The esophagus is a muscular tube that’s responsible for moving food from the throat to the stomach. Esophageal cancer can occur when a malignant tumor forms in the lining of the esophagus. As the tumor grows, it can affect the deep tissues and muscle of the esophagus. A tumor can appear anywhere along the length of the esophagus, including the junction of the esophagus and stomach, or where the two meet.
There are two common types of esophageal cancer.
Squamous cell carcinoma occurs when cancer starts in the flat, thin cells that make up the lining of the esophagus. This form most often appears in the top or middle of the esophagus, but it can appear anywhere.
Adenocarcinoma occurs when cancer starts in the glandular cells of the esophagus that are responsible for the production of fluids such as mucus. Adenocarcinomas are most common in the lower portion of the esophagus.
During the early stages of esophageal cancer, you probably won’t experience any symptoms. As your cancer progresses, you may experience:
- unintentional weight loss
- difficulty or painful swallowing
- frequent choking while eating
- food coming back up the esophagus
- chest pain
As with most cancers, the cause of esophageal cancer isn’t yet known. It’s believed to be related to abnormalities, or mutations, in the DNA of the cells related to the esophagus. These mutations signal the cells to multiply more rapidly than normal cells. These mutations also disrupt the signal for these cells to die when they should. This causes them to accumulate and become tumors.
Experts believe that the irritation of esophagus cells contributes to the development of cancer. Some habits and conditions that can cause irritation include:
- consuming alcohol
- having a reflux disorder, such as gastroesophageal reflux disease (GERD)
- being overweight
- not eating enough fruits and vegetables
- having Barrett’s esophagus, which is a condition characterized by damaged esophageal lining due to GERD
People at increased risk of esophageal cancer include the following:
- Men are three times as likely to develop esophageal cancer as women.
- Esophageal cancer is more common in African-Americans than in other races.
- Your chances of developing esophageal cancer increase with age. If you’re over the age of 45, your risk may be higher.
Testing methods for diagnosing esophageal cancer can include the following:
- An endoscopy involves the use of an instrument with a camera attached to a tube that goes down your throat and allows your doctor to view the lining of your esophagus to check for abnormalities and irritation.
- A barium swallow is an X-ray imaging test that allows your doctor to see the lining of your esophagus. To do this, you’ll swallow a chemical called barium while the images are being obtained.
- A biopsy is a process in which your doctor removes a sample of the suspicious tissue with the help of an endoscope and sends it to a lab for testing.
Your doctor may recommend surgery if the cancer hasn’t spread to other parts of your body. Your doctor may instead recommend chemotherapy or radiation therapy as the best course of action. These treatments are also sometimes done to shrink tumors in the esophagus so that they can be removed more easily with surgery.
If the cancer hasn’t grown past the superficial layers of the esophagus, your doctor can remove the tumor using an endoscope. In more serious cases, a portion of the esophagus and sometimes the lymph nodes around it are removed. The tube is reconstructed with tissue from the stomach or large intestine. In severe cases, a portion of the top of the stomach may be removed as well.
The risks of surgery can include bleeding, leaking in the area where the rebuilt esophagus was attached to the stomach, and infection.
Chemotherapy involves the use of drugs to attack cancer cells. Chemotherapy may be used before or after surgery. It sometimes accompanies the use of radiation therapy.
Chemotherapy does have several side effects. Most are related to the fact that the drugs used also kill healthy cells. Your side effects will vary depending on the drugs your doctor uses. These side effects can include:
- hair loss
Radiation therapy uses beams of radiation to kill cancer cells. Radiation may be administered externally with the use of a machine or internally with a device placed near the tumor, which is called brachytherapy. Radiation is commonly used along with chemotherapy and side effects are usually more severe when combined treatment is used. The side effects of radiation can include:
- skin that looks sunburned
- pain or difficulty when swallowing
- painful ulcers in the lining of the esophagus
It’s possible to experience some side effects of treatment long after treatment finishes. These can include esophageal stricture, where the tissue becomes less flexible and can cause the esophagus to narrow, making it painful or difficult to swallow.
If your esophagus is obstructed as a result of cancer, your doctor may be able to implant a stent, or tube made of metal, into your esophagus to keep it open.
They may also be able to use photodynamic therapy, which involves injecting the tumor with a photosensitive drug that attacks the tumor when exposed to light.
Your chances for recovery improve the earlier the cancer is found. Esophageal cancer is usually found in the later stages when it can only be treated but not cured. Your chances of survival may improve with surgery if the cancer hasn’t spread outside of your esophagus.
Although there’s no sure way to prevent esophageal cancer, there are a few steps you can take to lower your risk. Avoiding cigarettes and chewing tobacco is key. Limiting your consumption of alcohol is also thought to lower your risk. Eating a diet with lots of fruits and vegetables and maintaining a healthy weight may also be effective ways to avoid esophageal cancer.