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Esophageal cancer

Definition:

Esophageal cancer is a cancerous (malignant) tumor of the esophagus. This is the tube that moves food from the mouth to the stomach.



Alternative Names:

Cancer - esophagus



Causes, incidence, and risk factors:

Esophageal cancer is not common in the United States. It occurs most often in men over 50 years old.

There are two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. These two types look different from each other under the microscope.

Squamous cell esophageal cancer is linked to smoking and drinking too much alcohol.

Adenocarcinoma is the more common type of esophageal cancer. Having Barrett esophagus  increases the risk of this type of cancer. Acid reflux disease (gastroesophageal reflux disease , or GERD) can develop into Barett esophagus. Other risk factors include smoking, being male, or being obese.



Symptoms:
  • Backwards movement of food through the esophagus and possibly mouth (regurgitation)
  • Chest pain not related to eating
  • Difficulty swallowing solids or liquids
  • Heartburn
  • Vomiting blood
  • Weight loss


Signs and tests:

Tests used to help diagnose esophageal cancer may include:

Stool testing may show small amounts of blood in the stool.



Treatment:

Upper endoscopy (EGD) will be used to obtain a tissue sample from the esophagus to diagnose cancer.

When the cancer is only in the esophagus and has not spread, surgery will be done. The cancer and part, or all, of the esophagus is removed. The surgery may be done using:

  • Open surgery , during which one or two larger incisions are made.
  • Minimally invasive surgery , during which a 2 - 4 small incisions are made in the belly. A laparoscope with a tiny camera is inserted into the belly through one of the incisions.

Radiation therapy may also be used instead of surgery in some cases when the cancer has not spread outside the esophagus.

Either chemotherapy, radiation, or both may be used to shrink the tumor and make surgery easier to perform.

If the patient is too ill to have major surgery or the cancer has spread to other organs, chemotherapy or radiation may be used to help reduce symptoms. This is called palliative therapy. In such cases, the disease is usually not curable.

Beside a change in diet, other treatments that may be used to help the patient swallow include:

  • Dilating (widening) the esophagus using an endoscope. Sometimes a stent is placed to keep the esophagus open.
  • A feeding tube into the stomach.
  • Photodynamic therapy, in which a special drug is injected into the tumor and is then exposed to light. The light activates the medicine that attacks the tumor.


Support Groups:

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone



Expectations (prognosis):

When the cancer has not spread outside the esophagus, surgery may improve the chance of survival.

When the cancer has spread to other areas of the body, a cure is generally not possible. Treatment is directed toward relieving symptoms.



Complications:
  • Pneumonia
  • Severe weight loss from not eating enough


Calling your health care provider:

Call your health care provider if you have difficulty swallowing with no known cause and it does not get better. Also call if you have other symptoms of esophageal cancer.



Prevention:

To reduce your risk of cancer of the esophagus:

  • Do not smoke
  • Limit or do not drink alcoholic beverages
  • Get checked by your doctor if you have severe GERD
  • Get regular checkups if you have Barrett esophagus


References:

Das A. Tumors of the esophagus. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 46.

National Cancer Institute: PDQ Esophageal cancer treatment. Bethesda, MD: National Cancer Institute. Date last modified 2/1/2013. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/esophageal/HealthProfessional. Accessed February 4, 2013.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Esophageal and esophagogastric junction cancers. Version 2.2012. Available at http://www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf. Accessed February 4, 2013. 




Review Date: 1/22/2013
Reviewed By: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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