Esophageal Cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus.
The esophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach. The wall of the esophagus is made up of several layers of tissue, including mucous membrane, muscle, and connective tissue. Esophageal cancer starts at the inside lining of the esophagus and spreads outward through the other layers as it grows.
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The stomach and esophagus are part of the upper digestive system.
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 squamous cells, the thin, flat cells lining 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 (secretory) 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.
Symptoms of Esophageal Cancer
The most common signs of esophageal cancer are painful or difficult swallowing and weight loss.
These and other symptoms may be caused by esophageal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:
- Painful or difficult swallowing.
- Weight loss.
- Pain behind the breastbone.
- Hoarseness and cough.
- Indigestion and heartburn.
Tests that examine the esophagus are used to detect (find) and diagnose esophageal cancer.
- The following tests and procedures may be used:
- 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.
- Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.
- Barium swallow. The patient swallows barium liquid and it flows through the esophagus and into the stomach. X-rays are taken to look for abnormal areas.
- Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope, a thin, lighted tube, 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.
- 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.
Certain factors affect prognosis (chance of recovery) and treatment options.
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).
- The size of the tumor.
- 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.
Taking part in one of the clinical trials being done to improve treatment should be considered. Learn more about our clinical trials.
Treating Esophageal Cancer
There are different types of treatment for patients with esophageal cancer.
Different types of treatment are available for patients with esophageal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Patients have special nutritional needs during treatment for esophageal cancer.
Many people with esophageal cancer find it hard to eat because they have trouble swallowing. The esophagus may be narrowed by the tumor or as a side effect of treatment. Some patients may receive nutrients directly into a vein. Others may need a feeding tube (a flexible plastic tube that is passed through the nose or mouth into the stomach) until they are able to eat on their own.
Five types of standard treatment are used:
- Surgery: Surgery is the most common treatment for cancer of the esophagus. Part of the esophagus may be removed in an operation called an esophagectomy.
- Esophagectomy: A portion of the esophagus is removed and the stomach is pulled up and joined to the remaining esophagus.The doctor will connect the remaining healthy part of the esophagus to the stomach so the patient can still swallow. A plastic tube or part of the intestine may be used to make the connection. Lymph nodes near the esophagus may also be removed and viewed under a microscope to see if they contain cancer. If the esophagus is partly blocked by the tumor, an expandable metal stent (tube) may be placed inside the esophagus to help keep it open.
- Esophageal stent: A device (stent) is placed in the esophagus to keep it open to allow food and liquids to pass through into the stomach.
- Radiation therapy: A plastic tube may be inserted into the esophagus to keep it open during radiation therapy. This is called intraluminal intubation and dilation.
- Chemotherapy: Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
- Laser therapy: Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.
- Electrocoagulation: Electrocoagulation is the use of an electric current to kill cancer cells.
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Awards & Recognitions
The MedStar Georgetown University Hospital Lombardi Comprehensive Cancer Center is the only National Cancer Institute (NCI)-designated comprehensive cancer center in the Washington, D.C. region.
Learn more about GI care and support services at MedStar Georgetown:
- Esophageal Cancer Risk Factors and Screening
- Gastrointestinal Cancer Treatments
- Genetic Counseling Services