Esophageal Cancer

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Esophageal cancer is cancer that occurs in the esophagus — a long, hollow tube that runs from your throat to your stomach. Your esophagus carries food you swallow to your stomach to be digested. Esophageal cancer usually begins in the cells that line the inside of the esophagus.

SYMPTOMS

Signs and symptoms of esophageal cancer include:

  • Difficulty swallowing (dysphagia)
  • Weight loss without trying
  • Chest pain, pressure or burning
  • Fatigue
  • Frequent choking while eating
  • Indigestion or heartburn
  • Coughing or hoarseness

Early esophageal cancer typically causes no signs or symptoms.

CAUSES

It’s not clear what causes esophageal cancer. Esophageal cancer occurs when cells in your esophagus develop errors (mutations) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells form a tumor in the esophagus that can grow to invade nearby structures and spread to other parts of the body.

TYPES OF ESOPHAGEAL CANCER

Esophageal cancer is classified according to the type of cells that are involved. The type of esophageal cancer you have helps determine your treatment options. Types of esophageal cancer include:

  • Adenocarcinoma begins in the cells of mucus-secreting glands in the esophagus. Adenocarcinoma occurs most often in the lower portion of the esophagus.
  • Squamous cell carcinoma. The squamous cells are flat, thin cells that line the surface of the esophagus. Squamous cell carcinoma occurs most often in the middle of the esophagus. Squamous cell carcinoma is the most prevalent esophageal cancer worldwide.
  • Other rare types. Rare forms of esophageal cancer include choriocarcinoma, lymphoma, melanoma, sarcoma and small cell cancer.

RISK FACTORS

It’s thought that chronic irritation of your esophagus may contribute to the DNA changes that cause esophageal cancer. Factors that cause irritation in the cells of your esophagus and increase your risk of esophageal cancer include:

  • Drinking alcohol
  • Having bile reflux
  • Chewing tobacco
  • Having difficulty swallowing because of an esophageal sphincter that won’t relax (achalasia)
  • Drinking very hot liquids
  • Eating few fruits and vegetables
  • Having gastroesophageal reflux disease (GERD)
  • Being obese
  • Having precancerous changes in the cells of the esophagus (Barrett’s esophagus)
  • Undergoing radiation treatment to the chest or upper abdomen
  • Smoking

OTHER RISK FACTORS INCLUDE

  • Being male
  • Being between the ages of 45 and 70

COMPLICATIONS

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As esophageal cancer advances, it can cause complications, such as:

  • Obstruction of the esophagus. Cancer may make it difficult or impossible for food and liquid to pass through your esophagus.
  • Cancer pain. Advanced esophageal cancer can cause pain.
  • Bleeding in the esophagus. Esophageal cancer can cause bleeding. Though bleeding is usually gradual, it can be sudden and severe at times.
  • Severe weight loss. Esophageal cancer can make it difficult and painful to eat and drink, resulting in weight loss.
  • Esophageal cancer can erode your esophagus and create a hole into your windpipe (trachea). Known as a tracheoesophageal fistula, this hole can cause severe and sudden coughing whenever you swallow.

TESTS AND DIAGNOSIS

Tests and procedures used to diagnose esophageal cancer include:

  • Using a scope to examine your esophagus (endoscopy). During endoscopy, your doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your esophagus. Using the endoscope, your doctor examines your esophagus looking for cancer or areas of irritation.
  • X-rays of your esophagus. Sometimes called a barium swallow, an upper gastrointestinal series or an esophagram, this series of X-rays is used to examine your esophagus. During the test, you drink a thick liquid (barium) that temporarily coats the lining of your esophagus, so the lining shows up clearly on the X-rays.
  • Collecting a sample of tissue for testing (biopsy). A special scope passed down your throat into your esophagus (endoscope) or down your windpipe and into your lungs (bronchoscope) can be used to collect a sample of suspicious tissue (biopsy). What type of biopsy procedure you undergo depends on your situation. The tissue sample is sent to a laboratory to look for cancer cells.

ESOPHAGEAL CANCER STAGING

When you’re diagnosed with esophageal cancer, your doctor works to determine the extent (stage) of the cancer. Your cancer’s stage helps determine your treatment options. Tests used in staging esophageal cancer include computerized tomography (CT) and positron emission tomography (PET).

The stages of esophageal cancer are:

  • Stage I. This cancer occurs only in the top layer of cells lining your esophagus.
  • Stage II. The cancer has invaded deeper layers of your esophagus lining and may have spread to nearby lymph nodes.
  • Stage III. The cancer has spread to the deepest layers of the wall of your esophagus and to nearby tissues or lymph nodes.
  • Stage IV. The cancer has spread to other parts of your body.

TREATMENTS AND DRUGS

What treatments you receive for esophageal cancer are based on the type of cells involved in your cancer, your cancer’s stage, your overall health and your preferences for treatment.

SURGERY

Surgery to remove the cancer can be used alone or in combination with other treatments. Operations used to treat esophageal cancer include:

  • Surgery to remove very small tumors. If your cancer is very small, confined to the superficial layers of your esophagus and hasn’t spread, your surgeon may recommend removing the cancer and margin of healthy tissue that surrounds it. Surgery for very early-stage cancers can be done using an endoscope passed down your throat and into your esophagus.
  • Surgery to remove a portion of the esophagus (esophagectomy). Your surgeon removes the portion of your esophagus that contains the tumor and nearby lymph nodes. The remaining esophagus is reconnected to your stomach. Usually this is done by pulling the stomach up to meet the remaining esophagus. In some situations, a portion of the colon is used to replace the missing section of esophagus.
  • Surgery to remove part of your esophagus and the upper portion of your stomach (esophagogastrectomy). Your surgeon removes part of your esophagus, nearby lymph nodes and the upper part of your stomach. The remainder of your stomach is then pulled up and reattached to your esophagus. If necessary, part of your colon is used to help join the two.

Esophageal cancer surgery carries a risk of serious complications, such as infection, bleeding and leakage from the area where the remaining esophagus is reattached. Surgery to remove your esophagus can be performed as an open procedure using large incisions or with special surgical tools inserted through several small incisions in your skin (laparoscopically). How your surgery is performed depends on your situation and your surgeon’s experience and preferences.

CHEMOTHERAPY

Chemotherapy is drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically used before (neoadjuvant) or after (adjuvant) surgery in people with esophageal cancer. Chemotherapy can also be combined with radiation therapy. In people with advanced cancer that has spread beyond the esophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by the cancer.

The chemotherapy side effects you experience depend on which chemotherapy drugs you receive.

RADIATION THERAPY

Radiation therapy uses high-powered energy beams to kill cancer cells. Radiation can come from a machine outside your body that aims the beams at your cancer (external beam radiation). Or radiation can be placed inside your body near the cancer (brachytherapy).

Radiation therapy is most often combined with chemotherapy in people with esophageal cancer. It can be used before or after surgery. Radiation therapy is also used to relieve complications of advanced esophageal cancer, such as when a tumor grows large enough to stop food from passing to your stomach.

Side effects of radiation to the esophagus include sunburn-like skin reactions, painful or difficult swallowing, and accidental damage to nearby organs, such as the lungs and heart.

COMBINED CHEMOTHERAPY AND RADIATION

Combining chemotherapy and radiation therapy may enhance the effectiveness of each treatment. Combined chemotherapy and radiation may be the only treatment you receive, or combined therapy can be used before surgery. But combining chemotherapy and radiation treatments increases the likelihood and severity of side effects.

 

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