Esophageal Cancer

Esophageal cancer occurs when cancer cells develop in the esophagus, a tube-like structure that runs from your throat to your stomach. Food goes from the mouth to the stomach through the esophagus. The cancer starts at the inner layer of the esophagus and can spread throughout the other layers of the esophagus and to other parts of the body (metastasis).
What Are the Symptoms of Esophageal Cancer?

Symptoms of esophageal cancer include:

* Difficulty and pain when swallowing
* Weight loss
* Pain in the chest, behind the breastbone
* Coughing
* Hoarseness
* Indigestion and heartburn

What Causes Esophageal Cancer?

There are a number of factors which increase a person’s risk of developing esophageal cancer. They include:

* Smoking or other use of tobacco.
* Heavy alcohol use.
* Barrett’s esophagus, a condition that affects the lower part of the esophagus and can lead to esophageal cancer. Barrett’s esophagus may be caused by gastric reflux, in which contents and acid from the stomach back up into the esophagus and irritate it. This irritation can cause changes in the cells of the esophagus that can lead to cancer.

In addition, certain groups — men, the elderly, and African-Americans — are at greater risk for esophageal cancer.
How Is Esophageal Cancer Diagnosed?

To diagnose esophageal cancer, your doctor will review your symptoms, medical history, and examine you. In addition, he or she may order certain blood tests and X-ray exams.

Tests for esophageal cancer may include:

* Chest X-ray.
* Barium X-ray where you drink a liquid which coats your esophagus. This makes the esophagus stand out on the X-ray so that your doctor can identify certain problems.
* Endoscopy: the doctor passes an endoscope, a thin, lighted tube, down your throat into your esophagus in order to examine it.
* Biopsy: during an endoscopy, the doctor can take cells or tissue from your esophagus. The cells are examined under a microscope for signs of cancer.

Other tests, including computed tomography (CT) scans, may be performed to determine if the cancer has spread, or metastasized, outside of the esophagus. This process is called “staging.” The doctor needs this information in order to plan your treatment.
What Are the Types of Esophageal Cancer?

Esophageal cancer is divided into two major types:

* Squamous cell carcinoma. This type of cancer begins in the squamous cells that line the esophagus. This cancer usually affects the upper and middle part of the esophagus.
* Adenocarcinoma. This type of cancer develops in glandular tissue (like the tissue found in Barrett’s esophagus), and is usually found in the lower part of the esophagus. Glands and glandular tissue are groups of cells that secrete substances needed by the body.

What Are the Stages of Esophageal Cancer?

The stages of esophageal cancer are given a number (I through IV); the higher the number, the more advanced the cancer. The stages are:

* Stage 0. The cancer is in the cells that line the esophagus.
* Stage I. The cancer has moved to the next layer of cells in the esophagus.
* Stage II. The cancer is in the outer wall of the esophagus. In addition, the cancer may have spread to the lymph nodes (small glands that are part of the immune system).
* Stage III. The cancer has spread beyond the esophagus.
* Stage IV. This is the most advanced stage. The cancer has spread to other organs in the body as well as to lymph nodes far from the esophagus.

There are several tests to determine the stage of esophageal cancer, including:

* Chest X-ray.
* Bronchoscopy . The trachea (windpipe) and lungs are examined with a bronchoscope, a thin, lighted tube that is inserted through the nose or mouth.
* Laryngoscopy . The doctor uses the lighted tube to examine the larynx (voice box).
* CT scan. A procedure that creates sharp pictures of the inside of the body.
* Endoscopic ultrasound, or endosonography. A lighted tube bounces sound waves off organs in the body to create pictures called sonograms.
* Thoracoscopy. An endoscope is placed into the chest through an incision to examine the inside of the body for cancer.
* Laporoscopy. The lighted tube is inserted through an incision in the abdomen to examine the organs and take tissue samples.
How Is Esophageal Cancer Treated?

As with many cancers, esophageal cancer treatment has a greater chance of success if the cancer is caught early. Unfortunately, by the time esophageal cancer is usually diagnosed, it is often already in an advanced state (has spread throughout the esophagus and beyond).

Treatment of esophageal cancer depends on many factors, including the stage of the cancer and the overall health of the patient.

There are five standard methods for treating esophageal cancer:

* Surgery. Part of the esophagus may be removed.
* Radiation therapy. Kills cancer cells with X-rays or other radiation.
* Chemotherapy. Powerful drugs that kill cancer cells.
* Laser surgery. The cancer cells are killed with a beam of light.
* Electrocoagulation. The cancer cells are killed with an electric current.

Other types of treatment are being tested in clinical trials.

In addition, your doctor may recommend that you take part in a clinical trial, in which new drugs or treatments are tested in patients. The success of these tests helps determine if the drugs or treatments will be approved by the Food and Drug Administration.
How Are the Stages of Esophageal Cancer Treated?

Treatment options for esophageal cancer by stage involve the following:

* Stage 0. Surgery
* Stage I, II, and III. Surgery, clinical trials of chemotherapy and radiation, or clinical trials of new therapies
* Stage IV. Chemotherapy, radiation, laser, or clinical trials. Treatment for this stage focuses on “palliative” therapy. Palliative therapy is meant to relieve the pain and difficulty swallowing caused by cancer, and is often given to patients who are in an advanced stage of cancer, or who are near the end of their lives.

According to the American Cancer Society, the percentages of people who live for at least five years after being diagnosed with esophageal cancer is 16% for Caucasian patients and 9% for African-American patients.