Esophageal Cancer: The Basics
The esophagus is a tube made out of muscle that connects your mouth to your stomach. Esophageal cancer is caused by esophageal cells growing out of control. As the number of cells grows, they form into a tumor.
Esophageal cancer that has spread from the esophagus to another part of the body is called metastatic cancer.
- Smoking and drinking alcohol, especially doing both.
- Health issues like reflux (heartburn) and Barrett’s esophagus.
- Weighing more than you should.
- Eating a lot of pickled, dried, or smoked foods.
- Certain genetic syndromes like Tylosis, Zollinger-Ellison syndrome, Howel Evans’ syndrome, Bloom syndrome, and Fanconi anemia.
Signs of Esophageal Cancer
Signs can be:
- Trouble with swallowing which can make you lose weight.
- Feeling like food is getting stuck in your chest.
- Pain when swallowing.
Diagnosis of Esophageal Cancer
When your healthcare provider thinks you may have esophageal cancer, they will do a full exam of your body and ask you questions about your health history. They also may order tests:
These tests are important, but a biopsy is the only way to know for sure if you have cancer. A biopsy:
- Looks at a piece of the esophagus for cancer cells.
- Is used to find out the cancer type, how normal it is [grade], and if it has spread.
- May look at samples from lymph nodes to check for cancer.
A pathology report sums up these results and is sent to your healthcare provider, often 5-10 days after the biopsy. This report is an important part of planning your treatment. You can ask for a copy of your report for your records.
Staging Esophageal Cancer
To guide treatment, esophageal cancer is "staged." This stage is based on
- Size and location of the tumor.
- Whether cancer cells are in the lymph nodes.
- Whether cancer cells are in other parts of the body.
Stages range from stage I (smallest, most confined tumors) to stage IV (tumors that have spread to other parts of the body, also called metastatic cancer). The stage and type of esophageal cancer will guide your treatment plan.
Often, these treatments are used:
- Surgery can be used in some cases.
- Radiation is the use of high-energy x-rays to kill cancer cells.
- Chemotherapy, medications used to kill cancer cells, can be used to treat cancer that may have spread.
- Targeted therapy, medications that work specifically against a certain target, can be used to treat certain types of esophageal cancer.
- These treatments may be used alone or in combination.
This article is a basic guide to esophageal cancer. You can learn more about your type of esophageal cancer and treatment by using the links below.Surgical Procedures: Esophagectomy
American Cancer Society, Esophagus Cancer, https://www.cancer.org/cancer/esophagus-cancer.html
NCCN Guidelines, Esophageal and Esophagastic Junction Cancers, V.1.2019, https://www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf(log in required).
SEER Statistics, Esophageal Cancer, https://seer.cancer.gov/statfacts/html/esoph.html
Burt, B. M., Groth, S. S., Sada, Y. H., Farjah, F., Cornwell, L., Sugarbaker, D. J., & Massarweh, N. N. (2017). Utility of Adjuvant Chemotherapy After Neoadjuvant Chemoradiation and Esophagectomy for Esophageal Cancer. Annals of Surgery.
D’Journo, X. B., & Thomas, P. A. (2014). Current management of esophageal cancer. Journal of Thoracic Disease, 6(2), S253-S264.
Haefner, M. F., Lang, K., Krug, D., Koerber, S. A., Uhlmann, L., Kieser, M., ... & Sterzing, F. (2015). Prognostic factors, patterns of recurrence and toxicity for patients with esophageal cancer undergoing definitive radiotherapy or chemo-radiotherapy. Journal of Radiation Research, 56(4), 742-749.
Kadri S, Lao-Sirieix P, O'Donovan M, et al. (2010). Acceptability and accuracy of a non-endoscopic screening test for Barrett's oesophagus in primary care: cohort study. BMJ, 341, c4372, c4667.
Keith, B. (2016). Esophageal Cancer. Mosby's Oncology Nursing Advisor: A Comprehensive Guide to Clinical Practice, 58.
Kutup, A., Nentwich, M. F., Bollschweiler, E., Bogoevski, D., Izbicki, J. R., & Hölscher, A. H. (2014). What should be the gold standard for the surgical component in the treatment of locally advanced esophageal cancer: transthoracic versus transhiatal esophagectomy. Annals of Surgery, 260(6), 1016-1022.
Napier, K. J., Scheerer, M., & Misra, S. (2014). Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities. World J Gastrointest Oncol, 6(5), 112-20.
Purim, O., Beny, A., Inbar, M., Shulman, K., Brenner, B., Dudnik, E., ... & Sarid, D. (2018). Biomarker-driven therapy in metastatic gastric and esophageal cancer: Real-life clinical experience. Targeted oncology, 1-10.
Roeder, F., Nicolay, N. H., Nguyen, T., Saleh-Ebrahimi, L., Askoxylakis, V., Bostel, T., ... & Huber, P. E. (2014). Intensity modulated radiotherapy (IMRT) with concurrent chemotherapy as definitive treatment of locally advanced esophageal cancer. Radiation Oncology, 9(1), 191.
Salehi, M., Moradi-Lakeh, M., Salehi, M. H., Nojomi, M., & Kolahdooz, F. (2013). Meat, fish, and esophageal cancer risk: a systematic review and dose-response meta-analysis. Nutrition Reviews, 71(5), 257-267.
Saltzman, J. R., Gibson, M. K., & Goldberg, R. M. (2018). Clinical manifestations, diagnosis, and staging of esophageal cancer. UpToDate, Waltham, MA.
Shaheen, N. J., Falk, G. W., Iyer, P. G., & Gerson, L. B. (2016). ACG clinical guideline: diagnosis and management of Barrett’s esophagus. The American Journal of Gastroenterology, 111(1), 30-50.
Spechler, S. J. (2013). Barrett esophagus and risk of esophageal cancer: a clinical review. JAMA, 310(6), 627-636.
Spechler, S. J., & Souza, R. F. (2014). Barrett's esophagus. New England Journal of Medicine, 371(9), 836-845.
Stahl M, Walz M, Stuschke M, et al. (2009). Phase III comparison of preoperative chemotherapy compared with chemoraditherpy in patients with locally advanced adenocarcinoma of the esophagogastric junction. Journal of Clinical Oncology, 27, 836.
Takeuchi, M., Suda, K., Hamamoto, Y., Kato, M., Mayanagi, S., Yoshida, K., ... & Takeuchi, H. (2018). Technical feasibility and oncologic safety of diagnostic endoscopic resection for superficial esophageal cancer. Gastrointestinal endoscopy, 88(3), 456-465.
Talukdar, F. R., di Pietro, M., Secrier, M., Moehler, M., Goepfert, K., Lima, S. S. C., ... & Herceg, Z. (2018). Molecular landscape of esophageal cancer: implications for early detection and personalized therapy. Annals of the New York Academy of Sciences, 1434(1), 342-359.
Tsottles, N.D. & Byrnes, P. (2011). Esophageal Cancer In Yarbro C.H, Wujcik, D. & Gobel, B.H. (2011). Cancer Nursing (pp. 1295-1315). Sudbury, MA: Jones and Bartlett.
Watanabe, M., Baba, Y., Nagai, Y., & Baba, H. (2013). Minimally invasive esophagectomy for esophageal cancer: an updated review. Surgery Today, 43(3), 237-244.