Esophageal cancer Health Article

Definition

Esophageal cancer is a malignant (cancerous) tumor of the esophagus, the muscular tube that moves food from the mouth to the stomach.

See also: Barrett's esophagus

Alternative Names

Cancer - esophagus

Causes, incidence, and risk factors

Esophageal cancer is relatively uncommon in the United States, and occurs most often in men over 50 years old. It affects less than 5 in 100,000 people. There are two main types of esophageal cancer --squamous cell carcinoma and adenocarcinoma. These two types look different from each other under the microscope.

Squamous cell esophageal cancer is associated with smoking and alcohol consumption. The rate of this disease in the United States has remained mostly the same, while the rate of adenocarcinoma of the esophagus has risen dramatically.

Barrett's esophagus, a complication of gastroesophageal reflux disease (GERD), is a risk factor for the development of adenocarcinoma of the esophagus.

Risk factors for adenocarcinoma of the esophagus include male gender, obesity, poor nutrition, and smoking.

Symptoms

• Backwards movement of food through the esophagus and possibly mouth (regurgitation)
• Chest pain unrelated to eating
• Difficulty swallowing solids or liquids
• Heartburn
• Vomiting blood
• Weight loss

Signs and tests

Tests used to help diagnose esophageal cancer may include:

• Barium swallow
• Esophagogastroduodenoscopy (EGD) and biopsy
• Chest MRI or thoracic CT (usually used for helping to determine the stage of the disease)
• PET scan (sometimes useful for determining the stage of disease, and whether surgery is possible)

Stool sample testing may show signs of hidden (occult) blood in the stool.

Treatment

When esophageal cancer is only in the esophagus and has not spread elsewhere, surgery is the treatment of choice. The goal of surgery, in most cases, is to cure the patient. In some circumstances chemotherapy, radiation, or a combination of the two will be used instead of surgery, or to make surgery easier to perform.

If the patient cannot tolerate surgery or the cancer has spread to other organs, chemotherapy or radiation may be used to help reduce symptoms. This is called palliative therapy. In such circumstances, however, the disease is usually not curable.

Other treatments that may be used to improve a patient's ability to swallow include endoscopic dilation of the esophagus (sometimes with placement of a stent), or photodynamic therapy. In photodynamic therapy, a special drug is injected into the tumor, which is then exposed to light. The light activates the medicine that attacks the tumor.