Esophageal cancer

Other Names: Esophagus cancer Esophageal cancer (ee-SAH-fuh-JEE-ul KAN-ser)Cancer that forms in tissues lining the esophagus (the muscular tube through which food passes from the throat to the stomach). Two types of esophageal cancer are squamous cell carcinoma (cancer that begins in flat cells lining the esophagus) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).

Esophageal cancer (lower part) as a result of Barrettʼs esophagus

Cause

The exact cause of esophageal cancer usually is not known, but both environmental and genetic factors are thought to play a role in its development. For example, variations or mutations in any of several genes may cause susceptibility to esophageal cancer. Environmental factors that may increase a person's chance to develop esophageal cancer include tobacco use, heavy alcohol use, older age, obesity, and damage to the esophagus from acid reflux (Barrett esophagus).

Risk factors

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer.

• Tobacco use.
• Heavy alcohol use.
• Barrett esophagus: A condition in which the cells lining the lower part of the esophagus have changed or been replaced with abnormal cells that could lead to cancer of the esophagus. Gastric reflux (heartburn) is the most common cause of Barrett esophagus.

Older age.

Symptoms

Symptoms that may develop as the cancer grows include heartburn, pain when swallowing, difficulty swallowing, a hoarse voice, a cough that does not go away, weight loss, and coughing up blood These and other signs and symptoms may be caused by esophageal cancer or by other conditions. Check with your doctor if you have any of the following:

• Painful or difficult swallowing.
• Weight loss.
• Pain behind the breastbone.
• Hoarseness and cough.
• Indigestion and heartburn.
• A lump under the skin.

Types

The two most common forms of esophageal cancer are named for the type of cells that become malignant (cancerous):

• Squamous cell carcinoma: Cancer that forms in the thin, flat cells lining the inside of the esophagus. This cancer is most often found in the upper and middle part of the esophagus, but can occur anywhere along the esophagus. This is also called epidermoid carcinoma.
• Adenocarcinoma: Cancer that begins in glandular cells. Glandular cells in the lining of the esophagus produce and release fluids such as mucus. Adenocarcinomas usually form in the lower part of the esophagus, near the stomach.

Diagnosis

The following tests and procedures may be used:

Esophageal cancer as shown by a filling defect during an upper GI series

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken. Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope is inserted through the mouth or nose and down the throat into the esophagus. An esophagoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer. When the esophagus and stomach are looked at, it is called an upper endoscopy. Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy is usually done during an esophagoscopy. Sometimes a biopsy shows changes in the esophagus that are not cancer but may lead to cancer.

Prognosis

The prognosis (chance of recovery) and treatment options depend on the following: The stage of the cancer (whether it affects part of the esophagus, involves the whole esophagus, or has spread to other places in the body). Whether the tumor can be completely removed by surgery. The patient’s general health. When esophageal cancer is found very early, there is a better chance of recovery. Esophageal cancer is often in an advanced stage when it is diagnosed. At later stages, esophageal cancer can be treated but rarely can be cured.

Stages of Esophageal Cancer

The following stages are used for squamous cell carcinoma of the esophagus: Stage 0 (High-grade Dysplasia) Stage I squamous cell carcinoma of the esophagus Stage II squamous cell carcinoma of the esophagus Stage III squamous cell carcinoma of the esophagus Stage IV squamous cell carcinoma of the esophagus The following stages are used for adenocarcinoma of the esophagus: Stage 0 (High-grade Dysplasia) Stage I adenocarcinoma of the esophagus Stage II adenocarcinoma of the esophagus Stage III adenocarcinoma of the esophagus Stage IV adenocarcinoma of the esophagus

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  T1, T2, and T3 stages of esophageal cancer

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  Stage T4 esophageal cancer

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  Esophageal cancer with spread to lymph nodes

Treatment

Before and after a total esophagectomy

Typical scar lines after the two main methods of surgery

Six types of standard treatment are used:

• Surgery
• Radiation therapy
• Chemotherapy
• Chemoradiation therapy
• Laser therapy
• Electrocoagulation

New types of treatment are being tested in clinical trials.

• Targeted therapy

The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition.

• Porfimer sodium (Brand name: Photofrin)For the ablation of high-grade dysplasia in Barrett's esophagus patients who do not undergo esophagectomy.

Additional images

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  Endoscopic image of Barrett esophagus – a frequent precursor of esophageal adenocarcinoma

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  Endoscopy and radial endoscopic ultrasound images of a submucosal tumor in the central portion of the esophagus

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  Contrast CT scan showing an esophageal tumor (axial view)

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  Contrast CT scan showing an esophageal tumor (coronal view)

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  Esophageal cancer

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  Micrograph showing histopathological appearance of an esophageal adenocarcinoma (dark blue – upper-left of image) and normal squamous epithelium (upper-right of image) at H&E staining

Esophageal cancer Resources
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NIH genetic and rare disease info

• NIH info on Esophageal cancer

Esophageal cancer is a rare disease.