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Esophageal cancer

Cancer - esophagus

 

Esophageal cancer is cancer that starts in the esophagus. This is the tube that moves food from the mouth to the stomach.

Causes

 

Esophageal cancer is not common in the United States. It occurs most often in men over 50 years old.

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 esophageal cancer is linked to smoking and drinking too much alcohol.

Adenocarcinoma is the more common type of esophageal cancer. Having Barrett esophagus increases the risk of this type of cancer. Acid reflux disease ( gastroesophageal reflux disease , or GERD) can develop into Barrett esophagus. Other risk factors include smoking, being male, or being obese.

 

Symptoms

 

Symptoms may include any of the following:

  • Backward movement of food through the esophagus and possibly mouth (regurgitation)
  • Chest pain not related to eating
  • Difficulty swallowing solids or liquids
  • Heartburn
  • Vomiting blood
  • Weight loss

 

Exams and Tests

 

Tests used to help diagnose esophageal cancer may include:

  • Barium swallow
  • Chest MRI or thoracic CT (usually used to help determine the stage of the disease)
  • Endoscopic ultrasound (also sometimes used to determine the stage of disease)
  • Esophagogastroduodenoscopy (EGD) and biopsy
  • PET scan (sometimes useful for determining the stage of disease, and whether surgery is possible)

Stool testing may show small amounts of blood in the stool.

 

Treatment

 

Upper endoscopy (EGD) will be used to obtain a tissue sample from the esophagus to diagnose cancer.

When the cancer is only in the esophagus and has not spread, surgery will be done. The cancer and part, or all, of the esophagus is removed. The surgery may be done using:

  • Open surgery , during which one or two larger incisions are made.
  • Minimally invasive surgery , during which a 2 to 4 small incisions are made in the belly. A laparoscope with a tiny camera is inserted into the belly through one of the incisions.

Radiation therapy may also be used instead of surgery in some cases when the cancer has not spread outside the esophagus.

Either chemotherapy, radiation, or both may be used to shrink the tumor and make surgery easier to perform.

If the person is too ill to have major surgery or the cancer has spread to other organs, chemotherapy or radiation may be used to help reduce symptoms. This is called palliative therapy. In such cases, the disease is usually not curable.

Beside a change in diet, other treatments that may be used to help the patient swallow include:

  • Dilating (widening) the esophagus using an endoscope. Sometimes a stent is placed to keep the esophagus open.
  • A feeding tube into the stomach.
  • Photodynamic therapy, in which a special drug is injected into the tumor and is then exposed to light. The light activates the medicine that attacks the tumor.

 

Support Groups

 

You can ease the stress of illness by joining a cancer support group . Sharing with others who have common experiences and problems can help you not feel alone

 

Outlook (Prognosis)

 

When the cancer has not spread outside the esophagus, surgery may improve the chance of survival.

When the cancer has spread to other areas of the body, a cure is generally not possible. Treatment is directed toward relieving symptoms.

 

Possible Complications

 

Complications may include:

  • Pneumonia
  • Severe weight loss from not eating enough

 

When to Contact a Medical Professional

 

Call your health care provider if you have difficulty swallowing with no known cause and it does not get better. Also call if you have other symptoms of esophageal cancer.

 

Prevention

 

To reduce your risk of cancer of the esophagus:

  • DO NOT smoke
  • Limit or DO NOT drink alcoholic beverages
  • Get checked by your doctor if you have severe GERD
  • Get regular checkups if you have Barrett esophagus

 

 

Open References

References

Kleinberg L, Kelly R, Yang S, et al. Cancer of the esophagus. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology . 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 74.

National Cancer Institute: PDQ Esophageal cancer treatment. Bethesda, MD: National Cancer Institute. Date last modified 12/5/2014. www.cancer.gov/cancertopics/pdq/treatment/esophageal/HealthProfessional. Accessed January 22, 2014.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Esophageal and esophagogastric junction cancers. Version 1.2015. www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf. Accessed January 22, 2014.

 
  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Heartburn prevention

    Heartburn prevention - illustration

    Heartburn is a condition where the acidic stomach contents back up into the esophagus causing pain in the chest area. This reflux usually occurs because the sphincter muscle between the esophagus and stomach is weakened. Standing or sitting after a meal can help reduce the reflux which causes heartburn. Continuous irritation of the esophagus lining as in gastroesophageal reflux disease is a risk factor for the development of adenocarcinoma.

    Heartburn prevention

    illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Heartburn prevention

      Heartburn prevention - illustration

      Heartburn is a condition where the acidic stomach contents back up into the esophagus causing pain in the chest area. This reflux usually occurs because the sphincter muscle between the esophagus and stomach is weakened. Standing or sitting after a meal can help reduce the reflux which causes heartburn. Continuous irritation of the esophagus lining as in gastroesophageal reflux disease is a risk factor for the development of adenocarcinoma.

      Heartburn prevention

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Esophageal cancer

           
             

            Review Date: 1/22/2015

            Reviewed By: Subodh K. Lal, MD, gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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