The esophagus is a tube connecting the throat to the stomach. It carries food and liquid through a series of muscular motions. The act of swallowing contracts the esophagus, pushing the food downward.The mucosa and submucosa make up the inner lining of the esophagus, which is where esophageal cancers typically develop. Cancer in the glandular tissue, adenocarcinoma, located primarily in the middle and lower esophagus, is more common than cancer in the upper esophagus, or squamous cell carcinoma. Treatments, however, are similar.
- Risk increases with age
- A large majority of patients are male
- Heavy use of cigarettes, smokeless tobacco and alcohol
- The swallowing of caustic substances, which can irritate the esophageal lining, increases the chance of cancerous growth
- Exposure to certain chemicals like nitrosamines, asbestos fibers, and petroleum products are thought to contribute to squamous cell carcinoma
- Barrett's Esophagus, the condition in which stomach acid continually recedes into the esophagus may cause adenocarcinoma.
- A history of head or neck cancer
Those who suffer from esophageal cancer may experience a combination of the following symptoms:
- Difficulty swallowing, painful swallowing
- Severe weight loss
- Chest, throat or back pain
- Coughing up blood
- Vomiting, regurgitating
Detection and Diagnosis
If a patient has a number of symptoms or risk factors there are two ways a physician can make a diagnosis: through a barium swallow (esophagram), or an esophagoscopy (endoscopy).During a barium swallow, the patient drinks a liquid containing barium. The barium coats the esophageal lining, making any abnormal growth visible in x-rays.
When having an esophagoscopy, a long, thin lighted tube called an endoscope is inserted in the patient's esophagus to allow the physician to look closely at the lining. The endoscope can also collect tissue for a biopsy, which can detect cancerous growth.
Computerized Tomography (CT) scan is a type of x-ray that can take very detailed pictures. The CT scan is used to detect tumors and report on their size, shape and position. When having a CT scan the patient, lying down, is slowly slid through a ring, which takes pictures in sequence. A contrast dye is injected through an IV so internal structures can be seen more clearly on the resulting pictures. Together, the pictures create a thorough internal image of the body.
Positron Emission Tomography (PET) scans often are used to determine if cancer has spread. Cancer cells absorb great amounts of the radioactive material from radioactive glucose injected into the patient's body. A PET scan can then detect and create highly detailed pictures of the tumor.
If the tumor is small enough, surgery can remove the tumorous growth. If the cancer is too widespread to remove entirely, palliative surgery, such as radiation therapy, chemotherapy, laser therapy and photodynamic therapy can relieve the patient of some symptoms. Talk to your doctor about the best possible treatment options for your specific case. Endoscopic ultrasound can measure the thickness of the cancer and help plan for the best approach.
Surgery to remove all or a portion of the esophagus is called an esophagectomy. During this procedure lymph nodes near the esophagus will also be removed. The stage of the tumor and where it is located determine how much of the esophagus and which lymph nodes are removed. The upper part of the esophagus is then re-connected to the stomach which is pulled up into the chest area to replace the missing portion of esophagus. If a cancer is located in the part of the esophagus near the stomach or at the juncture where the esophagus and stomach meet, the surgeon will remove part of the stomach and part of the esophagus containing the cancer. Depending on the type of cancer, a patient has, surgical options include:
- Open esophagectomy: There are different surgical approaches in performing an esophagectomy. The esophagus can be removed via an incision in the chest (transthoracic esophagectomy) or the main incision may be placed in the abdomen (tranhiatal esophagectomy).
- Minimally invasive esophagectomy: In a minimally invasive esophagectomy, portions of the esophagus may be removed through several small incisions instead of 1 or 2 large incisions. During this procedure the surgeon makes small pencil-sized holes in the body while video equipment is used to provide a magnified view of the surgical site. Endoscopic instruments are inserted through the small incisions and used to perform the surgery. A successful minimally invasive esophagectomy allows the patient to leave the hospital sooner and recover faster. This approach is used most often for early and small cancers.
- Robotic Esophagectomy: During this procedure the surgeon makes small pencil-sized holes in the body while robotic arms and a video camera is inserted to provide a 3-D magnified view of the surgical site. A rotobic esophagectomy allows the patient to leave the hospital sooner and recover faster. This approach is used most often for early and small cancers. Learn more >
Radiation therapy kills cancer cells with intense x-rays aimed only at the cancerous growth. With advances in technology, particular medical equipment can emit radiation from outside the patient's body, or radioactive materials can be placed internally to the targeted area. Side effects from radiation therapy of the esophagus include loss of appetite, fatigue, swelling of mouth, gums, and dental cavities, dry mouth and changes in the region of the skin that received radiation. Radiation therapy is often used in combination with lower doses of chemotherapy to make it more effective.
Chemotherapy involves the injection of anticancer drugs into a vein, allowing the drug to circulate throughout the body. These drugs kill cells that are growing rapidly, thus noncancerous cells can be killed as well. Side effects vary by type of drug but in general, hair loss, nausea, vomiting, diarrhea, loss of appetite, sores on the mouth and the lips and a lower resistance to infection are expected.
Laser therapy can reduce symptoms by relieving the esophagus of blockages. Post-therapy discomfort is brief.
Photodynamic therapy (PDT) is a type of laser therapy whereby cancer cells absorb certain drugs. When exposed to a special light, the drugs become activated and they kill cancer cells. The patient may experience an increased eye and skin sensitivity to light, difficulty breathing, abdominal pain, coughing and trouble swallowing temporarily after PDT.