Esophageal cancer refers to a malignant tumor of the esophagus. The esophagus is the tube that connects the throat with the stomach.

It is rare in the United States but more common in Asia and parts of Africa. In 2015, esophageal cancer made up 1 percent of new diagnoses of cancer and 2.6 percent of deaths from cancer. It mostly affects individuals aged at least 55 years.

The two main subtypes of esophageal cancer are:

  • Squamous cell carcinoma: This arises from the cells lining the upper part of the esophagus.
  • Adenocarcinoma of the esophagus: This occurs due to changes in the glandular cells that exist at the junction of the esophagus and the stomach.

Rarer types include:

  • choriocarcinoma
  • lymphoma
  • melanoma
  • sarcoma
  • small cell cancer

The treatment, symptoms, and prognosis are similar for both main types of esophageal cancer.

Fast facts on esophageal cancer

  • Esophageal cancer often does not cause symptoms until it reaches an advanced stage. Symptoms can include swallowing difficulties and vomiting.
  • There are two types, adenocarcinoma and squamous cell carcinoma.
  • Treatment options include photodynamic therapy, chemotherapy, and radiotherapy.
  • The most recent 5-year survival rate recorded for esophageal cancer was 19.2 percent.

Symptoms


The esophagus is the tube connecting the throat to the stomach. Growth in this tube can affect swallowing and eating.

There are often no symptoms during the initial stages of this cancer. That is why the majority of diagnoses occur when the cancer is well advanced.

When symptoms are present, they may include:

  • Dysphagia: As the tumor narrows the passage in the esophagus, getting food through becomes harder. This is usually the first symptom.
  • Regurgitating: Food is vomited after getting stuck.
  • Weight loss: Dramatic and sudden weight loss can occur.
  • A cough: This becomes more common when trying to swallow. Sometimes the person may cough up blood.
  • Voice changes: The voice may become hoarse.
  • Pain and discomfort: These affect the throat.
  • Acid reflux: This can happen if cancer affects the lower part of the esophagus.
  • Chest pain: This is linked to acid reflux.

Causes

Cancer results from out-of-control cell growth. Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors.

Tumors can grow and interfere with body function. Those that stay in one location and do not grow bigger are generally considered benign. Malignant cancer is dangerous because it spreads.

Without treatment, malignant cancer can spread to other parts of the body, in a process known as metastasis. If cancer enters the lymphatic system, it can reach other parts of the body, including vital organs, more quickly.

Experts do not know exactly why esophageal cancer starts, but there appear to be some risk factors.

These include:

  • Achalasia: A type of esophageal motility disorder.
  • Age: It is more common after 60 years of age.
  • Alcohol and smoking: Either or both of these increase the risk.
  • Celiac disease: This has been linked to a higher risk of squamous cell carcinoma.
  • Diet: Consuming very little fruit and vegetables appears to increase the risk.
  • Genetic factors: Having a family member with this condition increases the risk.
  • Gastroesophageal reflux disease (GERD) and acid reflux can lead to Barrett’s esophagus, increasing the risk of future malignancy.
  • Human papillomavirus (HPV): HPV is a contagious, sexually transmitted virus.
  • Long-term exposure to chemicals or irritants: These include soot, metal dust, exhaust fumes, lye, and silica dust.
  • Sex: Males have a higher risk
  • Obesity: It is more common in people with obesity.
  • Other cancers: Those who have had head and neck cancers have a significantly higher risk.
  • Radiation therapy: When this treatment is received to the chest or head, it can increase the risk.
  • Smoking: Long-term, heavy, regular smoking is linked to esophageal cancer.

Treatment


Radiation therapy can shrink or kill the tumor.

Treatment depends on several factors, including:

  • the cellular type of cancer
  • the stage
  • the general health and age of the patient
  • the presence of other diseases

Treatment options include:

  • surgery
  • chemotherapy
  • radiation therapy

The person may need help to consume food and drink in the following ways:

  • If the person cannot swallow, a stent may be inserted to keep the esophagus unblocked.
  • A nasogastric tube, passed through the nose, may be needed to assist feeding while the tumor is treated.
  • A gastrostomy is a feeding hole in the skin that gives direct access to the stomach.

Treatment aims either to take out the whole tumor and any other cancerous cells or prevent the tumor from getting any bigger. Surgery, chemotherapy, or both may be used.

Surgery

The following surgical interventions may be used:

  • Esophagectomy: This removes part of the esophagus. The section that contains the tumor is removed, and the remaining part is reconnected to the stomach. Sometimes a small section of the large intestine is used to help connect the esophagus and the stomach.
  • Esophagogastrectomy: This removes the part of the esophagus where the tumor is and parts of the stomach and nearby lymph nodes. If the surgeon cannot connect the stomach and esophagus properly afterward, a small part of the large intestine may be used.

Other procedures

Other, non-surgical techniques may be used to treat esophageal cancer, including

  • Photodynamic therapy: A special substance is injected into the esophagus that makes the cells extra sensitive to light. With an endoscope that has a laser attached to the end, the surgeon destroys cancer cells by burning them.
  • Chemotherapy: This may be used before or after surgery, or both, and possibly in conjunction with radiation therapy. Chemotherapy can be used to remove the cancer, delay or prevent recurrence, slow down progression, or to relieve the symptoms of advanced cancer.
  • Radiation therapy: Beams of high-energy X-rays or particles or radiation are used to destroy cancer cells. Radiation therapy damages the DNA inside the tumor cells, destroying their ability to reproduce. It can be applied externally, through external beam radiation, or internally using brachytherapy. In cases of esophageal cancer, radiation therapy is usually given in combination with chemotherapy. Radiation therapy may also be given before or after surgery.

Diagnosis


An endoscope can help diagnosis the location and size of a tumor.

A doctor will examine the person presenting symptoms and ask for details. They may refer the individual to a specialist.

The following diagnostic tests will be ordered:

  • Gastroscopy, or endoscopy: A long, thin instrument called an endoscope is passed through the mouth, into the esophagus, and toward the stomach. The endoscope has a light and camera at the end. The doctor sees the images on a screen and determines whether there are any tumors or abnormalities.
  • Biopsy: A sample of tissue may be taken if the endoscopy shows anything unusual. A pathologist then examines the sample under a microscope. They can determine whether or not there are any cancerous cells.
  • Barium swallow test: The patient drinks a liquid containing barium. Barium shows up on x-rays. Several x-ray pictures are taken at intervals. They will reveal whether there are any obstructions, which would be caused by a tumor.
  • Endoscopic ultrasound: A small ultrasound probe is attached to an endoscope and is inserted through the mouth into a targeted area. This is usually done when the doctor knows there is cancer, but wants to have a better look at the tumor on a monitor. This type of test may show whether the cancer has spread into nearby tissue.
  • Other imaging scans: A CT scan can help determine the spread of the cancer

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Stages

There are five stages of esophageal cancer, each of which highlight the spread and severity of the cancer.

  • Stage 0: This stage refers to cells that have shown signs of cancerous activity without becoming cancerous.
  • Stage 1: Cancer has formed in the wall of the esophagus. The location of the tumor may not be apparent.
  • Stage 2: The cancer has spread to the muscular or connective tissue of the esophagus and one or two lymph nodes.
  • Stage 3: The cancer has spread to the muscular or connective tissue of the esophagus as well as possibly spread to the diaphragm, sac around the heart, or protective tissue around the lungs, and between 3 and 6 lymph nodes.
  • Stage 4: Cancer has spread to distant sites in the body.

The stage of a cancer will dictate how that cancer is treated and the likelihood of successful treatment.

Outlook

In 2014, the most recent year in which data was collected, the outlook for esophageal cancer was that 19.2 percent of people survived for five years after diagnosis.

The outlook depends strongly on the stage of the cancer. If cancer has not spread from the esophagus, the survival rate increases to 43 percent. If the disease has spread to surrounding organs, the survival rate drops to 23 percent. Once the cancer reaches distant sites, the survival rate can be as low as 5 percent.

If you experience any symptoms at all, it is vital that you contact a doctor.

While these figures are an estimate, they indicate a low overall survival rate and therefore highlight the severity of esophageal cancer.

Source: Esophageal cancer: Symptoms, causes, and treatment