Cancer - esophagus

Definition

Esophageal cancer is a malignant (cancerous) tumor of the esophagus, the muscular tube that transports food from the mouth to the stomach.

Alternative Names

Causes

Esophageal cancer is relatively uncommon in the United States, and occurs most often in men over 50 years old. It affects less than 5 in 100,000 people. There are two main types of esophageal cancer --squamous cell carcinoma and adenocarcinoma. These two types look different from each other under the microscope.

Squamous cell cancer is associated with smoking and alcohol consumption. The incidence of this disease in the United States has remained mostly the same, while the incidence of adenocarcinoma of the esophagus has risen dramatically.

Barrett's esophagus, a complication of gastroesophageal reflux disease

Risk factors for adenocarcinoma of the esophagus include male gender, obesity, western diet, and smoking.

Symptoms

• Difficulty swallowing solids or liquids
• Regurgitation of food
• Heartburn
• Weight loss
• Vomiting blood
• Chest pain unrelated to eating

Exams and Tests

• Barium swallow
• EGD (esophagogastroduodenoscopy) and biopsy
• Chest MRI or thoracic CT (usually used for helping to determine the stage of the disease)
• PET scan (sometimes useful for determining the stage of disease, and whether surgery is possible)
• Evidence of occult (hidden) blood in stool

Treatment

When esophageal cancer is only in the esophagus and has not spread elsewhere, surgery is the treatment of choice. The goal of surgery, in most cases, is to cure the patient. In some circumstances chemotherapy, radiation, or a combination of the two will be used to make surgery easier to perform.

In patients who cannot tolerate surgery, or in situations where the cancer has spread to other organs (metastatic disease), chemotherapy or radiation may be used to help reduce symptoms (this is called palliative therapy). In such circumstances, however, the disease is usually not curable.

Other treatments that may be used to improve a patient's ability to swallow include endoscopic dilation of the esophagus (sometimes with placement of a stent), or photodynamic therapy. In photodynamic therapy, a special drug is injected into the tumor, which is then exposed to light. The light activates the medicine that attacks the tumor.

Support Groups

The stress of illness can often be eased by joining a support group of people who share common experiences and problems. See cancer - support group.

Outlook (Prognosis)

Esophageal cancer is a very difficult disease to treat, but it can be cured in patients whose disease is confined to the esophagus. In circumstances in which surgery can be performed, cure rates are in the range of 25%.

In some circumstances in which the cancer is localized to the esophagus and radiation therapy is used instead of surgery, cure is possible but is less likely than with surgery.

For patients whose cancer has spread outside the esophagus, cure is generally not possible and treatment is directed toward relief of symptoms.

Possible Complications

• Severe weight loss resulting from not eating enough, or difficulty swallowing
• Spread of the tumor to other areas of the body

When to Contact a Medical Professional

Call your health care provider if difficulty swallowing, with no known cause, does not get better; call if other symptoms develop that may point to esophageal cancer.

Prevention

Avoiding smoking and reducing or eliminating alcohol consumption may help reduce the risk of developing squamous cell cancer of the esophagus.

Surveillance EGD (esophagogastroduodenoscopy) and biopsy in people with Barrett's esophagus may lead to early detection and improved survival. People with symptoms of severe reflux should seek medical attention.

People diagnosed with Barrett's esophagus should see a gastroenterologist (digestive system specialist) at least every year.