Esophageal Cancer

Definition

Esophageal cancer is a disease in which cancer cells grow in the esophagus. The esophagus is the tube that takes food from the throat to the stomach.

Cancer occurs when cells in the body (in this case esophageal cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissues and can spread to other parts of the body. A benign tumor does not invade or spread.


Causes

The cause of esophageal cancer is unknown.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• Age: 60 or older
• Sex: Male
• Smoking or smokeless tobacco use (such as chewing tobacco or snuff)
• Alcohol use
• History of gastroesophageal reflux, especially if this has caused Barrett's esophagus
• Damaged esophagus from toxic substances, such as lye
• History of cancer of the head and/or neck

Symptoms

Symptoms include:

• Trouble swallowing
• Painful swallowing
• Cough
• Hoarse voice
• Pain in the throat, back, chest
• Nausea, vomiting
• Coughing up blood
• Weight loss

Note: These symptoms may also be caused by other, less serious health conditions. Anyone experiencing these symptoms should see a doctor.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

Tests may include:
Chest X-ray – an x-ray of the chest area
Upper GI Series – a series of x-rays of the esophagus and stomach taken after drinking a barium solution (also called barium swallow)
Esophagoscopy – examination of the esophagus using a lighted scope
Biopsy – removal of a small sample of esophageal tissue to test for cancer cells
CT Scan - a type of x-ray that uses a computer to make pictures of structures inside the body
Bone Scan – to see if the cancer has spread to the bones

Treatment

Treatment may include:
Surgery – removal of the cancerous tumor. The doctor might remove all or part of your esophagus, as well. A plastic tube might be used to replace the missing portion of esophagus.
Radiation Therapy – the use of radiation to kill cancer cells and shrink tumors. 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 – the use of drugs to kill cancer cells. Chemotherapy may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells. Chemotherapy alone will not cure esophageal cancer. It is only used when the cancer has already spread and cannot be cured. The chemotherapy at this point is used to help shrink the tumor somewhat to help with pain or nausea control.
Chemoradiotherapy or combined modality therapy- chemotherapy and radiation therapy together are more curable than radiotherapy alone and it has been shown that these two treatments may be as effective as surgery alone.
Trimodality therapy - chemotherapy and radiation therapy followed by a completion esophagogastrectomy or surgery. This has been shown to be a most aggressive form of therapy and may be the best way to cure a patient of their disease.
Laser Therapy – high-intensity light used to try to kill cancer cells.
Photodynamic Therapy – a combination of drugs and special lights used to try to kill cancer cells. Photodynamic therapy is a promising treatment approach but is only appropriate in a very small number of patients with esophageal cancer because of the limits of how far the infrared light source will travel into the cancer itself. The tumor must be very small (smaller than ¼ inch thick) and it must not involve any lymph nodes or other structures.

Prevention

To help prevent esophageal cancer:

• Don't smoke or use other tobacco products.
• Drink alcohol only in moderation. Moderate alcohol intake is no more than 2 drinks per day for men and 1 drink per day for women.
• Get medical treatment for gastroesophageal reflux disease.