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Esophageal Cancer by Rosalyn Carson-DeWitt, MD

En Español (Spanish Version) More InDepth Information on This Condition

Definition

The esophagus is the tube that transports food from the throat to the stomach. Esophageal cancer is the growth of cancer cells the esophagus.

There are two main types of esophageal cancer:

Squamous cell cancer—arises from the cells that line the upper part of the esophagus
Adenocarcinoma—arises from glandular cells that are present at the junction of the esophagus and stomach

Cancer occurs when cells in the body divide out of control. If cells keep dividing, a mass of tissue forms. These are called growths or tumors. If the tumor is malignant, it is cancer. They can invade nearby tissue and spread to other parts of the body.

Esophageal Cancer

Causes

The cause of esophageal cancer is unknown.

Risk Factors

Factors that may increase your chance of esophageal cancer include:

Age: 60 or older
Sex: male
Smoking or smokeless tobacco use (such as chewing tobacco or snuff)
Alcohol use
History of gastroesophageal reflux , especially if this has caused Barrett's esophagus
Achalasia (chronic dilation of the esophagus)
Infection with Helicobacter pylori (causes stomach ulcers )
Certain rare genetic conditions such as Plummer Vinson syndrome and tylosis
Damaged esophagus from toxic substances, such as lye
History of cancer of the head and/or neck
Human papilloma virus (HPV) infection

Symptoms

Symptoms include:

Trouble swallowing
Painful swallowing
Cough
Hoarse voice
Pain in the throat, back, chest
Nausea, vomiting
Coughing up blood
Weight loss

The structure and location of the esophagus makes it easy for cancer to spread very early. This can make a cure more difficult. People who have related conditions, especially reflux, should discuss regular screening tests with their doctor. This may include endoscopy.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

Chest x-ray —an x-ray of the chest area
Upper GI series —a series of x-rays of the esophagus and stomach taken after drinking a barium solution (also called barium swallow)
Esophagoscopy—examination of the esophagus using a lighted scope
Biopsy —removal of a small sample of esophageal tissue to test for cancer cells
CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
Bone scan —to see if the cancer has spread to the bones

Treatment

Treatment may include:

Surgery

A surgery may be done to remove the tumor. The doctor might remove all or part of your esophagus, as well. A plastic tube might be used to replace the missing portion of esophagus.

Radiation Therapy

Radiation is used to kill cancer cells and shrink tumors. Radiation may be:

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

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given in many forms, including by pill, by injection, and via a catheter. The drugs enter the bloodstream. It travels through the body. It will kill mostly cancer cells. Some healthy cells may also be killed.

Chemotherapy alone will not cure this type of cancer. It is only used when the cancer has already spread and cannot be cured. At this point it is used to help shrink the tumor and help ease pain or control nausea.

Chemoradiotherapy or Combined Modality Therapy

Chemotherapy and radiation therapy together are better than radiotherapy alone. It has also been shown that these two treatments may be as effective as surgery alone.

Trimodality Therapy

Chemotherapy and radiation therapy are followed by a surgery. This has been shown to be a most aggressive form of therapy. It may be the best way to cure a patient of their disease.

Laser Therapy

High-intensity light used to try to kill cancer cells.

Photodynamic Therapy

A combination of drugs and special lights used to try to kill cancer cells.

This therapy is a promising treatment approach but is only appropriate in a very small number of patients. There are limits of how far the infrared light source will travel into the cancer itself. The tumor must be very small (smaller than ¼ inch thick). It must not involve any lymph nodes or other structures.

If you are diagnosed with esophageal cancer, be sure to follow your doctor's instructions.

Prevention

To help prevent esophageal cancer:

Don't smoke or use other tobacco products. If you smoke, quit .
Drink alcohol only in moderation. Moderate alcohol intake is no more than two drinks per day for men and one drink per day for women.
Get medical treatment for gastroesophageal reflux disease.

RESOURCES:

American Association of Otolaryngology, Head and Neck Surgery http://www.entnet.org/
American Cancer Society http://www.cancer.org/

CANADIAN RESOURCES:

Canadian Cancer Society http://www.cancer.ca/
Canadian Society of Otolaryngology http://www.entcanada.org/

References:

Abeloff MD. Clinical Oncology. 2nd ed. New York, NY: Churchill Livingstone, Inc.; 2000.
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: http://www.cancer.gov/cancertopics/pdq/treatment/esophageal/Patient . Updated August 2008. Accessed July 8, 2009.
Sleisenger MH, Fordtran JS, Feldman M, Scharschmidt B. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: W.B. Saunders Company; 1998.
1/13/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Wysowski DK. Reports of esophageal cancer with oral bisphosphonate use. N Engl J Med. 2009;360:89-90.
8/23/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Cardwell CR, Abnet CC, Cantwell MM, Murray LJ. Exposure to oral bisphosphonates and risk of esophageal cancer. JAMA. 2010;304(6):657-663.

Last reviewed September 2011 by Igor Puzanov, MD

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