What is Esophageal Cancer?

Esophageal cancer is a disease in which malignant cells form in the tissues lining the esophagus (the hollow, muscular tube that connects the throat and stomach). Part of the upper gastrointestinal (GI) tract, the esophagus carries food and liquids from the mouth to the stomach.

The wall of the esophagus is made up of several layers of tissue, including mucous membrane, muscle, and connective tissue. Cancer that forms in the esophagus beings in the innermost layer of tissue and spreads outward through the other layers as it grows.

Esophageal cancer is rare. The National Cancer Institute estimates that 16,470 Americans will be diagnosed with esophageal cancer in 2008.

 

Types of Esophageal Cancer?

The two most common forms of esophageal cancer, named for the type of cells that become cancerous, are as follows:

1-Squamous cell carcinoma usually begins in the squamous cells (the thin, flat cells that line the esophagus and look like fish scales under a microscope) in the top layer of the esophageal lining, most often in the upper or middle part of the esophagus.

2-Adenocarcinoma usually begins in glandular cells (the secretory cells that produce and release fluids like mucus) in the lining of the esophagus, most often in the lower part of the esophagus near the stomach.

While squamous cell cancers previously comprised the majority of esophageal tumors in the United States, the incidence of esophageal adenocarcinomas has risen considerably, making it the most common type of esophageal cancer.

Another, more rare form of esophageal cancer is small cell carcinoma, which is an aggressive tumor similar in appearance and behavior to its lung counterpart. In addition, cancers that start in the breast or lung can sometimes spread to the esophagus.

 

Esophageal Cancer Risk Factors

Anything that increases your risk of developing a disease is called a risk factor. One condition that can increase the risk of esophageal cancer is Barrett's esophagus. Barrett's esophagus is caused by long-term reflux of acid from the stomach into the esophagus (known as gastroesophageal reflux disease, or GERD). Over time, this chronic acid reflux causes changes in the cells lining the lower portion of the esophagus near the opening of the stomach.

In addition, according to the American Cancer Society, squamous cell carcinoma is more likely among African Americans, while esophageal adenocarcinoma is more likely among whites.

Some other potential esophageal cancer risk factors are as follows:

1-Being over age 60

2-Being male

3-Long-term tobacco use and/or heavy alcohol consumption

A diet low in fruits, vegetables, and certain vitamins and minerals

4-Being overweight

5-Frequent consumption of hot liquids

6-Previous radiation treatment near the esophagus

7-Occupational exposure to dry cleaning solvents or silica dust

8-Ingestion of lye or other caustic substances that damage the lining of the esophagus

In addition, sometimes esophageal cancer is associated with the following medical conditions:

1-Achalasia - a condition in which the esophagus fails to move food into the stomach properly

2-Tylosis - a rare, inherited disease that causes excess skin growth on the palms of the hands and soles of the feet

3-Esophageal webs - abnormal bands of tissue that protrude into the esophagus and make it difficult to swallow

4-A history of head and neck cancer

NOTE: Having a risk factor does not necessarily mean that you will get cancer. Not having risk factors doesn't mean that you will not get cancer. If you think you may be at risk for esophageal cancer, you should consult your doctor.

Esophageal Cancer Symptoms

Esophageal cancer symptoms vary from person to person. Unfortunately, esophageal cancer often does not present symptoms in the early stages of the disease.

The most common symptom of esophageal cancer is dysphagia, or difficulty swallowing.

This symptom usually doesn't appear until the disease is more advanced, when a tumor has grown large enough to narrow the esophagus to about half of its normal width. Pain when swallowing and a sensation of food getting stuck in the throat or chest may also occur.

Other potential esophageal cancer symptoms include the following:

1-Unintentional weight loss

2-Pain in the throat, behind the breastbone, or between the shoulder blades

3-Pressure or burning in the chest

4-Hoarseness, chronic cough, hiccups

5-Indigestion, heartburn, acid indigestion (caused by chronic acid reflux, or GERD)

6-Coughing up blood (in more severe cases)

NOTE: These and other symptoms may be caused by conditions other than esophageal cancer. If you are experiencing any of these symptoms, you should see your doctor.

 

 

Esophageal Cancer Staging

If tests show that esophageal cancer is present, your doctor will need to know the stage (extent) of the cancer to best plan treatment. Staging helps determine how much of the esophagus is affected and if cancer cells have spread outside the esophagus to nearby lymph nodes or other parts of the body (e.g., liver, lungs, brain, bones).

The stages of esophageal cancer can range from 0 through IV. In general, the higher the number the more advanced the cancer.

1-Stage 0 (carcinoma in situ) - Abnormal cells are found in the part of the mucosa forming the innermost lining of the esophagus

2-Stage I - Cancer is found in the top layer of cells lining the esophagus

3-Stage IIA - Cancer has spread into deeper layers of the esophagus lining

4-Stage IIB - Cancer has spread to any of the first three layers of the esophagus lining and to nearby lymph nodes

5-Stage III - Cancer has spread even more deeply to the outer wall of the esophagus and to nearby tissues or lymph nodes

6-Stage IVA - Cancer has spread to nearby or distant lymph nodes.

7-Stage IVB - Cancer has spread to distant lymph nodes and/or organs in other parts of the body.

 

Esophageal Cancer Diagnosis

In addition to a complete medical history, physical examination and blood tests (e.g., CBC), your doctor may use some of the following tests to diagnose and stage esophageal cancer:

1-Imaging tests (e.g., upper GI X-rays, chest X-ray, CT scan) create detailed images of areas inside the esophagus to confirm the location of a tumor and detect whether cancer has spread.

2-Barium swallow test (upper GI series) uses a liquid that, when swallowed, temporarily coats the esophagus so the lining shows up clearly on X-rays to reveal any irregularities.

3-Upper Endoscopy uses an endoscope (a thin, lighted tube with a tiny camera on the end) to examine the interior lining of the esophagus. If the tumor is blocking the opening of the esophagus, certain instruments may be used to enlarge the opening to help food and liquid pass.

4-Biopsy uses an endoscope to remove cells or small tissue samples for examination under a microscope.

5-Endoscopic ultrasound (EUS) uses an endoscope with a small ultrasound probe on its tip to evaluate how deeply the cancer is in the wall of the esophagus and how far the cancer has spread into nearby tissues or lymph nodes.

6-Bronchoscopy uses a bronchoscope (a thin, lighted tube) to look inside the trachea (windpipe) and bronchi (air passages leading to the lungs) to determine whether esophageal cancer has spread to these structures.

7-Thoracoscopy and laparoscopy uses a hollow, lighted tube to examine the lymph nodes inside the chest (thoracoscopy) or abdomen (laparoscopy) and/or to remove the nodes for further testing.