Esophageal Cancer

The esophagus is the muscular tube that connects the throat to the stomach. It joins the stomach at the diaphragm, which is the breathing muscle separating the chest and lungs from the abdomen.

The connection of the esophagus to the stomach at the diaphragm is called the gastro-esophageal junction, which serves as a one-way valve to keep stomach contents from being refluxed, or regurgitated, back into the esophagus.

The esophagus can be divided into thirds: top (proximal) or neck, middle or chest, and lower or abdominal. Esophageal cancer consists of mucous membrane cancer or adenocarcinomas most commonly, or squamous cell or epidermoid cancers. Adenocarcinomas can arise from pre-cancerous cells caused by heartburn or GERD.

Esophageal cancer is relatively common worldwide but rare in the U.S. Each year in the U.S., there are roughly 17,000 new cases of esophageal cancer and 15,000 deaths from the disease.

 

Causes

There are clear differences in the profiles of people with squamous cell cancer and adenocarcinoma of the esophagus. Esophageal adenocarcinoma is more common in white males and is strongly associated with a history of chronic gastroesophageal reflux disease (GERD). Squamous cell carcinoma is more common in minority populations including Asian Americans and African Americans. It is also more strongly linked to tobacco and alcohol use.

Symptoms

  • Difficulty swallowing or the sensation of food getting stuck in the throat (dysphagia)
  • Weight loss
  • Decreased appetite

Diagnosing Esophageal Cancer

Esophageal cancer may be discovered if you are being evaluated for symptoms of chronic heartburn, regurgitation or gastrointestinal bleeding. If you have chronic GERD or Barrett's esophagus (which occurs when tissue similar to stomach or intestinal lining replaces esophageal lining as a result of GERD), cancer may be detected during a routine check-up.  

Treatments

If cancer is caught at an early stage, a surgeon can remove the cancer and some of the normal surrounding tissue. Surgery may be combined with other treatments such as chemotherapy or radiation therapy. The treatment plan depends on the size, location and aggressiveness of the cancer.

  • Esophagectomy: Esophagectomy is a surgery that removes some or most of the esophagus. A part of the stomach is often removed, too. In that case, the upper part of the esophagus is connected to the remaining part of the stomach. Esophagectomy can be performed as a minimally invasive procedure or as a traditional, open one.
  • Radiation therapy: Radiation therapy, or radiation oncology, uses targeted, penetrating rays of energy (radiation) to destroy cancer cells. With esophageal cancer, radiation therapy can be used before surgery to shrink a tumor or after surgery to kill any remaining cancer cells.
  • Chemotherapy: With chemotherapy, medications are used to kill cancer cells via the bloodstream. Different chemotherapy drugs destroy cancer cells by a variety of different mechanisms. Chemotherapy can be used alone, or before or after surgery.
  • Endoscopic treatments: There are several types of treatment that can be performed by inserting an endoscope (a long, flexible tube) down the throat and into the esophagus. Some of these treatments may attempt to treat very early stage cancer. If the cancer is more advanced, these treatments may help relieve symptoms. In the case of Barrett’s esophagus or dysplasia, endoscopic treatments may be used to try to prevent cancer.