Filed under: Cancer & Chemo
Esophageal cancer is cancer that occurs in the esophagus — a long, hollow tube that runs from your throat to your stomach. Your esophagus carries food you swallow to your stomach to be digested.
Esophageal cancer usually begins in the cells that line the inside of the esophagus. Esophageal cancer can occur anywhere along the esophagus, but in people in the United States, it occurs most often in the lower portion of the esophagus. More men than women get esophageal cancer.
Esophageal cancer isn't common in the United States. In other areas of the world, such as Asia and parts of Africa, esophageal cancer is much more common.
Signs and symptoms of esophageal cancer include:
Early esophageal cancer typically causes no signs or symptoms.
When to see a doctor
Make an appointment with your doctor if you have any persistent signs and symptoms that worry you.
If you've been diagnosed with Barrett's esophagus, a precancerous condition that increases your risk of esophageal cancer caused by chronic acid reflux, ask your doctor what signs and symptoms to watch for that may signal that your condition is worsening.
Screening for esophageal cancer isn't done routinely because of a lack of an easily identifiable high-risk group and the possible risks associated with endoscopy. If you have Barrett's esophagus, discuss the pros and cons of screening with your doctor.
It's not clear what causes esophageal cancer. Esophageal cancer occurs when cells in your esophagus develop errors (mutations) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells form a tumor in the esophagus that can grow to invade nearby structures and spread to other parts of the body.
Types of esophageal cancer
Esophageal cancer is classified according to the type of cells that are involved. The type of esophageal cancer you have helps determine your treatment options. Types of esophageal cancer include:
It's thought that chronic irritation of your esophagus may contribute to the DNA changes that cause esophageal cancer. Factors that cause irritation in the cells of your esophagus and increase your risk of esophageal cancer include:
Other risk factors include
As esophageal cancer advances, it can cause complications, such as:
If your family doctor suspects you have esophageal cancer, you may be referred to a number of doctors who will help to evaluate your condition. Your health care team may include doctors who:
To get the most from your appointment, it's a good idea to be well prepared. Here's some information to help you get ready, and to know what to expect from your doctor.
What you can do
Preparing a list of questions will help you make the most of your time with your doctor. For esophageal cancer, some basic questions to ask your doctor include:
Don't hesitate to ask any other questions that occur to you during your appointment.
Tests and procedures used to diagnose esophageal cancer include:
Esophageal cancer staging
When you're diagnosed with esophageal cancer, your doctor works to determine the extent (stage) of the cancer. Your cancer's stage helps determine your treatment options. Tests used in staging esophageal cancer include computerized tomography (CT) and positron emission tomography (PET).
The stages of esophageal cancer are:
What treatments you receive for esophageal cancer are based on the type of cells involved in your cancer, your cancer's stage, your overall health and your preferences for treatment.
Surgery to remove the cancer can be used alone or in combination with other treatments. Operations used to treat esophageal cancer include:
Esophageal cancer surgery carries a risk of serious complications, such as infection, bleeding and leakage from the area where the remaining esophagus is reattached. Surgery to remove your esophagus can be performed as an open procedure using large incisions or with special surgical tools inserted through several small incisions in your skin (laparoscopically). How your surgery is performed depends on your situation and your surgeon's experience and preferences.
Surgery for supportive care
Besides treating the disease, surgery can help relieve symptoms or allow you to eat.
Chemotherapy is drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically used before (neoadjuvant) or after (adjuvant) surgery in people with esophageal cancer. Chemotherapy can also be combined with radiation therapy. In people with advanced cancer that has spread beyond the esophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by the cancer.
The chemotherapy side effects you experience depend on which chemotherapy drugs you receive.
Radiation therapy uses high-powered energy beams to kill cancer cells. Radiation can come from a machine outside your body that aims the beams at your cancer (external beam radiation). Or radiation can be placed inside your body near the cancer (brachytherapy).
Radiation therapy is most often combined with chemotherapy in people with esophageal cancer. It can be used before or after surgery. Radiation therapy is also used to relieve complications of advanced esophageal cancer, such as when a tumor grows large enough to stop food from passing to your stomach.
Side effects of radiation to the esophagus include sunburn-like skin reactions, painful or difficult swallowing, and accidental damage to nearby organs, such as the lungs and heart.
Combined chemotherapy and radiation
Combining chemotherapy and radiation therapy may enhance the effectiveness of each treatment. Combined chemotherapy and radiation may be the only treatment you receive, or combined therapy can be used before surgery. But combining chemotherapy and radiation treatments increases the likelihood and severity of side effects.
Clinical trials are research studies testing the newest cancer treatments and new ways of using existing cancer treatments. Clinical trials give you a chance to try the latest in cancer treatment, but they can't guarantee a cure. Ask your doctor if you're eligible to enroll in a clinical trial. Together you can discuss the potential benefits and risks.
Poor appetite, difficulty swallowing, weight loss and weakness often accompany esophageal cancer. These symptoms may be compounded by cancer treatments and by the need for a liquid diet, tube feeding or intravenous feeding during the course of treatment.
Ask your doctor for a referral to a registered dietitian, who can help you find solutions to dealing with difficulty eating or a loss of appetite. In the meantime, try to:
Complementary and alternative therapies may help you cope with the side effects of cancer and cancer treatment. For instance, people with esophageal cancer may experience pain caused by cancer treatment or by a growing tumor. Your doctor can work to control your pain by treating the cause or with medications. Still, pain may persist, and complementary and alternative therapies may help you cope.
Ask your doctor whether these options are safe for you.
Coping with the shock, fear and sadness that come with a cancer diagnosis can take time. You may feel overwhelmed just when you need to make crucial decisions. With time, each person finds a way of coping and coming to terms with the diagnosis. Until you find what brings you the most comfort, consider trying to:
You can take steps to reduce your risk of esophageal cancer. For instance: