Each year, nearly 18,000 people in the United States discover they have esophageal cancer, and more than 15,000 people die of the disease. In about half of new cases, the disease is already in its advanced stages, in large part because esophageal cancer causes few symptoms early on.
Two types account for more than 90 percent of all esophageal cancers:
- Squamous cell carcinoma grows in the squamous cells that line the long tubular muscle connecting the throat to the stomach.
- Adenocarcinoma develops in the mucus-producing glands in the lower part of the esophagus and spreads to the esophageal lining as precancerous lesions that are the hallmark of Barrett’s esophagus.
The cause of esophageal cancer isn’t known, but lifestyle and chronic acid reflux are thought to cause long-term irritation to the lining of the esophagus. Damaged squamous cells can multiply and form a tumor or adenocarcinoma cells may invade the esophagus.
Other risk factors include:
- Alcohol use in excess
- Chewing or smoking
- Drinking very hot liquids
- Eating too few fruits and vegetables
- Having precancerous cell changes in the esophagus (Barrett's esophagus)
- Having radiation treatment to the chest or upper abdomen
The biggest risk factor of all is being male. Almost 80% of esophageal cancers are found in men between the ages of 45 and 75.
Esophageal cancer in its earliest, most treatable stages typically causes no signs or symptoms. That is why many physicians suggest preventive screening of the esophagus to detect the cellular changes in the lining.
Once the cancer has begun to grow and infiltrate the esophageal lining, symptoms may include:
- Indigestion or heartburn
- Chest pain, pressure or burning
- Coughing or hoarseness
- Trouble swallowing (dysphagia)
- Frequent choking while eating
- Coughing up blood
- Unexplained weight loss
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Testing may include:
- Upper endoscopy
An endoscope, a thin tube equipped with a light and tiny camera, is passed down the throat and into the esophagus to examine the lining for areas of irritation, tumors or cancerous lesions.
- X-rays with a contrast medium
After the patient has swallowed a solution of barium to coat the esophagus, X-rays are able to show the contours of the esophagus.
Sample tissue is taken of suspicious areas, generally with an endoscope. The samples are tested for cancer cells.
If cancer cells are found, the physician needs to determine the extent, or stage, of the cancer.
- Stage I—Only the top layer of esophageal lining is involved
- Stage II—Cancer cells have penetrated into the lining and may have spread to adjacent lymph nodes
- Stage III—The cancer has spread to the deepest layers of the esophageal wall and to adjacent tissues or lymph nodes
- Stage IV—The cancer has spread to other parts of your body
Treatment depends on the type and stage of the cancer, as well as the age and health of the patient.
Options may include surgery to remove some or all of the esophagus, often in combination with radiation therapy and/or chemotherapy. Some patients also may be candidates for a drug therapy that targets a protein called HER2 found in certain types of esophageal cancer cells.
When surgery is required, our UCI Health esophageal disease specialists use the most advanced and least invasive techniques to achieve optimal results with low complication rates and short hospital stays. These include laparoscopic and endoscopic approaches. Our physicians are leaders in these techniques and they often train other physicians in the latest methods and technologies.
Learn more about our esophageal disease specialists ›
Surgical measures include:
- Endoscopic mucosal resection (EMR)
Early stage cancers that are small and limited to the top layer of the esophageal lining can be removed using an endoscope. Patients then take drugs called proton pump inhibitors to reduce stomach acid production.
If the cancer has penetrated deeper layers and may have spread, the surgeon may recommend an removal of the diseased part of the esophagus and nearby lymph nodes. The remaining part of the esophagus is reconnected to the stomach.
Depending on the spread of the cancer, the surgeon may recommend removal of part of the esophagus and the uppermost part of the stomach, along with lymph nodes. The remainder of the esophagus is reattached to the remainder of the stomach, sometimes using a portion of the colon to rejoin the organs.
Other endoscopic treatments:
- Radiofrequency ablation (RFA)
An endoscope equipped with electrodes delivers an electric current to the cancerous cells, killing them with heat. Regular screening for a recurrence is needed along with a drug regimen to block stomach acid production.
- Laser ablation
An endoscope equipped with a laser can help open the an esophagus blocked by an advanced tumor. The laser can destroy the tumor, but it often grows back, requiring additional treatments.
- Photodynamic therapy (PDT)
A light-activated drug is injected into a vein. After a few days, when the drug gathers in the cancerous tissue, an endoscope equipped with a special type of laser is passed down the throat into the esophagus. The laser light activates a chemical in the drug that destroys cancer cells. This procedure does little harm to healthy tissue but it cannot penetrate to deeper tumors.