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Esophageal cancer

Definition

Esophageal cancer is a cancerous (malignant) 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 not very common in the United States. It occurs most often in men over 50 years old.

Two main types of esophageal cancer exist: squamous cell carcinoma and adenocarcinoma. These two types look different from each other under the microscope.

Squamous cell esophageal cancer is linked to smoking and alcohol consumption.

Barrett's esophagus, a complication of gastroesophageal reflux disease (GERD), increases the risk for adenocarcinoma of the esophagus. This is the more common type of esophageal cancer. Other risk factors for adenocarcinoma of the esophagus include:

• Male gender
• Obesity
• 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
• Chest MRI or thoracic CT (usually used to help determine the stage of the disease)
• Endoscopic ultrasound (also sometimes used to determine the stage of disease)
• Esophagogastroduodenoscopy (EGD) and biopsy
• PET scan (sometimes useful for determining the stage of disease, and whether surgery is possible)

Stool testing may show small amounts of blood in the stool.

Treatment

When esophageal cancer is only in the esophagus and has not spread, surgery is the treatment of choice. The goal of surgery is to remove the cancer.

See:

• Esophagectomy
• Esophagectomy - minimally invasive

Sometimes chemotherapy, radiation, or a combination of the two may be used instead of surgery, or to make surgery easier to perform.

If the patient is too ill to have major 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 cases, the disease is usually not curable.

Other treatments that may be used to help the patient swallow include:

• Endoscopic dilation of the esophagus (sometimes with placement of a stent to keep the esophagus dilated).
• Photodynamic therapy, in which a special drug is injected into the tumor and is then exposed to light. The light activates the medicine that attacks the tumor.

Support Groups

Patients can often ease the stress of illness by joining a support group of people who share common experiences and problems. See cancer - support group.

Expectations (prognosis)

Esophageal cancer is usually not curable. When the cancer has not spread outside the esophagus, surgery may improve the chances of survival.

Radiation therapy is used instead of surgery in some cases where the cancer has not spread outside the esophagus.

For patients whose cancer has spread, a cure is generally not possible. Treatment is directed toward relieving symptoms.

Complications

• Difficulty swallowing
• Pneumonia
• Severe weight loss from not eating enough
• Spread of the tumor to other areas of the body

Calling your health care provider

Call your health care provider if you have difficulty swallowing with no known cause and it does not get better, or if you have other symptoms of esophageal cancer.

Prevention

The following may help reduce your risk of squamous cell cancer of the esophagus:

• Avoid smoking
• Limit or do not drink alcoholic beverages

People with symptoms of severe gastroesophageal reflux should seek medical attention.

Screening with EGD and biopsy in people with Barrett's esophagus may lead to early detection and improved survival. People who are diagnosed with Barrett's esophagus should consider getting regular checkups for esophageal cancer.

References

Das A. Tumors of the esophagus. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 46.

National Cancer Institute. Esophageal Cancer Treatment PDQ. Updated July 20, 2010.

National Comprehensive Cancer Network, Inc. NCCN Clinical Practice Guidelines in Oncology. Esophageal Cancer. V2. 2010. Accessed January 22, 2011.

Review Date: Jan 31, 2011
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.