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Esophageal Cancer

Esophageal Cancer Symptoms and Causes

The Esophageal Cancer Program at the North Shore-LIJ Cancer Institute provides a dedicated multi-specialty team of thoracic surgeons, gastroenterologists, medical oncologists and radiation oncologists to provide therapy designed to maximize cure rates, minimize toxicity and speed recovery.

Team specialists communicate with each other and with each patient to choose the best possible evidence-based treatment plan. Treatment options are discussed in detail with each patient, and the advantages and disadvantages of primary surgical or radiation treatment modalities are explained clearly. Surgical expertise is provided by highly experienced, board-certified surgeons. Radiation oncologists utilize state-of-the-art equipment and techniques such as Intensity-Modulated Radiation Therapy (IMRT) and respiratory cycle-gating to deliver curative radiation to the tumor while sparing surrounding normal tissue.

Since nutrition is a key aspect of the overall treatment and recovery plan, nutritionists and gastroenterologists work with each patient to assure that specific nutritional needs and goals are met during therapy and recovery. The program provides each patient full access to a variety of crucial National Cancer Institute-supported clinical trials that are designed to further improve the ability to prevent, detect and treat esophageal cancer.

Esophageal Cancer: An Overview

What Is Esophageal Cancer?

Esophageal cancer is cancer that develops in the esophagus, the muscular tube that connects the throat to the stomach. The esophagus, located just behind the trachea, is about 10 to 13 inches in length and allows food to enter the stomach for digestion. The wall of the esophagus is made up of several layers, and cancers generally start from the inner layer and grow outward.

What Causes Esophageal Cancer?

No one knows exactly what causes esophageal cancer. At the top of the esophagus is a muscle, or sphincter, that releases to let food or liquid go through. The lower part of the esophagus is connected to the stomach. Another muscle is located at this connection that opens to allow food to enter the stomach. This muscle also works to keep food and juices in the stomach from backing into the esophagus. When these juices do back up, reflux, commonly known as heartburn, occurs.

Long-term reflux can change the cells in the lower end of the esophagus. This condition is known as Barrett's esophagus. If these cells are not treated, they are at much higher risk of developing into cancer cells.

What Are the Different Types of Esophageal Cancer?

There are two main types of esophageal cancer. The most common type of esophageal cancer, known as adenocarcinoma, develops in the glandular tissue in the lower part of the esophagus, near the opening of the stomach. It occurs in just over 50 percent of cases. Squamous cell carcinoma grows in the cells that form the top layer of the lining of the esophagus, known as squamous cells. This type of cancer can grow anywhere along the esophagus.

What Are the Symptoms of Esophageal Cancer?

Often, there are no symptoms in the early stages of esophageal cancer. Symptoms do not appear until the disease is more advanced. The following are the most common symptoms of esophageal cancer. However, each individual may experience symptoms differently. Symptoms may include:

  • Difficult or painful swallowing – A condition known as dysphagia is the most common symptom of esophageal cancer. This gives a sensation of having food lodged in the chest. Persons with dysphagia often switch to softer foods to help with swallowing.
  • Pain in the throat or back, behind the breastbone or between the shoulder blades
  • Severe weight loss – Many persons with esophageal cancer lose weight unintentionally because they are not getting enough food.
  • Hoarseness or chronic cough
  • Vomiting
  • Coughing up blood

The symptoms of esophageal cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis. There is no routine screening examination for esophageal cancer; however, persons with Barrett's esophagus should be examined often because they are at greater risk for developing the disease.

How Is Esophageal Cancer Diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for esophageal cancer may include the following:

  • Chest x-ray
  • Upper GI (gastrointestinal) series (also called barium swallow) – a diagnostic test that examines the organs of the upper part of the digestive system: esophagus, stomach, and duodenum (the first section of the small intestine). Barium (a metallic, chemical chalky liquid used to coat the inside of organs so that they will show up on an x-ray) is swallowed. X-rays are then taken to evaluate the digestive organs. 
  • Esophagogastroduodenoscopy (also called EGD or upper endoscopy) – a procedure that allows the physician to examine the inside of the esophagus, stomach and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach and duodenum. The endoscope allows the physician to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).
  • Computed tomography scan (CT or CAT scan) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • Endoscopic ultrasound – an imaging technique that uses sound waves to create a computer image of the inside of the esophagus and stomach. The endoscope is guided into the mouth and throat, then into the esophagus and the stomach. As in standard endoscopy, this allows the physician to view the inside of this area of the body, as well as insert instruments to remove a sample of tissue (biopsy).
  • Thoracoscopy and laparoscopy – methods that allow the physician to examine the lymph nodes inside the chest or abdomen with a hollow, lighted tube and remove these nodes for further testing 

How is Esophageal Cancer Treated?

Specific treatment for esophageal cancer will be determined by your physician based on:

  • Your age, overall health and medical history
  • Extent of the disease
  • Your tolerance for specific medications, procedures or therapies
  • Expectations for the course of this disease
  • Your opinion or preference 

Treatment may include:

  • Surgery – Two types of surgery are commonly performed for esophageal cancer. In one type of surgery, parts of the esophagus and nearby lymph nodes are removed, and the remaining portion of the esophagus is reconnected to the stomach. In the other surgery, part of the esophagus, nearby lymph nodes and the top of the stomach are removed. The remaining portion of the esophagus is then reconnected to the stomach.
  • Chemotherapy – Chemotherapy uses anticancer drugs to kill cancer cells.
  • Radiation therapy – Radiation therapy uses high-energy rays to kill or shrink cancer cells.
Sometimes, several of these treatments may be combined in the treatment of esophageal cancer.

What are the Risk Factors for Esophageal Cancer?

The following factors can put an individual at greater risk for developing esophageal cancer:

  • Age — The risk increases with age, with three-fourths of people diagnosed between 55 and 85.
  • Gender — Men have a three times greater risk of developing esophageal cancer than women.
  • Tobacco use — Using any form of tobacco raises the risk of esophageal cancer. The longer tobacco is used, the greater the risk, with the greatest risk among persons who have indulged in long-term drinking with tobacco use. Scientists believe that these substances increase each other's harmful effects, making persons who do both especially susceptible to developing the disease.
  • Alcohol use — Chronic and/or long-term heavy drinking is another major risk factor for esophageal cancer.
  • Barrett's esophagus — Long-term irritation from reflux, commonly known as heartburn, changes the cells at the end of the esophagus. This is a pre-cancerous condition, which raises the risk of developing adenocarcinoma of the esophagus.
  • Diet — Diets low in fruits and vegetables and certain vitamins and minerals can increase risk for this disease.
  • Other irritants — Swallowing caustic irritants such as lye and other substances can burn and destroy cells in the esophagus. The scarring and damage done to the esophagus can put a person at greater risk for developing cancer many years after ingesting the substance.
  • Medical history — Certain diseases, such as achalasia, a disease in which the bottom of the esophagus does not open to release food into the stomach, and tylosis, a rare, inherited disease, increase the risk of esophageal cancer. In addition, anyone who has had other head and neck cancers has an increased chance of developing a second cancer in this area, which includes esophageal cancer.
  • Obesity

Esophageal Cancer Clinical Trials

The North Shore-LIJ Cancer Institute offers a full array of clinical trials. The result of this research not only impacts survival, but also enhances the quality of life. For more information about clinical trials for Esophogeal Cancer, visit Cancer Clinical Trials.

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To learn more about the different types of cancer and treatment options, visit our Cancer Institute.