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Esophageal cancer

Questions about esophageal cancer

Esophageal cancer is uncommon, accounting for only around 1 percent of all cancers diagnosed in the United States. The most common risk factors for developing esophageal cancer are smoking, excessive alcohol use and chronic gastroesophageal reflux disease.

What you should know about esophageal cancer

Most esophageal cancers aren’t diagnosed until they’ve advanced, and they are typically discovered when patients seek medical attention after they have difficulty swallowing food or liquids. A multidisciplinary team of experts is typically involved in treatment of esophageal cancer. The team may include an oncologist, gastroenterologist, radiation oncologist, surgical oncologist and dietitian.

What is esophageal cancer?

Esophageal cancer is cancer that develops in the 10-inch-long, muscular tube that connects the throat to the stomach. Cancer typically starts in the wall of the esophagus. Because two types of cells—squamous cells and gland cells—line the esophagus, esophageal cancer is characterized by two main types: squamous cell carcinoma and adenocarcinoma. Esophageal cancer generally grows outward and spreads through lymph nodes, eventually involving distant lymph nodes and organs such as the liver and lungs.

What are the main types of esophageal cancer?

The two main types of esophageal cancer are:

  • Squamous cell carcinoma: This type of cancer begins in the flat squamous cells that line the esophagus. Although squamous cell carcinomas may occur anywhere in the esophagus, they most commonly develop in the upper part of the esophagus. Smoking and alcohol use are linked to an increased risk for squamous cell carcinoma of the esophagus. Squamous cell carcinoma was once the most common type of esophageal cancer in the United States, but it now makes up less than half of all esophageal cancers in the country.
  • Adenocarcinoma: This type of cancer forms in gland cells and generally begins in the lower part of the esophagus. Adenocarcinomas occur when gland cells replace an area of squamous cells in the esophagus. This typically happens as a result of sustained reflux, which causes a condition known as Barrett’s esophagus. The longer the reflux persists, the higher the risk for developing Barrett’s esophagus, which carries a much higher risk for developing adenocarcinoma of the esophagus.

What are the most common risk factors for esophageal cancer?

Common risk factors for esophageal cancer include:

  • Excessive smoking and alcohol use
  • Obesity
  • Gastroesophageal reflux disease (GERD), also known as reflux
  • Age
  • Gender, with men at higher risk
  • Barrett’s esophagus

What are the symptoms of esophageal cancer?

Most esophageal cancers don’t cause symptoms in early stages. Because symptoms typically develop once they’ve grown and spread, these cancers are most commonly diagnosed after they’ve advanced. Rarely are esophageal cancers diagnosed before symptoms emerge.

Common esophageal cancer symptoms include:

  • Painful or difficulty swallowing
  • Chest pain
  • Unexplained weight loss
  • Heartburn and indigestion
  • Hoarseness
  • Persistent cough

How is esophageal cancer typically diagnosed?

A doctor will likely conduct several tests to diagnose esophageal cancer, including:

Questions about esophageal cancer treatment

Treatment for esophageal cancer generally depends on how advanced the cancer is. Earlier cancers are typically treated differently than more advanced disease. Also, depending on the stage of the cancer and other factors, certain treatments may be used in combination.

How is esophageal cancer treated?

Most early-stage esophageal cancers are treated with a combination of chemotherapy, radiation and surgery. In some early stages, the gastroenterologist may be able to remove the cancer during an endoscopic procedure, such as an endoscopic mucosal resection or photodynamic therapy. For esophageal cancers that have advanced, the most common treatments include chemotherapy, targeted therapy or immunotherapy.

Some endoscopic procedures, including radiofrequency ablation, may be used to treat Barrett’s esophagus to prevent the condition from developing into cancer. Some advanced esophageal cancers may require treatments to keep the esophagus open, including laser ablation, cryoablation and esophageal stents.

What are the potential side effects of esophageal cancer treatment?

Many treatments for esophageal cancer may cause side effects. An endoscopic mucosal resection, for example, may cause bleeding in the esophagus, or cause certain areas of the esophagus to narrow. An esophagectomy may increase the risk for complications. For example, patients aren’t able to lie flat to sleep afterward, and must eat smaller, more frequent meals. They also may require occupational or speech therapy to relearn how to swallow.

How can treatment-related side effects be managed?

Surgical procedures may be recommended to reduce the impact of certain side effects of esophageal cancer treatment, such as repairing a leak in the stomach’s connection to the esophagus after an esophagectomy. In other cases when lung complications develop, a longer hospital stay may be necessary as the patient recovers.

If treatments have caused areas of the esophagus to narrow, the surgeon or gastroenterologist may perform endoscopic procedures to expand these regions. For advanced cancer patients who have difficulty swallowing, radiation therapy may be used to shrink tumors blocking the esophagus. If the patient is unable to swallow food, a feeding tube may also be necessary.

Questions to ask your doctor

The earlier esophageal cancer is diagnosed, the more treatment options may be available. Existing conditions that increase the risk for esophageal cancer, such as Barrett’s esophagus, may require monitoring and treatment to help prevent esophageal cancer from developing. If esophageal cancer is diagnosed, knowing which questions to ask your doctor may help you make informed decisions about your treatment plan.

Do I have esophageal cancer?

Esophageal cancer is generally characterized by difficulty swallowing. In the beginning, an esophageal cancer patient may have trouble swallowing meat, but as the tumor grows in the esophagus, the challenges may progress to include difficulty swallowing other foods and, eventually, liquids. Seeking medical attention at the first sign of a swallowing problem may help your doctor diagnose cancer early, before it spreads. Diagnosing esophageal cancer requires a biopsy, which may include endoscopy or imaging tests, such as a CT scan.

Because Barrett’s esophagus increases the risk of esophageal cancer, people with this condition are often closely monitored by their doctor for early signs of cancer and pre-cancer. These patients may undergo a regular endoscopy and biopsies to check for abnormal cells.

What is the stage of my cancer?

After esophageal cancer is diagnosed, the doctor will determine whether the cancer has spread and, if so, how far. Most esophageal cancers form in the inner lining of the esophagus and then grow into the organ’s deeper layers, before spreading to the lymph nodes and other organs.

In esophageal cancer, staging usually ranges from 0, when cancer is confined to the inner lining of the esophagus, to IV, when cancer has spread to either nearby or distant organs and lymph nodes.

How will cancer and its treatment affect my quality of life?

Depending on the stage of the disease, esophageal cancer’s effect on a patient’s quality of life may vary. An early-stage cancer, for example, may require an endoscopic procedure or surgery to remove the disease. Advanced cancers, however, may require more extensive treatments, and may make swallowing difficult or even impossible. In these cases, a feeding tube may be required and procedures may be performed to open up the esophagus to allow foods and liquids to pass through.

After treatment is complete, patients with advanced cancers may have to relearn how to swallow, or may have to eat smaller, more frequent meals.

How important are follow-up appointments after treatment is complete?

For some esophageal cancer patients, the disease may never go away entirely. These patients may require regular treatments to prevent the disease from growing. For others, no further treatment may be necessary. Still, all esophageal cancer survivors are urged to keep up with follow-up visits with their doctor for several years. That way, if the cancer recurs, the disease can be detected and treated early.

Follow-up appointments also offer patients the opportunity to discuss lingering side effects they may be experiencing. For example, many patients struggle with reflux even after treatment.

What if my cancer comes back?

If cancer recurs, it may return in the same place, or it may develop somewhere else in your body. Esophageal cancer patients carry a higher risk for throat, oral, lung, thyroid and small intestine cancer, and men have a higher risk for stomach cancer.

Follow-up appointments help doctors monitor patients for signs of recurrence and allow them to address symptoms or side effects the patient may be experiencing.