Esophageal Cancer

Cancer of the esophagus, also called esophageal cancer, happens when abnormal cells form in the muscular tube that allows food to pass from your throat into your stomach. Your esophagus lies under your thorax and in front of your spine.

There are two types of esophageal cancer:

  • Squamous cell carcinoma begins in flat cells lining the esophagus. This generally occurs in the upper and middle portions of the esophagus.
  • Adenocarcinoma begins in cells that release mucus and other fluids. This usually affects the lower portion of the esophagus, closest to the stomach.

The American Cancer Society estimates that about 18,000 new cases of esophageal cancer will be diagnosed in 2020 and about 15,000 people will die from the disease. The lifetime risk of getting esophageal cancer if you live in the US is roughly 1 in 125 for men and about 1 in 417 for women.

Risk Factors

Many risk factors for developing esophageal cancer are out of your control. It’s more common in men than in women, and it’s associated with aging.

You can lower your chances of getting esophageal cancer by eating a diet rich in vegetables, fruits, and whole grains, drinking alcohol in moderation, stopping smoking, and maintaining a healthy weight.

Some risk factors for esophageal cancer include:

Chronic Acid Reflux

GERD (gastroesophageal reflux) causes about a third of esophageal cancers. Chronic GERD can also lead to Barrett’s esophagus, which has a high likelihood of becoming cancerous.

Diet

When you don’t eat a lot of vegetables and fruits, you increase your risk of esophageal cancer. This is especially true if your diet lacks vitamins A, C, and B1 (riboflavin). People with low levels of selenium also have a higher chance of this type of cancer. (Selenium supplements can be toxic, so doctors recommend getting this essential mineral from fish, whole-grain bread, Brazil nuts, and walnuts instead.)

Obesity

Scientists have linked having a body mass index above 25 with increased risk of adenocarcinoma, a type of esophageal cancer.

Heavy Alcohol Use

Squamous cell esophageal carcinoma is associated with heavy use of alcohol.

Smoking

Squamous cell esophageal carcinoma is also associated with heavy smoking.

Rare Medical Conditions

Esophageal cancer is also associated with:

  • Achalasia: the smooth muscles in the esophagus don’t relax
  • Esophageal webs: thin tissue protrusions in the esophagus
  • Plummer-Vinson or Paterson-Kelly syndrome
  • Tylosis, a rare inherited disorder

Signs of Esophageal Cancer

Often there are no obvious signs of esophageal cancer, but some symptoms can include:

  • Change in bowel habits or frequency, such as alternating episodes of diarrhea and constipation
  • Bloody bowel movements or rectal bleeding
  • General abdominal discomfort
  • Unexplained weight loss
  • Chronic fatigue
  • Bloating
  • Unexplained anemia

Diagnosis

Esophageal cancer is diagnosed using esophagoscopy and an upper GI series.

  • Esophagoscopy. Your doctor uses a thin flexible tube that contains a camera and a light to examine the inside of your esophagus and take a tissue sample or biopsy. That sample goes to a pathologist who examines it for abnormalities.
  • Upper GI series. You swallow a barium contrast dye that moves through the esophagus into the stomach. Then you’ll have an X-ray of your esophagus. The dye makes it easier to see how well fluid is passing through your esophagus.

If you are diagnosed with esophageal cancer, the tumor must be accurately staged to determine the best possible treatment for you. The cancer’s stage, from 0 to IV, indicates whether the cancer has spread beyond the superficial tissue, whether lymph nodes are involved, and how far it has spread to other parts of your body.

You’ll have three tests to determine your cancer’s stage:

  • Endoscopic transesophageal ultrasound (EUS) uses sound waves to visualize tumor depth, surrounding lymph nodes, and the tumor's relationship to adjacent structures. It is often used in combination with two other imaging systems—PET and CT scans.
  • During a PET (positron emission tomography) scan, a small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around your body and makes a picture of where glucose is being used in your body. Malignant tumor cells show up brighter than normal cells do.
  • A CT (computed tomography) scan takes data from several X-ray images of the body and converts them into pictures on a monitor.

Staging

Staging identifies how advanced your cancer is by looking at how deeply the tumor has penetrated the wall of your esophagus, whether your lymph nodes are involved and how many, and whether the cancer has spread to other parts of your body.

Different stages of esophageal cancer require different treatments.

  • Stage 0 or cancer in situ. Cancer cells are present only in the most superficial protective layer of your esophagus. We can often manage these tumors well with noninvasive treatments.
  • Stage I. These small, superficial tumors haven’t yet penetrated deeply into the esophagus wall. They can usually be treated with primary surgery.
  • Stage II and III or locally advanced. These tumors are larger and penetrate more deeply into the esophageal tissue. Your lymph nodes may also be involved. At this stage, cancer treatment usually calls for medication and/or radiation therapy to shrink the tumor, then surgery to remove it.
  • Stage IV or metastatic. Cancer has spread from the original tumor site to other parts of your body. At this stage, chemotherapy is the most common treatment.