Overview

Esophageal cancer occurs when cancer cells form in the tissues of the esophagus. People don’t usually undergo routine screenings for esophageal cancer as they do for other cancers, such as colon cancer.

Our approach

North Shore-LIJ Health System takes an advanced approach to treating esophageal cancer at the Gastrointestinal Oncology Center, part of North Shore-LIJ Cancer Institute. Utilizing the latest technology and research-backed therapies, the multidisciplinary team of specialists draws upon decades of experience in diagnosing and treating complex gastrointestinal cancers.

Multidisciplinary Esophageal Cancer Treatment

Within the first several days of a visit, the multidisciplinary team will conduct comprehensive testing, the results of which are used to develop a personalized esophageal cancer treatment program. 

Each esophageal cancer diagnosis is unique, so the team meets regularly to discuss patient treatment during weekly multidisciplinary conferences where esophageal cancer physicians share ideas and best practices for delivering the most advanced collaborative patient care. The specialists review each treatment phase to constantly improve care and ensure treatment milestones are reached.

From diagnosis through treatment, patients are in the capable hands of experts every step of the way. 

One of the most progressive cancer centers for esophageal cancer, treatments and services include:

  • Leading-edge diagnostic and therapeutic endoscopy, including endoscopic ultrasound
  • Highly precise radiation therapy techniques such as intensity-modulated radiation therapy (IMRT) and brachytherapy
  • Novel cutting-edge approaches to chemotherapy 
  • Supportive therapies to boost the immune system, reduce pain and improve quality of life

Symptoms

Esophageal cancer is normally discovered in patients experiencing specific symptoms such as:

  • Trouble swallowing that is mild at first but worsens over time
  • Pain, discomfort, pressure or burning in the middle part of the chest
  • Weight loss
  • Hoarseness
  • Chronic cough

Be aware that these symptoms could be due to conditions other than esophageal cancer, so it’s best to see a doctor right away.

Diagnosis

The first step in making a diagnosis of esophageal cancer is usually a physical, during which a doctor will review personal and family medical history. If esophageal cancer is suspected, the patient will undergo additional tests.  

Specialists use a variety of tests, typically outpatient procedures, to deliver an accurate esophageal cancer diagnosis:

  • Chest X-ray — X-rays of the heart, lungs and surrounding tissue are taken.
  • Barium swallow — Barium fluid is swallowed to coat the esophagus, stomach and duodenum (the first section of the small intestine) so they are visible on X-rays. 
  • Upper endoscopy (EGD) — A thin, flexible, lighted tube (endoscope) enables the physician to examine the inside of the esophagus, stomach, and duodenum as well as to take tissue samples for biopsy.
  • Endoscopic ultrasound (EUS) — An endoscope shows images of the esophagus and stomach. A probe at the end of the tube sends out sound waves to assess how deeply the tumor has spread. 
  • Laparoscopy — A minimally invasive procedure for esophageal cancer diagnosis, the surgery consists of making small incisions in the abdomen and inserting a thin, lighted tube called a laparoscope. Lymph nodes or other tissue samples may then be removed for biopsy.
  • CT or CAT scan (computerized axial tomography) — More detailed than an X-ray, this procedure uses a combination of X-rays and computer technology to produce detailed images. 
  • MRI scan (magnetic resonance imaging) — A powerful magnet, radio waves and computer imaging combine to create highly detailed pictures of areas inside the body.
  • PET scan (positron emission tomography) — Small amounts of radioactive sugar are injected to highlight cancers and areas of infection and inflammation.
  • Bone scan — The scanner makes images of the bones to show if the esophageal cancer has spread (metastasized).
  • Biopsy — A tissue sample is taken from the esophagus and examined by a pathologist under a microscope to determine the type of cancer. 

Staging

Once an esophageal cancer diagnosis has been confirmed, a doctor will conduct one or more of the diagnostic imaging tests listed above to determine the location of the cancer and how far it has spread. This process is called staging. Esophageal cancer has the following stages:

  • Stage 0: Abnormal cells called high-grade dysplasia are found. 
  • Stage I: Cancer is in the deeper areas of the esophagus, but hasn’t affected lymph nodes or other organs.
  • Stage II: Cancer has grown into the main muscle area of the esophagus and may have infected one or two nearby lymph nodes.
  • Stage III: Cancer has spread through the wall of the esophagus to the outer layer, and likely into nearby organs or tissues. Cancer also has likely spread to nearby lymph nodes.
  • Stage IV: Cancer has spread to distant lymph nodes or to other distant organs.

Staging is necessary in order to design the most effective treatment plan.