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Back to Oncology Diseases
Esophageal cancer
Esophageal cancer is cancer of the esophagus.
The esophagus is a hollow tube that carries food and liquids from the
throat to the stomach. When a person swallows, the muscular walls of
the esophagus contract to push food down into the stomach. Glands in
the lining of the esophagus produce mucus, which keeps the passageway
moist and makes swallowing easier. The esophagus is located just
behind the trachea (windpipe). In an adult, the esophagus is about 10
inches (25 cm) long.
Pathology of esophageal cancer
Cancer that begins in the esophagus (also called esophageal cancer) is
divided into two major types, squamous cell carcinoma and
adenocarcinoma, depending on the type of cells that are malignant.
Squamous cell carcinomas arise in squamous cells that line the
esophagus. These cancers usually occur in the upper and middle part of
the esophagus. Adenocarcinomas usually develop in the glandular tissue
in the lower part of the esophagus. The treatment is similar for both
types of esophageal cancer.
If the cancer spreads outside the esophagus, it often goes to the
lymph nodes first. (Lymph nodes are small, bean-shaped structures that
are part of the body's immune system.) Esophageal cancer can also
spread to almost any other part of the body, including the liver,
lungs, brain, and bones.
Risk Factors of esophageal cancer
The exact causes of cancer of the esophagus are not known. However,
studies show that any of the following factors can increase the risk
of developing esophageal cancer:
- Age. Esophageal cancer is more likely to occur as people get older;
most people who develop esophageal cancer are over age 60.
- Sex. Cancer of the esophagus is more common in men than in women.
- Tobacco Use. Smoking cigarettes or using smokeless tobacco is one of
the major risk factors for esophageal cancer.
- Alcohol Use. Chronic and/or heavy use of alcohol is another major risk
factor for esophageal cancer. People who use both alcohol and tobacco
have an especially high risk of esophageal cancer. Scientists believe
that these substances increase each other's harmful effects.
- Barrett's Esophagus. Long-term irritation can increase the risk of
esophageal cancer. Tissues at the bottom of the esophagus can become
irritated if stomach acid frequently "backs up" into the esophagus --
a problem called gastric reflux. Over time, cells in the irritated
part of the esophagus may change and begin to resemble the cells that
line the stomach. This condition, known as Barrett's esophagus, is a
premalignant condition that may develop into adenocarcinoma of the
esophagus.
- Other Types of Irritation. Other causes of significant irritation or
damage to the lining of the esophagus, such as swallowing lye or other
caustic substances, can increase the risk of developing esophageal
cancer.
- Medical History. Patients who have had other head and neck cancers
have an increased chance of developing a second cancer in the head and
neck area, including esophageal cancer.
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Symptoms of esophageal cancer
Early esophageal cancer usually does not cause symptoms. However, as
the cancer grows, symptoms may include:
- Difficult or painful swallowing
- Severe weight loss
- Pain in the throat or back, behind the breastbone or between the
shoulder blades
- Hoarseness or chronic cough
- Vomiting
- Coughing up blood
These symptoms may be caused by esophageal cancer or by other
conditions. It is important to check with a doctor.
Diagnosing Esophageal Cancer
To help find the cause of symptoms, the doctor evaluates a person's
medical history and performs a physical exam. The doctor usually
orders a chest x-ray and other diagnostic tests. These tests may
include the following:
A barium swallow (also called an esophagram) is a series of x-rays of
the esophagus. The patient drinks a liquid containing barium, which
coats the inside of the esophagus. The barium makes any changes in the
shape of the esophagus show up on the x-rays.
Esophagoscopy (also called endoscopy) is an examination of the inside
of the esophagus using a thin lighted tube called an endoscope. An
anesthetic (substance that causes loss of feeling or awareness) is
usually used during this procedure. If an abnormal area is found, the
doctor can collect cells and tissue through the endoscope for
examination under a microscope. This is called a biopsy. A biopsy can
show cancer, tissue changes that may lead to cancer, or other
conditions.
Staging the Disease
If the diagnosis is esophageal cancer, the doctor needs to learn the
stage (or extent) of disease. Staging is a careful attempt to find out
whether the cancer has spread and, if so, to what parts of the body.
Knowing the stage of the disease helps the doctor plan treatment.
Listed below are descriptions of the four stages of esophageal cancer.
Some tests used to determine whether the cancer has spread include:
- CAT (or CT) scan (computed tomography). A computer linked to an x-ray
machine creates a series of detailed pictures of areas inside the
body.
- Bone scan. This technique, which creates images of bones on a computer
screen or on film, can show whether cancer has spread to the bones. A
small amount of radioactive substance is injected into a vein; it
travels through the bloodstream, and collects in the bones, especially
in areas of abnormal bone growth. An instrument called a scanner
measures the radioactivity levels in these areas.
- Bronchoscopy. The doctor puts a bronchoscope (a thin, lighted tube)
into the mouth or nose and down through the windpipe to look into the
breathing passages.
Treatment of esophageal cancer
Treatment for esophageal cancer depends on a number of factors,
including the size, location, and extent of the tumor, and the general
health of the patient. Patients are often treated by a team of
specialists, which may include a gastroenterologist (a doctor who
specializes in diagnosing and treating disorders of the digestive
system), surgeon (a doctor who specializes in removing or repairing
parts of the body), medical oncologist (a doctor who specializes in
treating cancer), and radiation oncologist (a doctor who specializes
in using radiation to treat cancer). Because cancer treatment may make
the mouth sensitive and at risk for infection, doctors often advise
patients with esophageal cancer to see a dentist for a dental exam and
treatment before cancer treatment begins.
Many different treatments and combinations of treatments may be used
to control the cancer and/or to improve the patient's quality of life
by reducing symptoms.
Surgery is the most common treatment for esophageal cancer. Usually,
the surgeon removes the tumor along with all or a portion of the
esophagus, nearby lymph nodes, and other tissue in the area. (An
operation to remove the esophagus is called an esophagectomy.) The
surgeon connects the remaining healthy part of the esophagus to the
stomach so the patient is still able to swallow. Sometimes, a plastic
tube or part of the intestine is used to make the connection. The
surgeon may also widen the opening between the stomach and the small
intestine to allow stomach contents to pass more easily into the small
intestine. Sometimes surgery is done after other treatment is
finished.
Radiation therapy, also called radiotherapy, involves the use of
high-energy rays to kill cancer cells. Radiation therapy affects
cancer cells in the treated area only. The radiation may come from a
machine outside the body (external radiation) or from radioactive
materials placed in or near the tumor (internal radiation). A plastic
tube may be inserted into the esophagus to keep it open during
radiation therapy. This procedure is called intraluminal intubation
and dilation. Radiation therapy may be used alone or combined with
chemotherapy as primary treatment instead of surgery, especially if
the size or location of the tumor would make an operation difficult.
Doctors may also combine radiation therapy with chemotherapy to shrink
the tumor before surgery. Even if the tumor cannot be removed by
surgery or destroyed entirely by radiation therapy, radiation therapy
can often help relieve pain and make swallowing easier
Chemotherapy is the use of anticancer drugs to kill cancer cells. The
anticancer drugs used to treat esophageal cancer travel throughout the
body. Anticancer drugs used to treat esophageal cancer are usually
given by injection into a vein (IV). Chemotherapy may be combined with
radiation therapy as primary treatment (instead of surgery) or to
shrink the tumor before surgery.
Nutrition for Cancer Patients
Eating well during cancer treatment means getting enough calories and
protein to control weight loss and maintain strength. Eating well
often helps people with cancer feel better and have more energy.
However, many people with esophageal cancer find it hard to eat well
because they have difficulty swallowing. Patients may not feel like
eating if they are uncomfortable or tired. Also, the common side
effects of treatment, such as poor appetite, nausea, vomiting, dry
mouth, or mouth sores, can make eating difficult. Foods may taste
different.
After surgery, patients may receive nutrients directly into a vein.
(This way of getting nourishment into the body is called an IV.) Some
may need a feeding tube (a flexible plastic tube that is passed
through the nose to the stomach or through the mouth to the stomach)
until they are able to eat on their own.
Patients with esophageal cancer are usually encouraged to eat several
small meals and snacks throughout the day, rather than try to eat
three large meals. When swallowing is difficult, many patients can
still manage soft, bland foods moistened with sauces or gravies.
Puddings, ice cream, and soups are nourishing and are usually easy to
swallow. It may be helpful to use a blender to process solid foods.
The doctor, dietitian, nutritionist, or other health care provider can
advise patients about these and other ways to maintain a healthy diet.
The Importance of Follow up Care
Followup care after treatment for esophageal cancer is important to
ensure that any changes in health are found. If the cancer returns or
progresses or if a new cancer develops, it can be treated as soon as
possible. Checkups may include physical exams, x-rays, or lab tests.
Between scheduled appointments, patients should report any health
problems to their doctor as soon as they appear.
Providing Emotional Support
Living with a serious disease is challenging. Apart from having to
cope with the physical and medical challenges, people with cancer face
many worries, feelings, and concerns that can make life difficult.
They may find they need help coping with the emotional as well as the
practical aspects of their disease. In fact, attention to the
emotional burden of having cancer is often a part of a patient's
treatment plan. The support of the health care team (doctors, nurses,
social workers), support groups, and patient-to-patient networks can
help people feel less isolated and distressed, and improve the quality
of their lives. Cancer support groups provide a setting in which
cancer patients can talk about living with cancer with others who may
be having similar experiences. Patients may want to speak to a member
of their health care team about finding a support group. Many also
find useful information in NCI fact sheets and booklets, including
Taking Time and Facing Forward.
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