Esophageal Cancer: Overview and More

Cancer of the esophagus is rare, accounting for about 1% of diagnosed cancers in the United States. In the past, squamous cell carcinoma of the esophagus, associated with smoking and heavy alcohol use, was the most common type. But in recent years it has been overtaken by adenocarcinoma, often associated with prolonged acid reflux and obesity. Swallowing problems are often the first sign of esophageal cancer, and tests such as endoscopy can help confirm the diagnosis.

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If caught early, surgery can cure the disease, but too often the disease progresses and chemotherapy and radiation therapy become the mainstay of treatment.

Esophageal cancer varies greatly around the world, both in terms of incidence and general risk factors. Currently, the number of esophageal adenocarcinoma cases in the United States is declining slightly.

Understanding the esophagus

The esophagus is a muscular tube that connects the mouth to the stomach. It is located behind the breastbone and trachea (the tube that carries air to the lungs) and in front of the thoracic spine. The area in the middle of the chest that the esophagus passes through is called the mediastinum , the space that contains other structures such as the heart, large blood vessels (aorta), and many lymph nodes.

Within the esophagus, there are several important structures that control the passage of solids and liquids from the mouth to the stomach during swallowing. The upper esophageal sphincter is a muscular band in the upper part of the esophagus that prevents food from flowing back from the esophagus to the mouth and also helps prevent aspiration (inhalation of food into the windpipe). The lower esophageal sphincter is a strip of tissue near the junction of the esophagus with the stomach. When the tone of this sphincter is high or low (due to illness or medication), it can affect the way food passes from the esophagus to the stomach. Before reaching the stomach, the esophagus passes through the diaphragm . If this area of the diaphragm becomes weak (hiatal hernia), the stomach can move up into the chest cavity.

Most of the esophagus is lined with cells known as squamous cells, the same type of cells found in the mouth, large airways, and even on the skin. If the tumor begins in this area, it is called squamous cell carcinoma . The area at the bottom of the esophagus and where the esophagus meets the stomach is lined with columnar cells. If a malignant tumor begins in this area, it is called an adenocarcinoma .

Squamous cell carcinoma has become common in the United States and remains the most common type of esophageal cancer worldwide. Currently, adenocarcinomas are more common in the United States and some other developed countries.

Symptoms of esophageal cancer

Symptoms of esophageal cancer often only become apparent when the cancer is quite advanced. However , in hindsight, many people find that they have had symptoms for some time but have unknowingly adapted to these signs (by eating softer foods, for example).

Possible warning signs include:

Because some of these symptoms can occur with acid reflux, and because acid reflux is a risk factor for esophageal cancer, it is important for people to be aware of not only the new symptoms they are experiencing, but also also from any changes in your chronic symptoms.

Causes

We don't know the exact reasons, although genetics seem to play a role. Several risk factors for esophageal cancer have been identified, differing depending on the specific type of esophageal cancer.

Squamous cell carcinoma of the esophagus is often associated with a combination of smoking and heavy alcohol use, although there are other risk factors. Globally , esophageal cancer is more common in men than women, but squamous cell carcinoma is more common. in women in the United States. It is also more common in blacks than whites.

A diet rich in fruits and vegetables, low in red and processed meats, can have a protective effect.

Adenocarcinoma of the esophagus is often associated with chronic acid reflux (gastroesophageal reflux disease or GERD ), as well as Barrett's esophagus and obesity. In the United States, it is more common in men than women and more common in whites than blacks.

Diagnostics

Several different tests can be used to diagnose esophageal cancer . Often the first mass ordered is swallowing barium . However, if esophageal cancer is suspected, the primary test for diagnosis is upper gastric endoscopy (esophagogastric duodenoscopy). In this procedure, a tube is inserted through the mouth into the esophagus. A camera at the end of the tube allows doctors to directly view the inside of the esophagus and, if necessary, take a biopsy.

The stage is very important when choosing the best treatments for the disease. The earliest stages are found in the epithelial cells and the esophagus, and as it progresses, the cancer spreads to nearby lymph nodes, tissues, and organs.

Tests commonly used to determine staging include CT, PET, and sometimes additional tests such as bronchoscopy , thoracoscopy, and others.

Watch out

Treatment options for esophageal cancer will depend on the stage of the cancer, its location, and other factors.

For early tumors, surgery (esophagectomy) may provide a chance for a cure. However, it is a major operation that involves removing part of the esophagus and reconnecting the stomach with what is left of the upper esophagus (or adding part of the intestines if a large part of the esophagus is removed) .

Chemotherapy and radiation therapy are often given before surgery (neoadjuvant chemotherapy) to shrink the tumor, but they can also be used after surgery to make sure any remaining cancer cells are cured.

For those who are not candidates for surgery, there are more options. Chemotherapy with a combination of drugs can prolong life. Radiation therapy is often used along with chemotherapy before surgery, after surgery, or along with chemotherapy when surgery is not possible.

Discussion guide with an esophageal oncologist

Get our printable guide to your next doctor's appointment to help you ask the right questions.

Targeted therapy can also help control the disease, for example, in people with HER2-positive tumors (similar to breast cancer). Immunotherapy includes many treatments that involve using the body's own immune system to fight cancer and can sometimes control even advanced cancers .

Clinical trials are also exploring a variety of treatments that offer hope that more effective treatments will be available in the future.

For people with advanced cancer, quality of life treatments should not be underestimated and palliative care is often the goal of therapy. Palliative care is not the same as palliative care (it can even be used for people with tumors that are likely to be cured) and is intended to control the physical and emotional symptoms of living with cancer. We are learning that palliative care not only improves quality of life, but can also improve survival for people with advanced cancer.

Front facing

Coping with esophageal cancer can be very difficult. Physically, difficulty swallowing not only causes discomfort, it can also significantly interfere with nutrition. Emotionally, esophageal cancer's reputation as an aggressive tumor with a poor prognosis causes many problems, including problems at the end of life. Socially, the diagnosis of esophageal cancer often leads to unwanted changes in family roles. And practical matters ranging from insurance to finance add to the burden.

It takes an entire town to cope with an esophageal cancer diagnosis, and it is very important to bring your support system as close as possible. Seeking the support of the esophageal cancer community online can also be very beneficial, as it provides an opportunity to speak with other people and their families who are facing a similar problem .

Get the word of drug information

Esophageal cancer is often not diagnosed until it is in the later stages of the disease, but many people recognize symptoms long before they are diagnosed. Knowing the signs and symptoms, as well as the presence of risk factors, can help identify the disease as early as possible. However, it is important to note that even if the disease is not caught early and surgery is not possible, there are still treatments that can reduce symptoms and often prolong life.

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