • Dumping syndrome: This happens when your stomach takes the place of your esophagus. Your stomach may not be able to hold food for digestion so food passes too quickly into your intestines. Dumping syndrome symptoms may include nausea, vomiting, diarrhea, stomach cramps, sweating or flushing of the skin.

Yes, it can come back. You can reduce that risk by:

  • Limiting alcohol: Frequently drinking a lot of alcohol increases your risk that esophageal cancer will come back.
  • Avoiding tobacco: Tobacco use is another risk factor for esophageal cancer returning. If you smoke, please try to stop. Ask your healthcare provider if you want help to stop smoking.

When should I see my healthcare provider?

That depends on your situation. People who had early-stage cancer removed with surgery will have a different follow-up schedule from people who’ve advanced cancer that’s spread.

If your treatment was successful, your healthcare provider may recommend checkups every three to six months for the first two years after treatment and then checkups every six to 12 months for the next three years. Your healthcare provider may do a physical examination, blood tests, imaging tests and endoscopy.

What questions should I ask my healthcare provider?

Esophageal cancer is a life-threatening illness. If you have this condition, you may want to ask a healthcare provider the following questions:

  • What kind of esophageal cancer do I have?
  • What stage is my cancer?
  • What treatments do you recommend?
  • Is there a cure?
  • If there isn’t a cure, what can you do to help me?
  • How long can I live with this cancer?
  • Do I need any genetic or biomarker testing done?

A note from Cleveland Clinic

Esophageal cancer is the 10th most common cancer in the world. It’s also one of the most challenging cancers to treat. That’s because it causes symptoms that people may not notice until after the cancer has spread. Often, there’s no cure for esophageal cancer. In that situation, healthcare providers concentrate on treatments that will help people live as long as possible and have the best quality of life for as long as possible. Few things in life are more difficult than hearing you’re sick and there’s no cure. You may need time and help to come to terms with your situation. Healthcare providers understand that and will do everything they can to help you, such as recommending speaking with a mental health specialist.

Last reviewed by a Cleveland Clinic medical professional on 09/06/2022.

References

  • American Cancer Society: Living as an Esophageal Cancer Survivor. (https://www.cancer.org/cancer/esophagus-cancer/after-treatment/follow-up.html) Accessed 9/6/2022.
  • American Society of Clinical Oncology. Esophageal Cancer Guide. (https://www.cancer.net/cancer-types/esophageal-cancer/introduction) Accessed 9/6/2022.
  • Merck Manual. Consumer Version. Esophageal Cancer. (https://www.merckmanuals.com/home/digestive-disorders/tumors-of-the-digestive-system/esophageal-cancer) Accessed 9/6/2022.
  • National Cancer Institute: Esophageal Cancer. (https://www.cancer.gov/types/esophageal) Accessed 9/6/2022.

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