What is esophageal cancer?
Esophageal cancer is a rare type of cancer that begins in the esophagus, or swallowing tube. It is usually found in people over age 60, but it can occur at any age.
The esophagus is a hollow tube that connects your mouth and throat to your stomach. It has muscles that help push food into the stomach. The lining of the esophagus can be affected by cancer, including:
Squamous cell carcinoma (SCC) – the most common type of esophageal cancer; SCC starts in cells that line the bottom of the esophagus near where it joins the stomach
Adenocarcinoma – this form of esophageal cancer can occur anywhere along the length of the esophagus; it often has early symptoms such as heartburn and difficulty swallowing.
How common is esophageal cancer?
Esophageal cancer is relatively rare. In the United States, it accounts for about 2 percent of all new cancer cases each year.
In 2018, an estimated 17,850 people will be diagnosed with esophageal cancer and 13,190 will die from the disease.
Younger adults are more likely to be diagnosed with esophageal cancer than older people. Men are more likely to develop esophageal cancer than women.
The incidence rate of esophageal cancer in the U.S.:
- About 16 cases per 100,000 men per year
- About 7 cases per 100,000 women per year
What causes esophageal cancer?
Esophageal cancer can be caused by several factors. We don’t know which ones are most important. The exact cause of esophageal cancer isn’t known, but there are some risk factors that increase your chance of developing it. These include:
Smoking and tobacco use
Drinking alcohol to excess (excessive drinking is defined as more than two alcoholic drinks a day for men and one or more for women)
Being overweight or obese
Eating foods that irritate the lining of your esophagus (including spicy foods, citrus fruits and juices), which may cause inflammation and looseness of the tissue lining your esophagus ( Barrett’s esophagus ).
What are the symptoms of esophageal cancer?
Esophageal cancer is a disease that begins in the esophagus, the muscular tube that connects your throat and stomach. Symptoms of esophageal cancer may include:
- Heartburn or acid reflux
- Difficulty swallowing (dysphagia)
- Chest pain or chest discomfort that worsens when you lie down and eases when you sit up
What are the symptoms of esophageal cancer?
The symptoms of esophageal cancer vary depending on where the cancer develops. Some people with early stage cancers have no symptoms at all. For others, the symptoms may include:
Heartburn or acid reflux — Burning sensation in your chest under your breastbone (sternum) that may spread to your neck and throat, sometimes waking you up at night
Difficulty swallowing (dysphagia) — Painful difficulty swallowing solids or liquids that doesn’t go away after a few weeks of other treatments
Chest pain or chest discomfort that worsens when you lie down and eases when you sit up — Chest discomfort can range from mild to severe and may be accompanied by a feeling of tightness in your chest. This is often worse at night, especially while lying down.
How is esophageal cancer diagnosed?
Diagnosing esophageal cancer can be challenging because of the difficulty in distinguishing it from other, similar conditions.
If you have symptoms that suggest cancer, your doctor will likely perform a physical exam and order blood tests or other diagnostic tests to rule out other conditions. If your doctor suspects cancer based on your symptoms and test results, you may need more tests to confirm the diagnosis.
If it’s not possible to get biopsies of your esophagus during endoscopy, then additional testing to look for abnormal cells in the esophagus may be necessary. This can include an endoscopic ultrasound (EUS) or CT scan with contrast (CECT). These tests can help determine if there are any abnormalities in the esophagus that might be precancerous or actually cancerous.
Another way doctors diagnose esophageal cancer is by examining tissue samples taken during surgery or endoscopy and looking at them under a microscope (histology).
How is esophageal cancer treated?
The treatment for esophageal cancer may include surgery, chemotherapy, radiation therapy, and/or immunotherapy.
Surgery is the most common treatment for early-stage esophageal cancer and often involves removing the affected area of your esophagus as well as nearby lymph nodes (called a hemipelvectomy). Surgery is also used to remove cancerous lymph nodes in the chest and abdomen (called a thoracotomy).
Chemotherapy uses drugs that kill cancer cells. Drugs are injected into or near your esophagus directly into the lining of your esophagus using an endoscope. The drugs can be delivered directly to where they are needed without needing to travel through your bloodstream. The purpose of this type of treatment is to kill any remaining cancer cells that may have spread from where they started. Chemotherapy can also shrink tumors so they’re easier for surgeons to remove during surgery (called neoadjuvant therapy).
Radiation therapy uses high energy x-rays or other types of radiation to destroy cancer cells. Radiation is usually given after surgery or chemotherapy (called adjuvant therapy). It may also be used when surgery isn’t possible because there’s too much risk of causing more damage than good by operating on.
Can esophageal cancer be prevented?
If you have Barrett’s esophagus, you may wonder if it’s possible to prevent the disease from progressing to cancer. Unfortunately, there are no proven methods of prevention. However, it is important to understand what factors put you at risk for developing Barrett’s esophagus and esophageal cancer.
Risk factors for esophageal cancer include:
- Smoking tobacco products
- Drinking alcohol excessively (more than two drinks per day) or binge drinking (five or more drinks in one sitting)
- Having GERD or GERD complications that can cause irritation of the esophagus (such as frequent chest pain, difficulty swallowing)
- Having a family history of Barrett’s esophagus or adenocarcinoma of the stomach or colon