Esophageal cancer is cancer of the esophagus - a growth that begins in the cells that line the hollow tube that connects your throat to your stomach. The esophagus' primary function is to help move swallowed food into the stomach to be digested.
Esophageal cancer can occur anywhere in the esophagus. According to the American Cancer Society, esophageal cancer is more common in men than women, with the risk being about one in 127 men and one in 434 women in the U.S.
Treating esophageal cancer involves surgery to remove the tumor, as well as chemotherapy, radiation, immunotherapy, or a combination of treatment methods.
Esophageal cancer occurs when the cells in the esophagus lining experience changes in their DNA, which causes the cells to create more cells at a higher rate. Healthy cells grow and multiply at a set rate, but cancer cells receive different instructions, which results in this rapid growth. These cancer cells continue living when healthy cells would die, resulting in a mass called a tumor.
Tumors can grow, causing an invasion into healthy body tissue. As the cancer continues to grow, it can spread to other parts of the body, resulting in metastatic cancer.
TYPES OF ESOPHAGEAL CANCER
Esophageal cancer is classified based on the type of cells involved. Identifying the type of esophageal cancer you have helps your medical team determine your best course of treatment. Types of esophageal cancer include:
Adenocarcinoma
Adenocarcinoma starts in the mucus-producing glands in the esophagus. It is most often found in the lower part of the esophagus. Adenocarcinoma is the most common type of esophageal cancer in the U.S. and mainly affects white males. It is commonly associated with chronic acid reflux (GERD).
Squamous cell carcinoma
Squamous cell carcinoma begins in the flat, thin cells lining the esophagus’ surface. Squamous cell carcinoma occurs most often in the upper and middle parts of the esophagus and is the most common esophageal cancer worldwide. It is associated with tobacco use and heavy alcohol consumption.
Other types
There are some more rare types of esophageal cancer, which include small cell carcinoma, sarcoma, lymphoma, melanoma, and choriocarcinoma.
RISK FACTORS
Esophageal cancer risk factors include conditions and habits that irritate the esophagus. These risk factors may include:
A steady habit of drinking very hot liquids
Bile reflux
Difficulty swallowing due to a muscle in the esophagus failing to relax (Achalasia)
Esophageal cancer can cause complications as it advances, which may include:
A blockage in the esophagus: A tumor may make it difficult for food and liquid to travel through the esophagus.
Bleeding in the esophagus: Bleeding due to esophageal cancer is often gradual, but it can be sudden and severe at times.
Pain: Advanced esophageal cancer can cause pain.
WHEN TO SEE A DOCTOR
If you’ve experienced any signs or symptoms of esophageal cancer, such as difficulty swallowing, worsening heartburn or indigestion, or pain in the chest or throat, or if you have a family history of esophageal cancer, talk to a gastroenterologist near you. Early detection can help, and our board certified team at Charleston GI is here for you. So, schedule an appointment, no referral required!
DIAGNOSTIC TEST
There are a variety of methods used to diagnose esophageal cancer. Your gastroenterologist may use any of the following:
Upper endoscopy
An upper endoscopy uses a long, flexible tube with a camera at the end to look at your upper digestive system. Your gastroenterologist will pass the endoscope down the throat and into the esophagus to look for any signs of cancer.
Barium swallow study
A barium swallow study uses X-ray images to look at the digestive system. The test can show any changes in the esophagus, including a growth that could be cancerous. Before beginning the test, your gastroenterologist will have you drink a white liquid called barium, which will help them view any changes in your esophagus. If anything is found on the barium swallow study, your gastroenterologist may recommend having an endoscopy to take a closer look.
Biopsy
A biopsy procedure removes a tissue sample to be sent for testing in a lab. To get the sample, your gastroenterologist will pass special cutting tools through an endoscope to remove a very small amount of esophageal tissue. The tissue sample is then sent to a lab for evaluation.
TREATMENT
For esophageal cancer, the first step in treatment is typically surgery to remove the cancer. If the cancer is more advanced or has become metastatic, treatment may begin with chemotherapy and radiation.
When creating your treatment plan, your team will take factors such as your overall health, the type of esophageal cancer you have, the stage of your cancer, and your personal preferences into account to make it best fit your needs. Treatment options can include:
Surgery
Endoscopic resection:
Minimally invasive procedure to remove small tumors from inside the esophagus using an endoscope.
Typically used to treat early-stage cancer.
Esophagectomy:
Removes the affected part of the esophagus and surrounding tissue, including lymph nodes.
The stomach is often used to help reconnect the digestive system.
Esophagogastrectomy:
Removes the affected part of the esophagus, surrounding tissues, and the upper portion of the stomach.
Risks of surgery:
Infection, bleeding, or leakage at the reattachment site.
Chemotherapy
Uses powerful drugs to kill or stop the growth of cancer cells, either orally or intravenously
Can be utilized before or after surgery
Can help relieve symptoms of advanced cancer
Side effects:
Fatigue
Nausea and vomiting
Diarrhea
Loss of appetite
Radiation Therapy
Uses high-energy beams to kill cancer cells
Most often done with external beam radiation therapy (from outside the body)
Often used before surgery and can be combined with chemotherapy
Side effects:
Painful swallowing, skin reactions, and possible damage to nearby organs
Combined Chemotherapy and Radiation
Using both treatments together may increase the effectiveness
Often used to treat cancer before surgery
Side effects:
Higher likelihood of symptoms and increased severity with combined treatment
Targeted Drug Therapy
Targets specific chemicals or proteins in cancer cells to destroy them
May be combined with chemotherapy for advanced or recurring cancer
Only effective for cancer cells with specific DNA changes
Immunotherapy
Helps the immune system find and destroy cancer cells
Sometimes administered before or after surgery for advanced or recurring cancer
Other Treatments
Endoscopic submucosal dissection (ESD):
Treats precancerous, very early-stage cancer by removing the tumor
Targets tumors located under the GI tract’s lining
Endoscopic mucosal resection (EMR):
Removes tumors in the esophagus lining
Uses an endoscope with small surgical instruments attached
Endoscopic laser therapy:
Eases difficulties with swallowing caused by esophageal tumor blockages
Photodynamic therapy (PDT):
Utilizes light-activated drugs to kill cancer cells
PREVENTION
Although there’s no guaranteed way to prevent esophageal cancer, take these steps to help reduce your risk:
Screening
Screening involves various exams to check for signs of cancer in the esophagus
Ask about screening if you have Barrett's Esophagus, a precancerous condition caused by GERD or chronic acid reflux
Moderate Alcohol Consumption
If you drink alcohol, limit your intake to:
One drink per day for women
Two drinks per day for men
Eat More Fruits and Vegetables
A healthy diet with plenty of fruits and vegetables is beneficial
Fruits and vegetables help support your body with vitamins and nutrients
Exercise Regularly
Aim for 30 minutes of exercise most days of the week
If you're new to exercising, start slow with something as simple as a daily walk, and ask your healthcare provider for advice
Maintain a Healthy Weight
If you're already at a healthy weight, continue exercising and eating healthy to maintain it
Consult with your doctor for safe ways to lose weight, including diet changes and increased exercise
Stop Smoking
Talk to your doctor about strategies to help you quit smoking
Use aids like nicotine replacement therapy, medications, or support groups
If you don’t smoke, don’t start
These steps can help lower your risk, but discussing your situation with your board-certified gastroenterologist at Charleston GI is always the best preventive measure.
About 22,070 new esophageal cancer cases were diagnosed (approximately 17,430 in men and 4,640 in women)
About 16,250 deaths from esophageal cancer (approximately 12,940 in men and 3,310 in women)
What type of life can I expect to have with esophageal cancer?
Your overall quality of life with esophageal cancer will depend on what your overall health looks like and your diagnosis. Early-stage esophageal cancer is often successfully treated, with a 48% 5-year relative survival rate after receiving treatment for localized esophageal cancer (American Cancer Society).
In the case that your cancer has spread or your doctor isn’t able to destroy all of the cancer cells, they’ll provide treatment to help you ease symptoms and maintain quality of life. Your doctor may recommend palliative care to help you live comfortably and minimize pain.
Is there a cure for esophageal cancer?
Depending on your diagnosis, your doctor may be able to perform surgery and remove a tumor in its early stages, when the cancer is more likely to be eliminated.
In addition to surgery, they may also use additional treatments like chemotherapy, radiation, immunotherapy, or a combination to destroy the cancer. However, only approximately 25% of those with esophageal cancer receive an early-stage diagnosis before it spreads.
Is esophageal cancer usually fatal?
Everyone’s esophageal cancer prognosis is different, depending on where the tumor is located, the type of cancer, and what stage it was found.
According to the National Cancer Institute, the overall 5-year survival rate is about 20%, but it can range from 5% to 47% in the United States. Early diagnosis of esophageal cancer has a higher 5-year survival rate.
Who is more at risk for esophageal cancer?
In the U.S., esophageal cancer affects approximately four in 100,000 people.
Males aged 60 and older are more often affected, people who are black or Asian are more likely to have squamous cell esophageal cancer, and people who are white are more likely to be diagnosed with adenocarcinoma esophageal cancer.
How fast does esophageal cancer spread?
Esophageal cancer is typically a fast-growing cancer. The flexibility of your esophagus allows the organ to expand around a growing tumor, which is why most people don’t experience symptoms until the cancer has spread.
Does esophageal cancer run in families?
Yes, esophageal cancer can be genetic.
Recent research by the National Cancer Institute shows that approximately 9% of esophageal adenocarcinoma cases are linked to a family history of Barrett's esophagus, a condition known to cause esophageal adenocarcinoma. Researchers found these genetic cases may result from mutations in the gene VSIG10L.
What is esophageal cancer?
Esophageal cancer is cancer that starts in the tissues of your esophagus. It is the 10th most common cancer in the world. The main types of esophageal cancer include esophageal adenocarcinoma and squamous cell carcinoma, with each kind categorized based on where it's located.
Esophageal cancer in its early stages is typically treated with surgery to remove tumors and minimize symptoms. Chemotherapy, radiation therapy, immunotherapy, or a combination may be used to treat more advanced esophageal cancer.
How does esophageal cancer form?
Esophageal adenocarcinoma is commonly linked to Barrett's Esophagus - a condition caused by chronic acid reflux or GERD (gastroesophageal reflux disease).
Barrett's Esophagus can increase the risk of esophageal adenocarcinoma in those with the condition than those who do not have it. Esophageal squamous cell carcinoma is more commonly linked to smoking and alcohol use.
What’s the main cause of esophageal cancer?
While doctors don’t know the exact cause of esophageal cancer, they’ve identified certain risk factors that can increase your chance of developing it, including:
Tobacco use: This includes smoking and smokeless tobacco.
Alcohol use: Chronic and/or heavy use of alcohol can increase your risk.
Obesity: Being overweight or obese may result in inflammation in your esophagus that could increase your risk of cancer.
Barrett's Esophagus and untreated chronic acid reflux: Barrett's Esophagus is a condition caused by chronic, untreated acid reflux, where the cells at the lower end of your esophagus experience a change. Long-term heartburn, with or without a Barrett’s diagnosis, can increase your risk of developing esophageal adenocarcinoma.
Human papillomavirus (HPV): HPV is a common virus that causes tissue changes in your vocal cords, mouth, hands, feet, and genitals. It has been linked to squamous cell carcinoma in some areas of the body.
History of cancer: Those who've had cancer of the neck or head have an increased risk of developing esophageal cancer.
Other risks: Esophageal cancer is linked to some rare and/or inherited conditions, including achalasia, an uncommon disease that makes it hard for you to swallow, and tylosis, a rare, inherited disorder that causes excess skin to grow on the palms of your hands and the soles of your feet.
Occupational exposure to certain chemicals: Individuals exposed to dry cleaning solvents over a long period have an increased risk of developing esophageal cancer.
Is chemo worth it for stage 4 esophageal cancer?
For stage 4 esophageal cancer, chemotherapy can be a valuable part of treatment, though it doesn't guarantee a cure. It helps control cancer growth, ease symptoms, and improve overall quality of life. Chemotherapy may be used alone or combined with other therapies like radiation and/or targeted drugs.
Will I lose my hair with chemo for esophageal cancer?
Chemotherapy utilizes powerful drugs to destroy fast-growing cancer cells. The medicines can also affect other fast-growing cells in your body, including those in your hair roots. When treating your cancer with chemotherapy, you may experience hair loss all over your body, not just on your scalp.
What is the success rate with chemo for esophageal cancer?
Combining chemotherapy with radiation can help treat esophageal cancer, with one study showing a 20% to 27% 5-year survival rate when combining treatments. In some cases, radiation can cause long-term breathing issues, so it’s important to note the risk.
SCHEDULE YOUR GI APPOINTMENT TODAY, NO REFERRAL NEEDED
To learn more about esophageal cancer and your risks, schedule a screening with Charleston GI today! We’re committed to a higher standard of caring, providing a wide range of medical treatments to help you feel your best every day.
