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Definition

The esophagus is the tube that carries food from the mouth to the stomach. Esophageal cancer is the growth of cancer cells in this tube.

There are two main types of esophageal cancer:

  • Squamous cell cancer—from the cells that line the upper part of the esophagus
  • Adenocarcinoma—from cells where the esophagus meets the stomach
Esophageal Cancer
Esophageal cancer
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Causes

Cancer occurs when cells in the body divide without control or order. Eventually these uncontrolled cells form a growth or tumor. The term cancer refers to malignant growths. These growths invade nearby tissues and spread to other parts of the body. It is not clear exactly what causes these problems in the cells but is probably a combination of genetics and environment.

Risk Factors

Esophageal cancer is more common in men, and in people aged 50 years and older. Other factors that may increase your chance of esophageal cancer include:

  • Smoking, or smokeless tobacco use, such as chewing tobacco or snuff
  • Excess alcohol use (risk increases with combined alcohol and tobacco use)
  • History of gastroesophageal reflux, especially if this has caused Barrett's esophagus
  • Achalasia (chronic dilation of the esophagus)
  • Radiation therapy
  • Obesity
  • Damaged esophagus from toxic substances, such as lye
  • History of head and/or neck cancer
  • Human papilloma virus (HPV) infection
  • Certain rare genetic conditions, such as Plummer Vinson syndrome and tylosis

Symptoms

Esophageal cancer may cause:

  • Trouble swallowing
  • Painful swallowing
  • Weight loss
  • Cough (from aspiration)
  • Hoarse voice
  • Pain in the throat, back, chest
  • Nausea, vomiting
  • Coughing up blood
  • Black tarry stools
  • Hiccups

Diagnosis

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

Tests to look for esophageal tumors may include:

  • Esophagoscopy with biopsy—examination of esophagus with a lighted scope, and removal of a small sample of esophageal tissue
  • Barium swallow—use of contrast material to examine the esophagus with x-ray

Imaging tests may be used to determine if or where esophageal cancer has spread. These include:

Treatment

Talk with your doctor about the best treatment plan for you. Options may include one or more of the following:

Surgery

Surgery may be necessary to treat the cancer. Surgery may be the only treatment, or it may be done in combination with radiation therapy and/or chemotherapy. Surgical methods include:

Endoscopic Resection

Endoscopy uses tubes to insert a lighted camera and surgical instruments.

In early stage cancers, the endoscope may be inserted through the mouth to remove tumors from the wall of the esophagus.

Endoscopy in late stage cancers may be done through small incisions in the chest to remove all or part of the esophagus, along with surrounding tissues and lymph nodes. Endoscopy is less invasive and allows for faster healing than open esophagectomy.

Most esophageal cancers are detected in late stages, so endoscopic resection may not be an option.

Open Esophagectomy

Open esophagectomy allows for removal of part or all of the esophagus through one or two large incisions. In some cases, the the stomach or piece of small intestine is pulled up into the chest and attached to the upper end of the esophagus, above the cancer. In others, a synthetic tube or a piece of small intestine is substituted.

This procedure is difficult. It has high rates of complications, and low rates of success. Mortality immediately following surgery is often high.

Radiation Therapy

Radiation is used to kill cancer cells and shrink tumors. Radiation does not cure esophageal cancer, but it does offer temporary relief of symptoms, and in some cases, shrinkage of the tumor. Radiation used in conjunction with chemotherapy, and sometimes followed by esophagectomy, may offer improved survival over any method used alone. 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. It may be pills, injections, and/or catheters.

The drugs will enter the bloodstream and 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, 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

This is a three-step therapy. It includes chemotherapy, radiation therapy and 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 may be used to try to kill cancer cells.

Photodynamic Therapy

A combination of drugs and special lights are used to try to kill cancer cells. The medication is absorbed into the cancer cells. The special lights stimulate the medication to kill the cancer cells.

This therapy is a promising treatment. It 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. It is also not used in cancer that has spread to any lymph nodes or other structures.

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

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

Prevention

To help reduce your chance of developing esophageal cancer, take these steps:

  • Don't smoke or use other tobacco products. If you smoke, find out how you can 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.
  • Eat a healthful diet that includes fruits and vegetables, and foods high in dietary fiber, and less dairy, processed foods, and red meat.
  • Get medical treatment for gastroesophageal reflux disease (GERD).
  • If you are overweight or obese, talk with your doctor or a dietitian about losing weight.
  • Talk with your doctor the human papilloma virus vaccine (HPV) to prevent HPV infection.

This type of cancer is usually detected in later stages. People who have risk factors, especially GERD or Barrett's esophagus, should talk to their doctor about screening tests. Screening tests will look for cancer in people before they have any symptoms.

Revision Information

  • American Association of Otolaryngology, Head and Neck Surgery

    http://www.entnet.org

  • American Cancer Society

    http://www.cancer.org

  • Canadian Cancer Society

    http://www.cancer.ca

  • Canadian Society of Otolaryngology

    http://www.entcaada.org

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  • Esophageal cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 2, 2013. Accessed August 5, 2013.

  • Esophageal cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/esophageal. Accessed August 5, 2013.

  • Esophagus cancer. American Cancer Society website. Available at http://www.cancer.org/acs/groups/cid/documents/webcontent/003098-pdf.pdf. Accessed August 5, 2013.

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  • 8/23/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Cardwell CR, Abnet CC, Cantwell MM, Murray LJ. Exposure to oral bisphosphonates and risk of esophageal cancer. JAMA. 2010;304(6):657-663.

  • 6/17/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Liu X, Wang X, et al. Dietary patterns and oesophageal squamous cell carcinoma: a systematic review and meta-analysis. Br J Cancer. 2014;110(11):2785-2795.