Esophageal cancer is a type of cancer that develops in the esophagus, a long, hollow tube that runs from the throat to the stomach. This type of cancer usually begins in the cells that line the inside of the esophagus and can develop anywhere along the esophagus.
Esophageal cancer is the sixth most common cause of cancer deaths worldwide. Incidence rates vary within different geographic locations. In some regions, higher rates of esophageal cancer may be attributed to tobacco and alcohol use or to certain nutritional habits and obesity.
Types of esophageal cancer include:
- Adenocarcinoma. Cancer develops from glandular cells in the lining of the esophagus.
- Squamous cell carcinoma. The cancer develops from the thin, flat cells (called squamous cells) that make up the inner lining of the esophagus.
- Other rare types. Rare forms of esophageal cancer include small cell carcinoma, sarcoma, lymphoma, melanoma, and choriocarcinoma.
Symptoms
- Difficulty swallowing (dysphagia).
- Weight loss.
- Vomiting blood.
- Chest pain, pressure or burning.
- Worsening heartburn or indigestion.
- Cough or hoarseness.
- Voice alterations.
It is important to diagnose early and see a specialist as soon as the first symptoms are detected.
Causes
Esophageal cancer occurs when esophageal cells develop changes (mutations) in their DNA. The changes cause the cells to grow and divide uncontrollably, until the accumulation of abnormal cells generates a tumor in the esophagus. In some cases, it grows so large that it can invade nearby structures and spread to other parts of the body.
Risk Factors
Factors that cause irritation to esophageal cells and increase the risk of esophageal cancer include:
- Gastroesophageal reflux disease.
- Smoking.
- Precancerous changes in the cells of the esophagus (Barrett’s esophagus).
- Obesity.
- Apnea.
- excessive sweating
- low blood pressure
- consumption of alcoholic beverages
- bile reflux
- Swallowing difficulties due to an esophageal sphincter that does not relax (achalasia).
- habit of drinking very hot liquids
- Insufficient intake of fruits and vegetables.
- Radiation therapy treatments to the chest or upper abdomen.
Diagnosis of esophageal cancer
The main method for diagnosing esophageal cancer is esophagogastroscopy, an examination that provides direct images of the cause of esophageal obstruction and allows samples to be obtained to confirm the diagnosis by biopsy. With this system more than 96% of the cases are diagnosed.
A CT scan of the neck, thorax and abdomen can also be performed to evaluate for distant metastases. Other tests include X-rays, chest radiography and computed tomography (PET/CT).
Prevention
- Stop smoking.
- If you drink alcohol, do so in moderation.
- Eat more fruits and vegetables.
- Maintain a healthy weight.
Treatment
Treatment of esophageal cancer may include surgery, radiation therapy, and chemotherapy. The optimal combination of these three treatment modalities will depend on the type, location, and stage of the disease. In the late stages, esophageal cancer can be treated but can rarely be cured.
Surgery: Surgery is the most common treatment for esophageal cancer. It can be done alone, if the disease is in early stages, or in combination with other treatments, if the disease is advanced.
In more advanced cancers, part of the esophagus may be removed in an operation called esophagectomy.
Radiation therapy: This treatment uses high-energy x-rays or other types of radiation to kill cancer cells. Radiation therapy is usually combined with chemotherapy and surgery for patients with esophageal cancer, and is often used in patients who are not candidates for surgery.
Chemotherapy: substances or drugs are used to kill cancer cells and/or to stop cancer cells from dividing. Chemotherapy may be used before or after surgery and is also used to help relieve symptoms when esophageal cancer has spread (metastasized) beyond the esophagus.
Other treatments for esophageal cancer include:
Endoscopic treatments: used to treat precancerous lesions and cancer of the esophagus in early stages and to relieve pain.
Monoclonal antibody therapy: a small group of esophageal cancers have a very high amount of a HER2 protein. This targeted therapy can be combined with chemotherapy.
Immunotherapy: this approach uses drugs to strengthen the patient’s immune system to help control the cancer.
Chemoprevention: drugs, vitamins and other agents are being studied to try to reduce the risk of cancer and/or delay its development or recurrence.
Radiofrequency ablation: Barrett’s esophagus can be treated with radiofrequency ablation to control its progression to dysplasia and/or adenocarcinoma.
Because esophageal cancer can affect a person’s ability to swallow food, additional treatments may be needed to ensure adequate nutrition for the patient during and after treatment.
Some patients may receive nutrients directly through a vein. Others may require a feeding tube (a flexible plastic tube that is passed through the nose or mouth and into the stomach) until they are able to eat on their own.