Esophageal Cancer

Cancer of the esophagus is a tumor that grows in the lining of the esophagus. The esophagus is the tube connecting the mouth and upper throat to the stomach.

What is going on in the body?

The esophagus carries swallowed food to the stomach using a coordinated muscular effort. There is a muscular door called a sphincter between the esophagus and the stomach. Esophageal cancer can start anywhere along the lining of the esophagus. It begins in the inside lining. It then grows through the muscular wall of the esophagus. It can spread to other parts of the body through the blood or lymphatic system.

What are the causes and risks of the disease?

There appear to be many causes and risk factors for esophageal cancer. Certain conditions, if present for a long time, increase a person’s risk for esophageal cancer. These conditions include:

achalasia, a condition in which the esophagus muscle cannot relax

Barrett’s esophagus, an ulcer in the esophagus caused by long-term gastroesophageal reflux disease, or GERD

diverticuli, or pouches in the lining of the esophagus

lye or burn-related damage

tylosis, a genetic skin problem

People who smoke cigarettes, chew tobacco, and drink alcohol are at a higher risk for this cancer. It is also thought that chronic and recurring irritation can increase the risk of esophageal cancer. These irritations include drinking very hot liquids, eating pickled foods, and being exposed to environmental toxins.

Esophageal cancer is rarely seen in people younger than 25 years old. The disease is more common in men than in women. It is seen more often in African Americans than in Caucasians. Overall, esophageal cancer is relatively uncommon in the United States. In some parts of Asia it is the second most common cancer, accounting for as much as 50% of all cancer deaths.

What are the signs and symptoms of the disease?

Someone who has esophageal cancer may have the following symptoms:

difficulty swallowing

heartburn

inability to swallow solid foods and, eventually, liquids

pain with swallowing

weight loss

If the cancer spreads to other body organs, it may cause pain. Since it spreads easily to the liver, the person may develop the following symptoms of liver failure:

abdominal pain

enlarged liver

jaundice, or yellowing of the eyes and skin

How is the disease diagnosed?

Diagnosis of esophageal cancer begins with a medical history and physical exam. The healthcare provider may order an endoscopy of the esophagus. If a tumor is seen, a biopsy is done.

If the tumor is found to be cancerous, a staging work-up is done. This includes a physical exam, blood tests, and CAT scans of the chest and abdomen. This will give an indication of the size of the tumor. It will also show any metastasis to the chest, lymph nodes, lungs, or liver.

What can be done to prevent the disease?

The best way to prevent esophageal cancer is to avoid tobacco and alcohol.

People who have Barrett’s esophagus need aggressive treatment of their GERD to prevent esophageal cancer. Treatment for GERD may include the following:

fundoplication, a surgical procedure that strengthens the esophageal sphincter

GI stimulants that empty the stomach faster, such as metoclopramide

H2 blockers, such as cimetidine, ranitidine, and famotidine

proton pump inhibitors, such as omeprazole, lansoprazole, or rabeprazole

People with Barrett’s esophagus may have regular endoscopies, which use a lighted tube to examine the esophagus. Biopsies, which involve removing a small piece of tissue, are sometimes needed. These screenings may detect an esophageal cancer early, when it is most treatable.

What are the long-term effects of the disease?

Esophageal cancer is a deadly disease. The 5-year survival rate is poor, even with aggressive treatment. It often recurs, despite surgery, chemotherapy, and radiation therapy.

What are the risks to others?

Esophageal cancer is not contagious. It poses no risk to others.

What are the treatments for the disease?

Persons who have metastases that cannot be cured with surgery may still benefit from radiation therapy or chemotherapy. Radiation does not help if the cancer has spread to the liver or lungs.

Chemotherapy has short-term benefit for cancer that has spread to other parts of the body. It can be combined with radiation therapy. It involves toxic drugs, and the potential benefit must be balanced with the side effects.

Surgery of the esophagus can be complicated. It may involve removing the esophagus, stomach, spleen, and lymph nodes inside the chest. Another part of the lower bowel or stomach can be pulled up and attached to the remaining esophagus. This allows the person to continue eating. People need to be in relatively good health to tolerate this surgery.

Whether preoperative chemotherapy and radiation therapy can improve the cure rate with this extensive surgery is controversial and under study.

What are the side effects of the treatments?

Following are some of the side effects of radiation:

burning of the skin

damage to the heart or lungs

irritation of the esophagus

loss of appetite

more difficulty swallowing

nausea

Side effects of chemotherapy include the following:

anemia, or a low red blood cell count

diarrhea

hair loss

increased susceptibility to infection

irritation of the mouth and intestines

nausea and vomiting

Surgery alone is associated with a 5% to 10% mortality rate. Side effects include bleeding, infection, and allergic reaction to anesthesia.

What happens after treatment for the disease?

It may take several months to recover from treatment. The person who may be cured can live a relatively normal lifestyle. He or she may not be able to eat certain foods. He or she also may not be able to absorb iron and vitamins or certain foods. Most people, if they survive, do not have long-term effects from chemotherapy or radiation.

How is the disease monitored?

Esophageal cancer is monitored with physical exams, lab tests, endoscopies, chest X-rays, and CAT scans or MRIs. Any new or worsening symptoms should be reported to the healthcare provider.