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Esophageal Cancer

Esophageal Cancer Overview

Esophageal cancer is any abnormality in the reproduction of cells in the esophagus. The esophagus is the tube from your mouth to your stomach. Think of it as a hollow tube with several layers on the inside. These layers all have specialized cells that secrete mucous and move food along the digestive tract. In one of the two main types of esophageal cancer, squamous cell carcinoma, the innermost lining of flat cells begins to replicate in abnormal ways. In the second main type of esophageal cancer, adenocarcinoma, the layer of cells (underneath your squamous cells) that produces mucous begins to replicate oddly. While there are other types of esophageal cancer, they tend to be rare, or are attributed to other body systems whose cancers have metastasized to the esophagus.

Risk Factors

There are many risk factors for esophageal cancer. Some of the most common ones are:

GERD – If the patient has GERD or gastrointestinal reflux disease, this puts them at a much higher risk for esophageal cancer, especially adenocarcinoma. If the contents of the stomach continuously burn the bottom part of the esophagus, this can result in a phenomenon called Barrett's esophagus, which is where abnormal cells replace the typical esophageal cells.

Alcohol/Tobacco – Both of these have carcinogenic agents that can pass through to the esophageal cells and cause abnormal growths. While they are each separate risk factors in and of themselves, a combined use of the two only further increases the risk for esophageal cancer.

Age – Increased age is a risk factor for esophageal cancer. Most people with the disease are between the ages of 45 and 70.

Gender – Men have a much higher incidence and mortality rate from esophageal cancer than do women.

Race – African Americans are more disposed to squamous cell carcinoma, whereas Caucasian Americans are more likely to have adenocarcinoma.

Radiation – People who have had their chests exposed to radiation are more likely to have cancer than those who have not.

Diet - People whose diets are low in fruits and vegetables are at a much higher risk for esophageal cancer.

Obesity – Those who are 20 to 30 pounds or more overweight are at increased risk for esophageal cancer.

 

Signs and symptoms

Unusually husky or raspy voice – This may be the earliest sign. A small tumor may affect the way air travels through your throat changing the sound your voice makes.

Dysphagia – Difficulty swallowing may occur because the esophagus is narrowing. Sadly, this is generally a late stage in esophageal cancer because by this point the esophagus has already narrowed to half of its normal width. Swallowing may even become painful.

Drastic, unintended weight loss – This is a very common sign of esophageal cancer. Because of the difficulty or even pain of swallowing, nutritional intake may not meet the metabolic requirements of the body. Also, because cancerous cells are present, the metabolic needs of the body are changing.

Nausea/Vomiting – The way the tumor effects peristalsis (the way the esophagus moves food to the stomach) may lead to vomiting and nausea due to blockages.

Diagnosis

Barium Swallow – This test is typically used for anyone that has had persistent difficulty swallowing. The doctor orders the patient to swallow a thick liquid containing barium that coats the entire esophagus and allows the doctor to use an x-ray to see the lining of the esophagus. This is useful if the cancer has not metastasized.

Esophagogastroduodenoscopy – A small tube with a camera that hooks up to a TV monitor is passed down the throat. You will typically have some sort of numbing solution and may receive other comfort measures.

Biopsy – Suspicious pieces of tissue are usually taken during an Esophagogastroduodenoscopy and sent back to the laboratory for further studies. The lab then determines if there are any signs of malignancy in these tissues.

CT Scan – This may be used in the staging of a cancer to see if it has metastasized or not. Several "slices" of your body are taken with a camera. A computer then puts these slices together to form a 3D image that the doctor can use to better look at the affected area.

Endoscopic Ultrasound – A small ultrasound probe is passed down the throat where a small sonic wave is passed through your tissues. The amount of sound bounced back allows the physician to see tissue masses.

PET Scan – A radioactive tracer of some sort is ingested. This tracer binds to all tissues, but binds differently to cancerous tissue. The doctor then takes a picture of this and looks to see if the cancer has moved anywhere in the body.

Complications

Tracheoesophageal Fistula – Sometimes a hole develops between the esophagus and trachea. This can cause the person to cough because food may go into the lungs. This can also result in pneumonia if the food settles into the lungs and bacteria develop on it.

Metastasis – This is perhaps the most serious complication, especially for esophageal cancer. Because esophageal cancer is usually diagnosed so late, it has already metastasized and affected more than just the esophagus.

Treatments

Surgical approaches are available for the treatment of esophageal cancer or as a way to manage the symptoms. Sometimes whole parts of the esophagus can be removed, and the surgeon has to then reattach it.

Chemotherapy is another way to treat esophageal cancer. By using caustic agents that target cells that rapidly divide, the cancer could be halted. However this tends to have side effects such as in normal body tissues that rapidly divide such as bone marrow.

Radiation therapy is thought to be good in conjunction with chemotherapy. By shooting potent, focused radioactive beams, it is possible to just kill the cancerous area. Some side effects may be a rash in the area of treatment or fatigue.

For symptom treatment, sometimes a stent of metal or plastic can be inserted into the esophagus to help keep it open and to assist with swallowing.

For more information:

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This article is a NetWellness exclusive.

Last Reviewed: Feb 22, 2007

Abbas  Abbas, MD Abbas Abbas, MD
Formerly:
Assistant Professor of Surgery
College of Medicine
The Ohio State University

Susan  Moffatt-Bruce, MD, PhD Susan Moffatt-Bruce, MD, PhD
Associate Professor of
Thoracic Surgery
Molecular, Virology, Immunology & Medical Genetics
College of Medicine
The Ohio State University