Does Esophageal Cancer Frequently Lead to Lung Cancer?

Where does esophageal cancer commonly spread to?

Researchers have found that, after the liver, the lungs are the next most common metastatic site for esophageal cancer. Metastasis to the bones or brain can also happen.

How does esophageal cancer spread to the lungs?

Esophageal cancer can spread in several ways. These include:

• locally through surrounding tissue
• via the bloodstream
• by the lymphatic system

A 2017 study notes that the nature of the wall of the esophagus means there’s less of a barrier for esophageal cancer to spread locally to nearby tissues in the neck and chest. This includes the lungs.

Tumor location may also play a role. A 2019 study found that tumors in the upper esophagus were more likely to spread to the lungs. Tumors in the lower esophagus were more likely to spread to the liver.

Researchers note that the lungs and liver are both richly supplied with blood, and that blood from the upper esophagus first drains into the lung. This could explain the correlation between upper esophageal tumors and metastasis to the lung.

When is esophageal cancer typically diagnosed?

Esophageal cancer is an aggressive type of cancer. This means it’s able to grow and spread quickly.

Only about 1 in 8 esophageal cancers are diagnosed while still at an early stage. Most aren’t diagnosed until symptoms develop, like trouble swallowing. At this point, the cancer is typically at a more advanced stage.

About 50% of esophageal cancers have spread to lymph nodes or other distant organs at diagnosis, according to a 2017 study.

Indeed, a 2020 study found that the most common stage at diagnosis for the two most common types of esophageal cancer was stage 4.

How is esophageal cancer that has spread to the lungs treated?

Esophageal cancer that has spread to the lungs is classified as stage 4, or metastatic, cancer. As such, treatment is usually systemic, meaning it acts throughout the entire body instead of locally.

Treatment typically involves one or a combination of the following:

• chemotherapy
• targeted therapy with drugs like trastuzumab (Herceptin) or larotrectinib (Vitrakvi)
• immunotherapy with drugs such as nivolumab (Opdivo) or ipilimumab (Yervoy)

The American Cancer Society notes that surgery to remove the cancer isn’t typically a good option once it has spread.

However, a 2017 study found that a small percentage of people with metastatic esophageal cancer received an esophagectomy.

Palliative treatments are also used for esophageal cancer that’s spread to the lungs. These treatments help reduce symptoms and improve quality of life rather than cure cancer.

Palliative treatments may include:

• endoscopic procedures to help open an esophagus that’s narrow or blocked
• chemotherapy to help control the growth and symptoms of the cancer
• radiation therapy to help with pain and trouble swallowing
• pain medications
• anxiety medications or relaxation techniques to help with stress associated with shortness of breath
• draining fluid that’s collected around the lungs

What’s the outlook for people with esophageal cancer?

Overall, the outlook for people with metastatic esophageal cancer is poor. A 2021 study involving people with esophageal cancer that had spread to the lung found that the median survival time was 4 months.

The table below shows the 5-year relative survival rates for people with esophageal cancer according to the National Cancer Institute’s SEER Database. The data is from 2013–2019.

A relative survival rate is an estimate of how long someone with a specific condition may live after their diagnosis compared with someone without the condition.

For example, a 5-year relative survival rate of 48.8% means someone with that condition is 48.8% as likely to live for 5 years as someone without the condition.

Every person with cancer is different. Statistics don’t reflect individual factors or recent advances in treatment. An open conversation with your care team can give you a better sense of your condition and outlook.

Takeaway

Esophageal cancer tends to grow and spread quickly. Many times, a diagnosis isn’t made until cancer has spread to more distant tissues. The lungs are a common metastatic site for esophageal cancer.

When esophageal cancer has spread to the lungs, it’s typically treated with some combination of chemotherapy, targeted therapy, or immunotherapy. Palliative treatments are used as well.

The outlook for people with metastatic esophageal cancer is poor. However, it’s still important to work with your care team about your outlook and treatment options. It’s possible you may be eligible for a clinical trial that’s testing new treatments.