Esophageal cancer

Definition

Esophageal cancer is a cancerous (malignant) tumor of the esophagus, the muscular tube that moves food from the mouth to the stomach.

See also: Barrett's esophagus

Alternative Names

Cancer - esophagus

Causes, incidence, and risk factors

Esophageal cancer is relatively uncommon in the United States. It occurs most often in men over 50 years old. Two main types of esophageal cancer exist: squamous cell carcinoma and adenocarcinoma. These two types look different from each other under the microscope.

Squamous cell esophageal cancer is associated with smoking and alcohol consumption.

Barrett's esophagus, a complication of gastroesophageal reflux disease (GERD), significantly increases the risk for adenocarcinoma of the esophagus. Other risk factors for adenocarcinoma of the esophagus include:

• Alcohol use
• Male gender
• Obesity
• Poor nutrition
• Smoking

Symptoms

• Backwards movement of food through the esophagus and possibly mouth (regurgitation)
• Chest pain unrelated to eating
• Difficulty swallowing solids or liquids
• Heartburn
• Vomiting blood
• Weight loss

Signs and tests

Tests used to help diagnose esophageal cancer may include:

• Barium swallow
• Esophagogastroduodenoscopy (EGD) and biopsy
• Chest MRI or thoracic CT (usually used to help determine the stage of the disease)
• PET scan (sometimes useful for determining the stage of disease, and whether surgery is possible)
• Endoscopic ultrasound (also sometimes used to determine the stage of disease)

Stool testing may show small amounts of (occult) blood in the stool.

Treatment

When esophageal cancer is only in the esophagus and has not spread, surgery is the treatment of choice. The goal of surgery is to remove the cancer.

See:

• Esophagectomy
• Esophagectomy - minimally invasive

Sometimes chemotherapy, radiation, or a combination of the two may be used instead of surgery, or to make surgery easier to perform.

If the patient cannot tolerate surgery or the cancer has spread to other organs, chemotherapy or radiation may be used to help reduce symptoms. This is called palliative therapy. In such cases, the disease is usually not curable.

Other treatments that may be used to improve a patient's ability to swallow include endoscopic dilation of the esophagus (sometimes with placement of a stent to keep the esophagus dilated), or photodynamic therapy. In photodynamic therapy, a special drug is injected into the tumor, which is then exposed to light. The light activates the medicine that attacks the tumor.

Support Groups

Patients can often ease the stress of illness by joining a support group of people who share common experiences and problems. See cancer - support group.

Expectations (prognosis)

Esophageal cancer is a very difficult disease to cure. When the cancer has not spread outside the esophagus, surgery may improve chances of survival.

Radiation therapy is used instead of surgery in some cases where the cancer has not spread outside the esophagus.

For patients whose cancer has spread, cure is generally not possible and treatment is directed toward relieving symptoms.

Complications

• Difficulty swallowing
• Pneumonia
• Severe weight loss resulting from not eating enough
• Spread of the tumor to other areas of the body

Calling your health care provider

Call your health care provider if you have difficulty swallowing with no known cause and it does not get better, or if you have other symptoms of esophageal cancer.

Prevention

The following may help reduce your risk of squamous cell cancer of the esophagus:

• Avoid smoking
• Limit or eliminate alcoholic drinks

People with symptoms of severe gastroesophageal reflux should seek medical attention.

Screening with EGD and biopsy in people with Barrett's esophagus may lead to early detection and improved survival. People who are diagnosed with Barrett's esophagus should be checked regularly for esophageal cancer.

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References

Orlando RC. Diseases of the esophagus. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 140.

National Cancer Institute. Esophageal Cancer Treatment PDQ. Updated July 2, 2009.

Esophageal Cancer. NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network, Inc. 2009. Accessed October 17, 2009.