The esophagus is the muscular tube extending from the neck to the abdomen, connecting the mouth to the stomach. Esophageal cancer is the uncontrolled growth of cells in the esophagus, and the lining of the esophagus is the most common region for cancers of the esophagus to start to grow.
The esophagus is mostly lined with squamous cells, which is why, when malignant cancer cells form, this type of esophageal cancer is known as squamous cell carcinoma. Near the bottom of the esophagus, near the stomach, are cells that, when they become cancerous, are referred to as adenocarcinomas. Other, rarer forms of esophageal cancer include sarcoma and small cell cancer.
Is Esophageal Cancer Common?
Esophageal cancer is not nearly as common as breast, lung, prostate or colon cancer, with annual incidence rates between 12,000 and 18,000 new case in the United States. The number varies because sometimes cancers in the lower esophagus may be classified as stomach cancer in some cases.
Causes of Esophageal Cancer
There are different causes for esophageal cancer, depending on the type. Risk factors for squamous cell cancer include:
- Heavy alcohol use
- Human papillomavirus
Risk factors for development of adenocarcinoma are less well-understood, although individuals with the following conditions are at increased risk of developing it:
Who is at Risk for Esophageal Cancer?
Most people who develop esophageal cancer do so in their later years, from age 50 years onward. In the United States, men tend to develop squamous cell cancers more often than women, and African-Americans more than Caucasians. Adenocarcinomas are also more common in men than women, and are much more likely to occur in Caucasians than in minorities.
Signs & Symptoms
Difficulty swallowing is the most common symptom of esophageal cancer, or the sensation of food being stuck in the throat before reaching the stomach. As a progressive disease, it will advance to the point where even liquids won't go down easily. Other symptoms may include:
- Weight loss
- Pain when swallowing
- Regurgitation of undigested food
- Vomiting blood
- Black or tarry stool
Diagnosis & Testing
Upon experiencing difficulty swallowing or unexplained weight loss, you should contact your physician, who will do tests to determine whether thre is a growth (tumor) in the esophagus that is causing the swallowing difficulty. If found, your physician will perform a biopsy to confirm the diagnosis.
An endoscopy is a common early step for diagnosis. This outpatient procedure will use a thin, flexible tube topped with a camera to allow your physician to examine the esophagus and, if necessary collect a biopsy sample for analysis.
Other tests may include an X-ray of the esophagus and stomach (barium swallow test) that will reveal the condition of the lining of the esophagus, and computed tomography (CT) scan of the chest and abdomen to obtain a picture of the lungs, liver and other organs surrounding the esophagus.
Your physician may examine the tumor and adjacent lymph nodes by means of endoscopic ultrasonography (EUS), which uses ultrasound waves to create an image of the tumor and surrounding lymph nodes. Positron emission tomography (PET) scanning may also be used to measure activity in cells and find information about possible locations of cancer.
Staging & Treatment of Esophageal Cancer
If your physician diagnoses you with esophageal cancer, they will then stage the cancer, which is the determination of how advanced teh cancer is, and whether it has spread to other parts of the body. Esophageal cancer may commonly spread to:
- Lymph nodes
- Adrenal glands
- Lining of the chest and abdomen
Treatment depends on the stage of the esophageal cancer at the time of diagnosis, as well as your overall condition and what symptoms you are having. Because esophageal cancer may be asymptomatic at early stages, it is often only found at later stages, when causing swallowing difficulty.
For patients for whom the esophageal cancer has not spread to other organs, surgery (esophagectomy) is the primary treatment, which may be used in combination with chemotherapy or radiotherapy.
For patients for whom the cancer has spread to other organs, or for whom surgery is not an option, combination therapy is the most common treatment.
Prognosis for patients with esophageal cancer depends on the stage of the cancer at time of diagnosis, with 80 percent to 90 percent of patients recovering if the cancer is discovered early enough. Overall success rates for patients with later stage esophageal cancer are far lower.
Why Choose Northwestern Memorial?
The Thoracic Surgery Program at Northwestern Memorial Hospital offers the latest surgical procedures for benign and malignant diseases of the esophagus. Your physician will discuss the most appropriate treatment for esophageal cancer.