What is esophageal cancer?
Esophageal cancer affects the esophagus, which is the tube that carries food and liquids from the mouth to the stomach. It is a relatively rare cancer, accounting for about 1% of all cancers in the United States.
A cancerous esophageal tumor begins in the epithelial cells that line the esophagus. There are two main types of esophageal cancer, depending on the type of cell where it starts, glandular epithelia or surface epithelia:
Adenocarcinoma begins in the gland cells that make mucus and other fluids.
Squamous cell carcinoma starts in the surface cells lining the esophagus.
Together, these two types make up nearly all cases of esophageal cancers. There are a few very rare nonepithelial tumors that account for less than 1% of esophageal cancer. Since most cases are a form of carcinoma, you may hear specialists using the term esophageal carcinoma.
Lifestyle factors and certain disorders can increase the risk of esophageal cancer. Knowing your risk is important because there are rarely early signs of esophageal cancer. As a result, doctors often diagnose it in advanced stages, when symptoms develop. For many people, this includes swallowing problems that worsen with time.
Esophageal cancer can be hard to treat. Usually, doctors recommend chemotherapy and radiation therapy. Surgery can be an option after these therapies shrink the tumor. The earlier you find esophageal cancer, the better the outcome of these treatments is likely to be. So, seek prompt medical care if you notice changes in swallowing or other suspicious symptoms.
What are the symptoms and signs of esophageal cancer?
In general, people usually do not experience early symptoms of esophageal cancer. When symptoms develop in later stages, the most common one is swallowing problems. This can include difficult or painful swallowing, choking, or feeling like food gets stuck in the esophagus. At first, people may notice mild problems with substantial foods, such as meats or raw vegetables. As the disease progresses and the tumor obstructs the esophagus, swallowing becomes more problematic. Eventually, people can struggle to consume even very soft foods.
Other esophageal cancer symptoms and signs
Other esophageal cancer symptoms can include:
Chest pain or pressure, especially behind the breastbone
Heartburn or indigestion
Most of the time, another noncancerous condition will be at the root of these symptoms. But you need to see your doctor for an accurate diagnosis. Whatever the cause, seeking prompt treatment is generally better.
Some of these symptoms can also be present with a heart attack. Seek immediate medical care (call 911) if you, or someone you are with, have new onset heartburn, indigestion, and chest pain or pressure that persists.
What causes esophageal cancer?
The exact cause of esophageal cancer, like any cancer, remains elusive. Cancer starts at the cellular level. For some reason, certain cells stop responding to normal body processes that tell them to stop growing and multiplying. Scientists continue to search for the exact triggers that start this uncontrolled growth. It is likely a combination of inherited and environmental factors that cause accumulated gene mutations. This damage eventually leads to cells that do not look or act like normal cells. These abnormal cells continue multiplying, forming tumors and other cancerous masses.
What are the risk factors for esophageal cancer?
Risk factors are conditions and characteristics that increase the risk of a disease. Not all people with risk factors will get the disease. But they can help doctors identify people at higher risk than normal. Risk factors for esophageal cancer include:
Achalasia, which is a progressive condition that makes it hard to pass food and liquids through the esophagus
Age 55 or older
Barrett’s esophagus, which is a change in the cells lining the esophagus
GERD (gastroesophageal reflux disease), which can lead to Barrett’s esophagus
Male gender. Men are 3 to 4 times as likely as women to get esophageal cancer.
Lifestyle factors can also play a role in your risk of esophageal cancer. This includes heavy alcohol use, tobacco use of any kind, and obesity, which often causes reflux. The more tobacco you use and the longer you use it, the higher your risk of esophageal cancer. Combining alcohol and tobacco use raises the risk even more.
Reducing your risk of esophageal cancer
Managing cancer risk starts by changing risk factors you can control. For esophageal cancer, this means making lifestyle changes and treating chronic conditions. You may be able to lower your risk of esophageal cancer by:
Eating a healthy diet with lots of fruits, vegetables, and whole grains
Following your doctor’s recommendations for treating and managing GERD and Barrett’s esophagus
Losing weight if you are overweight, and maintaining a healthy body weight
Stopping smoking and other tobacco use or never starting
If you need help with any of these areas, talk with your doctor. Help is available to assist you in reaching healthy goals. If you suffer from GERD, Barrett’s esophagus, or achalasia, ask your doctor about your risk. Find out if screening tests are necessary.
How is esophageal cancer treated?
With cancer, the treatment goal is to eliminate cancer if possible. When this is not possible, goals can include controlling symptoms, prolonging life, and improving quality of life. The stage of cancer will play a role in treatment decisions. In general, lower cancer stages have a better outlook because treatment is more effective. Higher stages can be more difficult to treat.
The main esophageal cancer treatment is chemotherapy (chemo) in combination with radiation therapy. These therapies can shrink the tumor, making it easier to remove with surgery. Surgery in early stages usually involves removing a section of the esophagus containing the tumor. Doctors connect the stomach to the remaining esophagus or use a section of intestine to replace the section. Doctors may recommend chemo and radiation after surgery as well. The purpose is to kill any remaining cancer cells.
Other treatments may include:
Endoscopic treatments to treat late-stage cancers that are blocking the esophagus. This involves putting an endoscope—a thin, lighted tube with a camera—down the throat. Doctors deliver various forms of energy, such as heat or laser energy, to destroy the tumor.
Immunotherapy to treat some advanced cancers when other treatments haven’t worked. This therapy boosts the body’s immune response to cancer. It can help shrink tumors and relieve symptoms.
Targeted therapy to treat cancers with specific markers. Some esophageal cancers make too much HER2 protein. Targeted therapy drugs can use the abundance of this marker on the cell surface to identify and destroy cancer cells. Other drugs target VEGF, a protein the tumor uses to create new blood vessels.
The information on your pathology report will guide your doctor’s treatment recommendations. Ask questions when you are discussing your options. Make sure you understand the goals, benefits and risks of each potential treatment. Consider getting a second opinion if you are struggling with a treatment decision. And if your cancer is advanced, ask your doctor about a clinical trial. Participating in a clinical trial can expand your treatment options.
What are the potential complications of esophageal cancer?
When people think of cancer complications, cancer spread—or metastasis—is a common concern. Unfortunately, more than 30% of people with esophageal cancer already have metastatic disease at diagnosis. Another 30% have regional spread of the disease to lymph nodes. This affects prognosis and survival.
Doctors talk about survival with esophageal cancer in terms of the five-year relative survival rate. Relative survival rates tell you what percent of people with the disease are still alive compared to people without the disease. The five-year rate looks at survival five years after being diagnosed with cancer. So a 75% five-year relative survival rate means someone with cancer is 75% as likely as someone without it to be alive five years after diagnosis. For early stage, localized esophageal cancer, the five-year relative survival rate is 43%. The number drops to 23% for regional disease and 5% for distant metastatic disease.
Survival numbers are only estimates. Other factors influence your outlook. This includes your age, your overall health, and how well the cancer responds to treatment. For esophageal cancer, it also depends on which type you have. In general, adenocarcinoma tends to have a slightly better outlook. Your doctor is the best resource for information on your prognosis. He or she can help you understand how all these factors apply to you.