Esophageal cancer
Definition:
Esophageal cancer is cancer that occurs in the esophagus — a long, hollow tube that runs from your throat to your stomach. Your esophagus carries food you swallow to your 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, but in people in the United States, it occurs most often in the lower portion of the esophagus. More men than women get esophageal cancer.
Esophageal cancer isn't common in the United States. In other areas of the world, such as Asia and parts of Africa, esophageal cancer is much more common.
Symptoms:
Signs and symptoms of esophageal cancer include:
When to see a doctor
Make an appointment with your doctor if you have any persistent signs and symptoms that worry you.
If you've been diagnosed with Barrett's esophagus, a precancerous condition that increases your risk of esophageal cancer caused by chronic acid reflux, ask your doctor what signs and symptoms to watch for that may signal that your condition is worsening.
Screening for esophageal cancer isn't done routinely because of a lack of an easily identifiable high-risk group and the possible risks associated with endoscopy. If you have Barrett's esophagus, discuss the pros and cons of screening with your doctor.
Causes:
It's not clear what causes esophageal cancer. Esophageal cancer occurs when cells in your esophagus develop errors (mutations) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells form a tumor in the esophagus that can grow to invade nearby structures and spread to other parts of the body.
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:
Complications:
As esophageal cancer advances, it can cause complications, such as:
Treatments and drugs:
What treatments you receive for esophageal cancer are based on the type of cells involved in your cancer, your cancer's stage, your overall health and your preferences for treatment.
Surgery
Surgery to remove the cancer can be used alone or in combination with other treatments. Operations used to treat esophageal cancer include:
Surgery for supportive care
Besides treating the disease, surgery can help relieve symptoms or allow you to eat.
Chemotherapy is drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically used before (neoadjuvant) or after (adjuvant) surgery in people with esophageal cancer. Chemotherapy can also be combined with radiation therapy. In people with advanced cancer that has spread beyond the esophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by the cancer.
The chemotherapy side effects you experience depend on which chemotherapy drugs you receive.
Radiation therapy
Radiation therapy uses high-powered energy beams to kill cancer cells. Radiation can come from a machine outside your body that aims the beams at your cancer (external beam radiation). Or radiation can be placed inside your body near the cancer (brachytherapy).
Radiation therapy is most often combined with chemotherapy in people with esophageal cancer. It can be used before or after surgery. Radiation therapy is also used to relieve complications of advanced esophageal cancer, such as when a tumor grows large enough to stop food from passing to your stomach.
Side effects of radiation to the esophagus include sunburn-like skin reactions, painful or difficult swallowing, and accidental damage to nearby organs, such as the lungs and heart.
Combined chemotherapy and radiation
Combining chemotherapy and radiation therapy may enhance the effectiveness of each treatment. Combined chemotherapy and radiation may be the only treatment you receive, or combined therapy can be used before surgery. But combining chemotherapy and radiation treatments increases the likelihood and severity of side effects.
Clinical trials
Clinical trials are research studies testing the newest cancer treatments and new ways of using existing cancer treatments. Clinical trials give you a chance to try the latest in cancer treatment, but they can't guarantee a cure. Ask your doctor if you're eligible to enroll in a clinical trial. Together you can discuss the potential benefits and risks.
Definition:
Esophageal cancer is cancer that occurs in the esophagus — a long, hollow tube that runs from your throat to your stomach. Your esophagus carries food you swallow to your 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, but in people in the United States, it occurs most often in the lower portion of the esophagus. More men than women get esophageal cancer.
Esophageal cancer isn't common in the United States. In other areas of the world, such as Asia and parts of Africa, esophageal cancer is much more common.
Symptoms:
Signs and symptoms of esophageal cancer include:
- Difficulty swallowing (dysphagia)
- Weight loss without trying
- Chest pain, pressure or burning
- Fatigue
- Frequent choking while eating
- Indigestion or heartburn
- Coughing or hoarseness
When to see a doctor
Make an appointment with your doctor if you have any persistent signs and symptoms that worry you.
If you've been diagnosed with Barrett's esophagus, a precancerous condition that increases your risk of esophageal cancer caused by chronic acid reflux, ask your doctor what signs and symptoms to watch for that may signal that your condition is worsening.
Screening for esophageal cancer isn't done routinely because of a lack of an easily identifiable high-risk group and the possible risks associated with endoscopy. If you have Barrett's esophagus, discuss the pros and cons of screening with your doctor.
Causes:
It's not clear what causes esophageal cancer. Esophageal cancer occurs when cells in your esophagus develop errors (mutations) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells form a tumor in the esophagus that can grow to invade nearby structures and spread to other parts of the body.
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:
- Adenocarcinoma. Adenocarcinoma begins in the cells
of mucus-secreting glands in the esophagus. Adenocarcinoma occurs most
often in the lower portion of the esophagus. Adenocarcinoma is the most
common form of esophageal cancer in the United States, and it affects
primarily white men.
- Squamous cell carcinoma. The squamous cells are
flat, thin cells that line the surface of the esophagus. Squamous cell
carcinoma occurs most often in the middle of the esophagus. Squamous
cell carcinoma is the most prevalent esophageal cancer worldwide.
- Other rare types. Rare forms of esophageal cancer include choriocarcinoma, lymphoma, melanoma, sarcoma and small cell cancer.
Complications:
As esophageal cancer advances, it can cause complications, such as:
- Obstruction of the esophagus. Cancer may make it difficult or impossible for food and liquid to pass through your esophagus.
- Cancer pain. Advanced esophageal cancer can cause pain.
- Bleeding in the esophagus. Esophageal cancer can cause bleeding. Though bleeding is usually gradual, it can be sudden and severe at times.
- Severe weight loss. Esophageal cancer can make it difficult and painful to eat and drink, resulting in weight loss.
- Coughing. Esophageal cancer can erode your esophagus and create a hole into your windpipe (trachea). Known as a tracheoesophageal fistula, this hole can cause severe and sudden coughing whenever you swallow.
Treatments and drugs:
What treatments you receive for esophageal cancer are based on the type of cells involved in your cancer, your cancer's stage, your overall health and your preferences for treatment.
Surgery
Surgery to remove the cancer can be used alone or in combination with other treatments. Operations used to treat esophageal cancer include:
- Surgery to remove very small tumors. If your cancer
is very small, confined to the superficial layers of your esophagus and
hasn't spread, your surgeon may recommend removing the cancer and
margin of healthy tissue that surrounds it. Surgery for very early-stage
cancers can be done using an endoscope passed down your throat and into
your esophagus.
- Surgery to remove a portion of the esophagus (esophagectomy).
Your surgeon removes the portion of your esophagus that contains the
tumor and nearby lymph nodes. The remaining esophagus is reconnected to
your stomach. Usually this is done by pulling the stomach up to meet the
remaining esophagus. In some situations, a portion of the colon is used
to replace the missing section of esophagus.
- Surgery to remove part of your esophagus and the upper portion of your stomach (esophagogastrectomy). Your surgeon removes part of your esophagus, nearby lymph nodes and the upper part of your stomach. The remainder of your stomach is then pulled up and reattached to your esophagus. If necessary, part of your colon is used to help join the two.
Surgery for supportive care
Besides treating the disease, surgery can help relieve symptoms or allow you to eat.
- Relieving esophageal obstruction. A number of
treatments are available to relieve esophageal obstruction. One option
includes using an endoscope and special tools to widen the esophagus and
place a metal tube (stent) to hold the esophagus open. Other options
include surgery, radiation therapy, chemotherapy, laser therapy and
photodynamic therapy.
- Providing nutrition. A surgeon inserts a feeding tube (percutaneous gastronomy) so you can receive nutrition directly into your stomach or intestine. This is usually temporary until the surgical site heals or until you're finished with chemotherapy and radiation therapy.
Chemotherapy is drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically used before (neoadjuvant) or after (adjuvant) surgery in people with esophageal cancer. Chemotherapy can also be combined with radiation therapy. In people with advanced cancer that has spread beyond the esophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by the cancer.
The chemotherapy side effects you experience depend on which chemotherapy drugs you receive.
Radiation therapy
Radiation therapy uses high-powered energy beams to kill cancer cells. Radiation can come from a machine outside your body that aims the beams at your cancer (external beam radiation). Or radiation can be placed inside your body near the cancer (brachytherapy).
Radiation therapy is most often combined with chemotherapy in people with esophageal cancer. It can be used before or after surgery. Radiation therapy is also used to relieve complications of advanced esophageal cancer, such as when a tumor grows large enough to stop food from passing to your stomach.
Side effects of radiation to the esophagus include sunburn-like skin reactions, painful or difficult swallowing, and accidental damage to nearby organs, such as the lungs and heart.
Combined chemotherapy and radiation
Combining chemotherapy and radiation therapy may enhance the effectiveness of each treatment. Combined chemotherapy and radiation may be the only treatment you receive, or combined therapy can be used before surgery. But combining chemotherapy and radiation treatments increases the likelihood and severity of side effects.
Clinical trials
Clinical trials are research studies testing the newest cancer treatments and new ways of using existing cancer treatments. Clinical trials give you a chance to try the latest in cancer treatment, but they can't guarantee a cure. Ask your doctor if you're eligible to enroll in a clinical trial. Together you can discuss the potential benefits and risks.
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