Esophageal cancer is a malignant growth, or tumor, in the esophagus, the tube that delivers food from the mouth to the stomach. The esophagus is made of several layers of tissue. Esophageal cancer starts in the inner lining and moves out through the other layers.
Cancer of the esophagus comes in two common forms:
- Adenocarcinoma: Starts in the esophageal glandular (secretory) cells that generate mucus and other fluids. Adenocarcinomas usually form in the lower part of the esophagus, near the stomach.
- Squamous cell carcinoma: Starts in the flat squamous cells lining the esophagus. This cancer is usually found in the upper and middle parts of the esophagus, but can occur anywhere in the esophagus.
The rates of esophageal cancer had been steady in the United States for a long time, but recently the incidence of esophageal adenocarcinoma has been increasing. Researchers are not sure why, but one theory is that more Americans are overweight, which puts them at increased risk for acid reflux that may damage the esophagus.
Men are about three times more likely than women to get esophageal cancer. More than 85% of people who get this cancer are over age 55.2
The Link Between Barrett’s Esophagus and Esophageal Cancer
With Barrett’s esophagus, the cells lining the esophagus change due to repeated exposure to stomach acid, sometimes becoming precancerous. The longer a person has Barrett’s esophagus, the more likely that esophageal cancer will develop.
By closely monitoring their condition, patients with Barrett’s esophagus patients may detect esophageal cancer early, when it is more likely to respond to treatment. Once the cancer has spread, the 5-year survival rate for esophageal cancer is 20%.2
Risk Factors for Esophageal Cancer
Many factors may increase one’s risk of developing esophageal cancer, including:
- Achalasia: The muscle at the low end of the esophagus does not relax when it should, so food and drinks accumulate before they enter the stomach. The esophagus becomes stretched, and the esophagus tissue is exposed to food for longer times than normal. People who have this condition are at much higher risk than normal for esophageal cancer.2
- Being an older adult
- Being male
- Dietary factors: A diet that emphasizes vegetables and fruits lowers the risk of esophageal cancer. Drinking hot liquids often can raise the risk of squamous cell esophageal cancer.
- Use of tobacco and alcohol: Use of tobacco carries a high risk of esophageal cancer, and the risk rises the longer a person uses tobacco. The risk decreases if tobacco use goes down or stops. Consuming alcohol also increases the risk of esophageal cancer, and the risk increases with greater consumption. A combination of alcohol and tobacco use increases the risk of esophageal cancer much more than if either is used alone.2
- Obesity: Overweight people are more likely to have acid reflux, which can damage cells lining the esophagus.
- Drinking very hot fluids, which may also damage cells lining the esophagus.
- Human papilloma virus (HPV) infection: The genetic material from this virus has been identified in as many as one-third of esophageal cancers in Asian and South African patients. HPV infection has also been associated with cancers of the throat, cervix and anus.
- Gastroesophageal reflux disease (GERD): Also called acid reflux, people with GERD are at greater risk for getting esophageal adenocarcinoma. If GERD develops into Barrett’s esophagus, a serious precancerous condition, the risk for esophageal adenocarcinoma is even higher.
- History of other cancers: A history of other cancers - including throat, mouth and lung cancer - carries a high risk of esophageal cancer.
Symptoms of Esophageal Cancer
Common signs and symptoms of esophageal cancer include:
- Difficulty or painful swallowing: A feeling that food hasn’t gone down after swallowing. This problem gets worse over time.
- Chest pain or discomfort: May feel like burning or pressure, and is not related to eating. This symptom is often caused by heartburn or other problems, rather than cancer.
- Weight loss (unexplained): About half of people with esophageal cancer have unexplained weight loss.
- Bleeding into the esophagus: The blood goes through the gastrointestinal tract, and can make the stools appear black. This blood loss may lead to anemia.
Note: if you have one or more of these symptoms, this does not mean that you have esophageal cancer. These symptoms are seen with other conditions, too. But you should see a doctor if you have these symptoms, especially if you have difficulty swallowing.
The doctor will take your medical history and do a physical examination, paying special attention to your chest and neck. The doctor may follow up with a test or a scan that allows the doctor to see inside your esophagus. Common diagnostic tests include:
Endoscopy: The doctor uses a thin, flexible tube with a light and tiny camera on it to see inside the esophagus.
Imaging Tests: The doctor may ask you to swallow a liquid called Barium, which can be seen on a fluoroscope, in order to take a series of x-rays. The doctor may also order a CT or a PET scan
Staging Esophageal Cancer
After esophageal cancer is diagnosed, doctors will use a variety of endoscopic procedures, imaging tests and biopsy to determine whether, and how far, the cancer has spread. There are five stages of esophageal cancer.
- Stage 0: Abnormal cells are found only in the inner layer of the esophagus. It's called carcinoma in situ.
- Stage I: The cancer has grown through the inner layer to the submucosa layer.
- Stage II is one of the following:
- The cancer has grown through the inner layer to the submucosa, and cancer cells have spread to lymph nodes.
- Or, the cancer has invaded the muscle layer. Cancer cells may be found in lymph nodes.
- Or, the cancer has grown through the outer layer of the esophagus.
- Stage III is one of the following:
- The cancer has grown through the outer layer, and cancer cells have spread to lymph nodes.
- Or, the cancer has invaded nearby structures, such as the airways. Cancer cells may have spread to lymph nodes.
- Stage IV: Cancer cells have spread to distant organs, such as the liver.
More details about esophageal cancer staging are available in the American Cancer Society’s detailed guide on esophageal cancer.
Treatments for Esophageal Cancer
There are four ways to treat esophageal cancer: Surgery, chemotherapy, radiation therapy and a combination of those treatments. The doctor will recommend a treatment based on the patient’s:
- Cancer stage (the extent of spread of the cancer)
- Location of the cancer in the esophagus
Esophageal cancer is difficult to treat. Because of this, patients are often encouraged to participate in a clinical study. Clinical studies are research projects that test new treatments that are not otherwise available. The National Cancer Institute states on their web site that, “Clinical trials are an important option for people with all stages of esophageal cancer.”
Surgery for Esophageal Cancer
In a surgical procedure called an esophagectomy, the doctor removes part of the esophagus. The doctor will connect the remaining healthy part of the esophagus to the stomach using a plastic tube or part of the intestine, so the patient can still swallow. Lymph nodes near the esophagus may also be removed and examined to find out if they contain cancerous tissue.
Surgery may not be possible for patients in poor overall health. For these patients, doctors may recommend chemotherapy, radiation therapy and endoscopic stenting.
Radiation Therapy for Esophageal Cancer
Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
- External radiation therapy uses a machine outside the body to send radiation toward the cancer.
- Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly in or near the cancer.
The way radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy for Esophageal Cancer
Chemotherapy is treatment with drugs given by IV infusion to kill fast-growing cancer cells. Most people with esophageal cancer will get chemotherapy. Because chemotherapy also kills healthy cells, people getting chemotherapy have significant side effects, including hair loss, nausea, and infections. These side effects usually go away once chemotherapy is completed.
Targeted Therapy for Esophageal Cancer
Targeted Therapy is treatment with drugs that try to block the growth and spread of cancer cells. It’s usually given by infusion. Treatment may cause diarrhea, joint pain, heartburn, stomach pain, tingling or, in some cases, heart problems. When treatment ends, most side effects go away.
- PubMed Health: Esophageal cancer
- PubMed Health: Esophageal cancer treatment (PDQ®), patient version
- National Cancer Institute: Esophageal cancer
- National Cancer Institute: Esophageal cancer treatment (PDQ®)
- WebMD: Esophageal cancer directory
- American Cancer Society: Esophagus cancer
- American Cancer Society: Esophagus cancer—detailed guide