About esophageal cancer

What is esophageal cancer?

What is the esophagus?

The esophagus is a muscular tube in the chest. It's about 10 inches (25 centimeters) long.

This organ is part of the digestive tract. Food moves from the mouth through the esophagus to the stomach.

The wall of the esophagus has several layers:

  • Inner layer or lining: The lining (mucosa) of the esophagus is wet, which helps food to pass to the stomach.
  • Submucosa: Glands in the submucosa layer make mucus, which helps keep the lining of the esophagus wet.
  • Muscle layer: The muscles push the food down to the stomach.
  • Outer layer: The outer layer covers the esophagus.

Cancer Cells

Cancer begins in cells, the building blocks that make up all tissues and organs of the body, including the esophagus.

Normal cells in the esophagus and other parts of the body grow and divide to form new cells as they are needed. When normal cells grow old or get damaged, they die, and new cells take their place.

Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

A tumor in the esophagus can be benign (not cancer) or malignant (cancer):

  • Benign tumors:
    • Are rarely a threat to life
    • Don't invade the tissues around them
    • Don't spread to other parts of the body
    • Can be removed and don't usually grow back
  • Malignant tumors (cancer of the esophagus):
    • May be a threat to life
    • Can invade and damage nearby organs and tissues
    • Can spread to other parts of the body
    • Sometimes can be removed but may grow back

Esophageal cancer cells can spread by breaking away from an esophageal tumor. They can travel through blood vessels or lymph vessels to reach other parts of the body. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.

When esophageal cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if esophageal cancer spreads to the liver, the cancer cells in the liver are actually esophageal cancer cells. The disease is metastatic esophageal cancer, not liver cancer. For that reason, it is treated as cancer of the esophagus, not liver cancer.

Types of Esophageal Cancer

The two most common types are named for how the cancer cells look under a microscope:

  • AC: About 12,000 Americans will be diagnosed with AC (adenocarcinoma) of the esophagus in 2013. In the United States, AC is the most common type of esophageal cancer. Usually, AC tumors are found in the lower part of the esophagus, near the stomach. AC of the esophagus may be related to having acid reflux (the backward flow of stomach acid), having a disease of the lower esophagus known as Barrett esophagus, or being obese.
  • SCC: About 6,000 Americans will be diagnosed with SCC (squamous cell carcinoma) of the esophagus in 2013. In other parts of the world, SCC is the most common type of esophageal cancer. Usually, SCC tumors are found in the upper part of the esophagus. SCC of the esophagus may be related to being a heavy drinker of alcohol or smoking tobacco.

If you smoke, talk with an expert about quitting. It's never too late to quit. Quitting can help cancer treatments work better. It may also reduce the chance of getting another cancer.

To get help with quitting smoking...

  • Go online to Smokefree.gov.
  • Call NCI's Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
  • Sign up for the free mobile service SmokefreeTXT to get tips and encouragement to quit. To sign up, text the word QUIT to IQUIT (47848) from your mobile phone. Or, go to http://smokefree.gov/smokefreetxt/ Signup.aspx

Tests

After you learn that you have cancer of the esophagus, you may need other tests to help with making decisions about treatment.

Tumor Grade Test

The tumor tissue that was removed during your biopsy procedure can be used in lab tests. The pathologist studies tissue samples under a microscope to learn the grade of the tumor. The grade tells how different the tumor tissue is from normal esophagus tissue.

Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with other factors to suggest treatment options.

Staging Tests

Staging tests can show the stage (extent) of esophageal cancer, such as whether cancer cells have spread to other parts of the body.

When cancer of the esophagus spreads, cancer cells are often found in nearby lymph nodes. Esophageal cancer cells can spread from the esophagus to almost any other part of the body, such as the liver, lungs, or bones.

Staging tests may include...

  • CT scan: Your doctor may order a CT scan of your chest and abdomen. An x-ray machine linked to a computer will take a series of detailed pictures of these areas. You'll receive contrast material by mouth and by injection into a blood vessel in your arm or hand. The contrast material makes abnormal areas easier to see. The pictures can show cancer that has spread to the liver, lungs, bones, or other organs.
  • PET scan: Your doctor may use a PET scan to find cancer that has spread. You'll receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in the body. Because cancer cells use sugar faster than normal cells, areas with cancer cells look brighter on the pictures. The pictures can show cancer that has spread to the lymph nodes, liver, or other organs.
  • EUS: An EUS (endoscopic ultrasound) can show how deeply the cancer has invaded the wall of the esophagus. It can also show whether cancer may have spread to nearby lymph nodes. Your doctor will pass a thin, lighted tube (endoscope) through your mouth to your esophagus. A probe at the end of the tube sends out high-energy sound waves. The waves bounce off tissues in your esophagus and nearby organs, and a computer creates a picture from the echoes. During the exam, the doctor may take tissue samples of lymph nodes.

Stages

Doctors describe the stages of esophageal cancer using the Roman numerals I, II, III, and IV. Stage I is early-stage cancer, and Stage IV is advanced cancer that has spread to other parts of the body, such as the liver.

The stage of cancer of the esophagus depends mainly on...

  • How deeply the tumor has invaded the wall of the esophagus
  • The tumor's location (upper, middle, or lower esophagus)
  • Whether esophageal cancer cells have spread to lymph nodes or other parts of the body

Stages I and II of Adenocarcinoma of the Esophagus

Stage IA

Cancer has grown through the inner layer and invades the wall of the esophagus. The grade is 1 or 2.

Stage IB

Cancer has invaded the wall of the esophagus and is grade 3. Or, cancer has invaded more deeply into the muscle layer of the esophagus, and the grade is 1 or 2.

Stage IIA

Cancer has invaded the muscle layer of the esophagus, and the grade is 3.

Stage IIB

Cancer has invaded the outer layer of the esophagus. Or, cancer has not invaded the outer layer, but cancer cells are also found in one or two nearby lymph nodes.

Stages I and II of Squamous Cell Cancer of the Esophagus

Stage IA

Cancer has grown through the inner layer and invaded the wall of the esophagus. The grade is 1.

Stage IB

Cancer has invaded the wall of the esophagus and is grade 2 or 3. Or, cancer is found in the lower part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 1.

Stage IIA

Cancer is found in the upper or middle part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 1. Or, cancer is found in the lower part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 2 or 3.

Stage IIB

Cancer is found in the upper or middle part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 2 or 3. Or, cancer has not invaded the outer layer, and cancer cells are found in one or two nearby lymph nodes.

Stages III and IV of Esophageal Cancer (Both Types)

Stage IIIA

Stage IIIA is one of the following:

  • Cancer has not invaded the outer layer, and cancer cells are found in 3 to 6 nearby lymph nodes.
  • Or, cancer has invaded the outer layer of the esophagus, and cancer cells are also found in 1 or 2 nearby lymph nodes.
  • Or, cancer extends through the esophageal wall and has invaded nearby tissues, such as the diaphragm or pleura. No cancer cells are found in lymph nodes.

Stage IIIB

Cancer has invaded the outer layer of the esophagus, and cancer cells are found in 3 to 6 nearby lymph nodes.

Stage IIIC

Stage IIIC is one of the following:

  • Cancer has invaded tissues near the esophagus, and cancer cells are found in up to 6 nearby lymph nodes.
  • Or, cancer cells are found in 7 or more nearby lymph nodes.
  • Or, the cancer can't be removed by surgery because the tumor has invaded the trachea or other nearby tissues.

Stage IV

The esophageal cancer has spread to other parts of the body, such as the liver, lungs, or bones.



What are the symptoms for esophageal cancer?

Signs and symptoms of esophageal cancer include:

Early esophageal cancer typically causes no signs or symptoms.

When to see a doctor

Make an appointment with your doctor if you have any persistent signs and symptoms that worry you.

If you've been diagnosed with Barrett's esophagus, a precancerous condition that increases your risk of esophageal cancer caused by chronic acid reflux, ask your doctor what signs and symptoms to watch for that may signal that your condition is worsening.

Screening for esophageal cancer isn't done routinely except for patients with Barrett's esophagus because of a lack of other easily identifiable high-risk groups. If you have Barrett's esophagus, discuss the pros and cons of screening with your doctor.



What are the causes for esophageal cancer?

It's not exactly clear what causes esophageal cancer.

Esophageal cancer occurs when cells in your esophagus develop errors (mutations) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells form a tumor in the esophagus that can grow to invade nearby structures and spread to other parts of the body.

Types of esophageal cancer

Esophageal cancer is classified according to the type of cells that are involved. The type of esophageal cancer you have helps determine your treatment options. Types of esophageal cancer include:

  • Adenocarcinoma. Adenocarcinoma begins in the cells of mucus-secreting glands in the esophagus. Adenocarcinoma occurs most often in the lower portion of the esophagus. Adenocarcinoma is the most common form of esophageal cancer in the United States, and it affects primarily white men.
  • Squamous cell carcinoma. The squamous cells are flat, thin cells that line the surface of the esophagus. Squamous cell carcinoma occurs most often in the upper and middle portions of the esophagus. Squamous cell carcinoma is the most prevalent esophageal cancer worldwide.
  • Other rare types. Some rare forms of esophageal cancer include small cell carcinoma, sarcoma, lymphoma, melanoma and choriocarcinoma.



What are the treatments for esophageal cancer?

In 2013, about 18,000 Americans will be diagnosed with esophageal cancer.

The two most common types are named for how the cancer cells look under a microscope:

  • AC: About 12,000 Americans will be diagnosed with AC (adenocarcinoma) of the esophagus in 2013. In the United States, AC is the most common type of esophageal cancer. Usually, AC tumors are found in the lower part of the esophagus, near the stomach. AC of the esophagus may be related to having acid reflux (the backward flow of stomach acid), having a disease of the lower esophagus known as Barrett esophagus, or being obese.
  • SCC: About 6,000 Americans will be diagnosed with SCC (squamous cell carcinoma) of the esophagus in 2013. In other parts of the world, SCC is the most common type of esophageal cancer. Usually, SCC tumors are found in the upper part of the esophagus. SCC of the esophagus may be related to being a heavy drinker of alcohol or smoking tobacco.

If you smoke, talk with an expert about quitting. It's never too late to quit. Quitting can help cancer treatments work better. It may also reduce the chance of getting another cancer.

To get help with quitting smoking...

  • Go online to Smokefree.gov.
  • Call NCI's Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
  • Sign up for the free mobile service SmokefreeTXT to get tips and encouragement to quit. To sign up, text the word QUIT to IQUIT (47848) from your mobile phone. Or, go to http://smokefree.gov/smokefreetxt/ Signup.aspx



What are the risk factors for esophageal cancer?

It's thought that chronic irritation of your esophagus may contribute to the changes that cause esophageal cancer. Factors that cause irritation in the cells of your esophagus and increase your risk of esophageal cancer include:

  • Having gastroesophageal reflux disease (GERD)
  • Smoking
  • Having precancerous changes in the cells of the esophagus (Barrett's esophagus)
  • Being obese
  • Drinking alcohol
  • Having bile reflux
  • Having difficulty swallowing because of an esophageal sphincter that won't relax (achalasia)
  • Having a steady habit of drinking very hot liquids
  • Not eating enough fruits and vegetables
  • Undergoing radiation treatment to the chest or upper abdomen



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