About esophageal cancer (cancer of the esophagus)
What is esophageal cancer (cancer of the esophagus)?
Esophageal cancer occurs when cancer cells develop in the esophagus, a tube-like structure that runs from your throat to your stomach. Food goes from the mouth to the stomach through the esophagus. The cancer starts at the inner layer of the esophagus and can spread throughout the other layers of the esophagus and to other parts of the body (metastasis).
There are two main types of esophageal cancer. One type is squamous cell carcinoma. Squamous cells line the inner esophagus, and cancer developing from squamous cells can occur along the entire esophagus. The other type is called adenocarcinoma. This is cancer that develops from gland cells. To develop adenocarcinoma of the esophagus, squamous cells that normally line the esophagus are replaced by gland cells. This typically occurs in the lower esophagus near the stomach and is believed to be largely related to acid exposure to the lower esophagus.
What are the symptoms for esophageal cancer (cancer of the esophagus)?
- Difficulty or Pain when swallowing
- Weight loss
- Pain in the chest, behind the breastbone
- Indigestion and heartburn
What are the causes for esophageal cancer (cancer of the esophagus)?
It's not exactly clear what causes esophageal cancer.
Esophageal cancer occurs when cells in the esophagus develop changes (mutations) in their DNA. The changes 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 (cancer of the esophagus)?
As with many cancers, esophageal cancer treatment has a greater chance of success if the cancer is caught early. Unfortunately, by the time esophageal cancer is diagnosed for many people, it is often already in an advanced stage (has spread throughout the esophagus and beyond).
Treatment of esophageal cancer depends on many factors, including the stage of the cancer and the overall health of the patient.
- Surgery. Part or all of the esophagus may be removed.
- Radiation therapy. Kills cancer cells with radiation.
- Chemotherapy. Powerful drugs that attack cancer cells throughout the body; typically used in combination with radiation therapy and/or surgery.
- Targeted therapy. Newer treatments that target specific aspects of a cancer to curb cancer growth and spread.
- Immunotherapy. Helps the immune system to attack cancer cells.
- Photodynamic therapy. Targets cancer cells with a special laser light.
- Electrocoagulation. Uses electric current to destroy cancer cells.
- Cryotherapy. Freezes cancer cells to help shrink a tumor.
Endoscopic mucosal resection may be done to treat precancers or very small early cancers by removing the inner lining of the esophagus. Radiofrequency ablation treatment using a device that targets cancer cells with radiofrequency energy is sometimes used for early cancers.
In addition, your doctor may recommend that you take part in a clinical trial, in which new drugs or treatments are tested in patients. The success of these tests helps determine if the drugs or treatments will be approved by the Food and Drug Administration.
How Are the Stages of Esophageal Cancer Treated?
Treatment options for esophageal cancer by stage may involve the following:
- Stage 0 . Options include surgery, photodynamic therapy, radiofrequency ablation, or endoscopic mucosal resection.
- Stage I, II, and III . Surgery, chemotherapy, radiation
- Stage IV . Chemotherapy, radiation, targeted therapy, immunotherapy; treatment for this stage focuses on "palliative" therapy. Palliative therapy is meant to relieve the pain and difficulty swallowing caused by cancer.
According to the American Cancer Society, the percentages of people who live for at least five years after being diagnosed with esophageal cancer (taking into account that some people with esophageal cancer will have other causes of death) is 47% for localized cancer to the esophagus, 25% for cancer that has spread regionally, and 5% with distant cancer spread.
What are the risk factors for esophageal cancer (cancer of the esophagus)?
There are a number of factors which increase a person's risk of developing esophageal cancer. They include:
- Smoking or other use of tobacco
- Heavy alcohol use
- Gastroesophageal reflux disease (GERD), in which contents and acid from the stomach back up into the esophagus
- Barrett's esophagus, a condition that affects the lower part of the esophagus and can lead to esophageal cancer; Barrett's esophagus may be caused by GERD. Over time, stomach acid in the esophagus can cause changes in the cells that increase risk for adenocarcinoma.
In addition, certain groups -- men, the elderly, and people who are obese -- are at greater risk for esophageal cancer. Risk of adenocarcinoma of the esophagus is higher in white men, but squamous cell carcinoma of the esophagus is more common in Asian men and men of color.