The esophagus is part of the digestive system. It is a muscular tube in the chest. Food moves through the esophagus to get from the mouth to the stomach.
The wall of the esophagus has several layers: the inner layer, submucosa, muscle, and outer layers. Esophageal cancer starts in the cells of one of these layers.
Esophageal cancer begins when a normal cell becomes abnormal. Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die and the body makes new cells to replace them. Sometimes, however, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
Tumors in the esophagus can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors.
There are two main types of esophageal cancer. Both types are diagnosed, treated, and managed in similar ways:
- Adenocarcinoma: This type is usually found in the lower part of the esophagus, near the stomach. In the United States, adenocarcinoma is the most common type of esophageal cancer.
- Squamous cell carcinoma: This type is usually found in the upper part of the esophagus. This type is becoming less common in the United States; however, around the world, squamous cell carcinoma is the most common type.
The source for this information is the National Cancer Institute.
Doctors can't always explain why one person gets esophageal cancer and another doesn't. However, certain risk factors make a person more likely than others to develop esophageal cancer. A risk factor is something that may increase the chance of getting a disease.
Having a risk factor does not mean that a person will get esophageal cancer. Many people who get esophageal cancer have none of these risk factors, and many people who have known risk factors never get cancer. A person with one or more of these risk factors should talk with his or her doctor about cancer risk.
Certain factors raise a person's risk for esophageal cancer:
- Acid reflux: Acid reflux is the backward flow of stomach acid into the esophagus. The stomach acid can damage the tissue of the esophagus. After many years of reflux, this tissue damage may lead to adenocarcinoma of the esophagus.
- Age: Age is the main risk factor for esophageal cancer. A person's risk of this disease gets higher as he or she gets older. In the United States, most people are 65 or older when diagnosed.
- Barrett's esophagus: Acid reflux may cause a condition known as Barrett's esophagus. This occurs when cells in the lower part of the esophagus become abnormal. Barrett's esophagus increases the risk of adenocarcinoma of the esophagus.
- Being male: In the United States, men are more than three times as likely as women to develop esophageal cancer.
- Diet: A diet low in fruits and vegetables may increase the risk of esophageal cancer.
- Heavy alcohol drinking: People who have more than three alcoholic drinks each day are more likely than people who don't drink to develop squamous cell carcinoma of the esophagus. Heavy drinkers who smoke are at a much higher risk than heavy drinkers who don't smoke.
- Obesity: Being obese increases the risk of adenocarcinoma of the esophagus.
- Smoking: People who smoke are more likely than people who don't smoke to develop esophageal cancer.
Early esophageal cancer may not cause symptoms. As the cancer grows, these are the most common symptoms:
- A hoarse voice or a cough that doesn't go away within two weeks
- Food getting stuck in your esophagus or food coming back up
- Pain in your chest or back
- Pain when you swallow
- Weight loss
Most often, these symptoms do not mean cancer. A person with these symptoms should tell his or her doctor so any health problem can be diagnosed and treated as early as possible.
Currently, there are no screening methods for esophageal cancer.
If symptoms suggest esophageal cancer, the doctor will try to find out what's causing the problems. The doctor will perform a physical exam, ask about the patient's personal and family health history, and may take a sample of the patient's blood. The doctor may have one or more of the following tests done:
- Barium swallow (or upper GI series): After the patient drinks a barium solution, x-rays are taken of the esophagus and stomach. The barium solution makes the esophagus show up more clearly on the x-rays.
- Upper endoscopy (EGD or esophagoscopy): The doctor uses a thin, lighted tube (endoscope) to look down the esophagus. The tube is passed through the mouth or nose to the esophagus.
- Biopsy: The doctor uses an endoscope to remove tissue from the esophagus and sends it to a lab. The doctor in the lab looks at the tissue under a microscope. The removal of tissue to look for cancer cells is called a biopsy. In most cases, a biopsy is the only sure way to tell whether cancer is present.
If esophageal cancer is diagnosed, the doctor needs to learn the extent (stage) of the disease to help choose the best treatment.
Staging is a careful attempt to find out if the cancer has spread, and if so, to what parts of the body. The doctor may order one or more of these staging tests:
- Endoscopic ultrasound: The doctor passes a thin, lighted tube (endoscope) down your throat, which has been numbed with anesthetic. A probe at the end of the tube sends out sound waves that can't be heard. The waves bounce off tissues in the esophagus and nearby organs. A computer creates a picture from the echoes. The picture can show how deeply the cancer has invaded the wall of the esophagus. The doctor may use a needle to take tissue samples of lymph nodes.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of the chest and abdomen. The patient may receive contrast material by mouth or by injection into a blood vessel. The contrast material makes abnormal areas easier to see.
- MRI: A strong magnet linked to a computer is used to make detailed pictures of the inside of the body. An MRI can show whether cancer has spread to lymph nodes or other areas. Sometimes contrast material is given by injection into a blood vessel. The contrast material makes abnormal areas show up more clearly on the picture.
- PET scan: The patient receives an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes pictures of the sugar used by cells in the body. Cancer cells use sugar faster than normal cells, so areas with cancer look brighter on the pictures. A PET scan shows whether esophageal cancer may have spread.
- Bone scan: The patient gets an injection of a small amount of a radioactive substance that collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones. The pictures may show cancer that has spread to the bones.
- Laparoscopy: After the patient is given general anesthesia, the surgeon makes small incisions (cuts) in the abdomen. The surgeon inserts a thin, lighted tube (laparoscope) into the abdomen. Lymph nodes or other tissue samples may be removed to check for cancer cells.
Stages of Esophageal Cancer
Stage 0: The cancer cells are found only in the inner layer of the esophagus. The doctor may call this carcinoma in situ.
Stage I: The cancer has grown deeper into the submucosa of the esophagus.
Stage II: The cancer has grown through the inner layer, muscle layer, or outer layer of the esophagus. There may also be cancer in the lymph nodes.
Stage III: The tumor has grown through the outer layer of the esophagus or has invaded nearby structures such as the airways. There may also be cancer in the lymph nodes.
Stage IV: Cancer cells have spread to distant organs such as the liver.
At Huntsman Cancer Institute, esophageal cancer is treated by a team of specialists, including gastroenterologists (doctors who specialize in treating problems of the digestive organs), surgeons, medical oncologists (doctors who treat cancer with medicine), radiation oncologists (doctors who treat cancer with radiation), nurses, dietitians, respiratory therapists, speech pathologists, and social workers.
Common treatment options for esophageal cancer include the following:
- Radiation therapy
- Clinical trials
A patient may have a combination of treatments. The treatment that's right for each patient depends on many factors:
- The location of the cancer in the esophagus
- Whether the cancer has invaded nearby structures
- Whether the cancer has spread to lymph nodes or other parts of the body
- The patient's symptoms
- The patient's age and general health
The health care team can describe all of the treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Patients are encouraged to discuss treatment side effects with their health care team.
There are several types of surgery for esophageal cancer. The type depends mainly on where the cancer is located. The surgeon may remove the whole esophagus or only the part that has the cancer. Usually, the surgeon removes the section of the esophagus with the cancer, lymph nodes, and nearby soft tissues. Part or all of the stomach may also be removed. The patient and his or her surgeon can talk about and decide on the best type of surgery.
The surgeon makes incisions into the chest and abdomen to remove the cancer. In most cases, the surgeon pulls up the stomach and joins it to the remaining part of the esophagus. Or a piece of intestine may be used to connect the stomach to the remaining part of the esophagus. The surgeon may use either a piece of small intestine or large intestine. If the stomach was removed, a piece of intestine is used to join the remaining part of the esophagus to the small intestine.
During surgery, the surgeon may place a feeding tube into the small intestine. This tube helps the patient get enough nutrition while he or she heals.
Most people with esophageal cancer get chemotherapy. Chemotherapy uses drugs to kill and control cancer cells. Learn more about chemotherapy in our introduction to chemotherapy video.
Radiation therapy uses high-energy rays to kill cancer cells. Radiation therapy only affects cells in the treated area.
Doctors use two types of radiation therapy to treat esophageal cancer. Some patients receive both types:
- External radiation: The radiation comes from a large machine outside the body. The machine aims beams of radiation at the cancer. Patients go to a hospital or clinic for treatment. This type of treatment uses computers to closely target the cancer, which protects healthy tissue near the esophagus.
- Internal radiation therapy (brachytherapy): The doctor numbs the throat and gives the patient medicine to help relax. The doctor puts a tube into the esophagus. The radiation comes from the tube. Once the tube is removed, no radioactivity is left in the body. Usually, only a single treatment is done.
These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI's clinical trials website.
When you or someone you love is diagnosed with cancer, concerns about treatments and side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, work, or normal daily life.
There are several places you can go for support:
- Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
- Our Patient and Family Support Services offer emotional support and resources for coping with cancer and its impact on daily life to Huntsman Cancer Institute (HCI) patients and their families.
- The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers many programs to increase the quality of life and well-being of HCI patients and their families
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Gastrointestinal Cancer Program
Did You Know?
- In the United States, men are more than three times as likely as women to develop esophageal cancer.
- Early esophageal cancer may not cause symptoms.
- Dietitians and speech pathologists at Huntsman Cancer Institute work closely with esophageal cancer patients who may have trouble eating or swallowing.