Esophageal Cancer
The esophagus (ĕ-sof´ah-gus) is the hollow, muscular tube that moves food and liquid from the mouth to the stomach. The wall of the esophagus is made up of several layers of tissue, including muscle, connective tissue that supports the framework of the body, and an inner lining called the mucosa.

Cancer is an abnormal growth of cells (the building blocks that make up the tissue and organs in the body).Old or damaged cells usually die, and new cells take their place. But sometimes, the process goes wrong or a single cell starts to grow uncontrollably until it becomes a mass of tissue called a tumor. Sometimes, tumors are benign and are not life threatening; other times, the tumors are cancerous (malignant) and can invade surrounding tissues or spread to other areas of the body.

The American Cancer Society (ACS) estimates that about 17,000 new cases of esophageal cancer will be diagnosed and nearly 16,000 patients will die from esophageal cancer in 2015 in the United States. The incidence of esophageal cancer is higher in other areas of the world, such as Asia and Africa. Four out of five cases of esophageal cancer in the US occur in men.

Types of Esophageal Cancer
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Types of Esophageal Cancer

There are two main types of esophageal cancer:

  1. Adenocarcinoma - the most common esophageal cancer in the US and primarily affects older, white men. The incidence of adenocarcinoma has increased markedly over the past two decades for unknown reasons.  Adenocarcinoma begins in the glandular cells (cells that produce and release fluids such as mucous), usually in the lower part of the esophagus near the stomach.
  2. Squamous cell carcinoma - the most common type of esophageal cancer worldwide. This type of esophageal cancer starts in squamous cells (thin, flat cells that line the esophagus) and is found most often in the upper and middle parts of the esophagus.

Causes and Symptoms of Esophageal Cancer
Cough
A forceful release of air from your lungs 
Hoarseness
Being hoarse, having a scratchy voice 
Dysphagia
Difficulty swallowing 
Unexplained weight loss
Losing weight without trying
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Causes and Symptoms of Esophageal Cancer

Smoking, heavy alcohol use, and diseases such as achalasia can cause squamous cell carcinoma, while gastroesophageal reflux disease (GERD) can lead to Barrett’s esophagus and increase the risk of developing esophageal adenocarcinoma. 

Early esophageal cancer usually has no signs or symptoms. As the disease advances, the symptoms may include difficulty swallowing (dysphagia), unintentional weight loss, pain or pressure behind the breastbone, hoarseness, and coughing. 

If you think you have any of the signs or symptoms listed above and have been diagnosed with either GERD or Barrett’s esophagus, speak with your primary physician about your risk for esophageal cancer. You can print these sample questions to use as a basis for discussion with your doctor. 

The sooner esophageal cancer is found, the better the chance of recovery; however, esophageal cancer is often found at an advanced stage when it is diagnosed. At later stages, esophageal cancer can be treated, but rarely can be cured.
Diagnosis and Treatment Options
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Diagnosis and Treatment Options

Tests that are most often used to examine the esophagus and find signs of cancer are barium swallow (upper GI series) and esophagoscopy that may include biopsy.  

Normal barium swallow

Normal barium swallow

For more information on these tests, visit our common diagnostic tests page.  

Stages of Esophageal Cancer 
Once you have been diagnosed with cancer, imaging studies such as a chest and abdominal computed tomography (CT) scan, a positron emission tomography (PET) scan, and endoscopic ultrasound will be performed to determine the extent, or stage, of the tumor.

The stage of your esophageal cancer will help you understand how advanced the disease is, whether the cancer has spread to other parts of your body, and what treatments to consider.

A higher stage tumor means that the cancer is more advanced and has a worse outcome (prognosis).

Surgery, performed by a cardiothoracic surgeon, is the most common treatment for esophageal cancer. 

Surgery

If you and your cardiothoracic surgeon decide to move forward with surgery, you likely would undergo an esophagectomy, which is an operation to remove the cancer along with most of the esophagus. After the cancerous part of your esophagus is removed, your surgeon will connect the remaining part of the esophagus to your stomach. If the stomach cannot be used due to involvement by the cancer or previous stomach surgery, the large or small intestine may be used to replace the esophagus.

If you and your cardiothoracic surgeon decide to move forward with surgery, you likely would undergo an esophagectomy, which is an operation to remove the cancer along with most of the esophagus. After the cancerous part of your esophagus is removed, your surgeon will connect the remaining part of the esophagus to your stomach. If the stomach cannot be used due to involvement by the cancer or previous stomach surgery, the large or small intestine may be used to replace the esophagus.

Conexión durante una esofagectomía transtorácica
Equipo quirúrgico realiza una esofagectomía transtorácica
After most surgical procedures, you may have one or two tubes inserted into your chest to help fluid drain out of the area and tube in your nose to drain the stomach. Once the drainage has decreased, the tubes will be removed.
Recovery
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Recovery

As with any surgery or operation, there are risks involved. Possible complications depend on the extent of the surgery and your overall health. Serious complications can include bleeding, infections, pneumonia, hoarseness, or a leak or scarring at the connection between the esophagus and the stomach.

You can expect to go home from the hospital 5-7 days after surgery. While in the hospital, it is important that you work on deep breathing, coughing, and walking to keep your lungs functioning and to prevent blood clots. 

Keeping yourself in good health and staying active will reduce your chance of complications and make recovery after surgery much easier. It also is essential to maintain good nutrition before surgery. Many patients with esophageal cancer find it hard to eat because they have trouble swallowing. Some patients temporarily may require a feeding tube through their nose (Dobhoff tube) or small bowel (jejunostomy tube).  

If you require preoperative chemotherapy and radiation, restaging studies including a chest and abdominal CT scan will be done to confirm that the cancer has not spread elsewhere in the body. You also will need to see your cardiothoracic surgeon again before the surgery to make sure that you have recovered adequately from your chemoradiation before proceeding with surgery.


Reviewed by: Robbin G. Cohen, MD, with assistance from John Hallsten and Travis Schwartz
August 2016 

Previously reviewed by: Jules Lin, MD and Rishindra Reddy, MD 
 

Questions for Your Doctor
Will my condition ever get better without treatment? Can it get worse?
What is the survival rate for the type of cancer I have?
What are my treatment options?
What are the potential side effects of this treatment?
How often do you perform the procedure that you’ve recommended for me?
What is the success rate for that specific procedure?
Are there any lifestyle changes I can make now?
When should I seek medical attention if I am experiencing symptoms following treatment?
Will I have any restrictions after treatment? (activity, driving, etc)
How long will I be out of work?
Will I have to change my diet and/or lifestyle after treatment?
Will I have to take any long-term medications?
How likely is it that I will need additional treatment later?
Are there any clinical trials relevant to my cancer?
If I want a second opinion, how would I get one?
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