Cancer - esophagus

Alternative names
Esophageal cancer

Definition
Esophageal cancer is a malignant tumor of the esophagus, the muscular tube that transports food from the mouth to the stomach.

Causes, incidence, and risk factors

Esophageal cancer is relatively uncommon in the United States, and occurs most often in men over 50 years old. It affects less than 5 in 100,000 people. There are two main types of esophageal cancer, squamous cell carcinoma and adenocarcinoma. These two types are distinguished by the way they look under the microscope.

Squamous cell cancer is associated with smoking and alcohol consumption. The incidence of this disease in the United States has remained relatively constant, while the incidence of adenocarcinoma of the esophagus has risen dramatically.

Barrett’s esophagus, a complication of gastroesophageal reflux disease (GERD), is a risk factor for the development of adenocarcinoma of the esophagus.

Risk factors for adenocarcinoma of the esophagus include male gender, obesity, western diet, and smoking.

Symptoms

     
  • Difficulty swallowing solids or liquids  
  • Regurgitation of food  
  • Heartburn  
  • Weight loss  
  • Vomiting blood  
  • Chest pain unrelated to eating

Signs and tests

     
  • Barium swallow  
  • EGD (esophagogastroduodenoscopy) and biopsy  
  • Chest MRI or thoracic CT (usually used for helping to determine the stage of the disease)  
  • PET scan (sometimes useful for determine stage of disease and whether surgery is possible)  
  • Evidence of occult (hidden) blood in stool

Treatment

When esophageal cancer is localized to the esophagus and has not spread elsewhere, surgery is the treatment of choice. The goal of surgery, in most cases, is to cure the patient. In some circumstances chemotherapy, radiation, or a combination of the two will be used to make surgery easier to perform.

In patients who cannot tolerate surgery, or in situations where the cancer has spread to other organs (metastatic disease), chemotherapy or radiation may be used to help alleviate symptoms (palliative therapy). In such circumstances, however, the disease is usually not curable.

Other treatments that may be used to improve a patient’s ability to swallow include endoscopic dilation of the esophagus (sometimes with placement of a stent) or photodynamic therapy.

Support Groups
The stress of illness can often be eased by joining a support group of people who share common experiences and problems. See cancer - support group.

Expectations (prognosis)

Esophageal cancer is a very difficult disease to treat, but it can be cured in patients whose disease is confined to the esophagus. In circumstances in which surgery can be performed, cure rates are in the range of 25%.

In some circumstances in which the cancer is localized to the esophagus and radiation therapy is used instead of surgery, cure is possible but is less likely than with surgery.

For patients whose cancer has spread outside the esophagus, cure is generally not possible and treatment is directed toward relief of symptoms.

Complications

     
  • Severe weight loss resulting from inadequate food intake or difficulty swallowing  
  • Spread of the tumor to other areas of the body

Calling your health care provider
Call your health care provider if difficulty with swallowing persists that is not attributed to other causes or if other symptoms develop that may indicate esophageal cancer.

Prevention

Avoiding smoking and reducing or eliminating alcohol consumption may help reduce the risk of developing squamous cell cancer of the esophagus.

Surveillance EGD (esophagogastroduodenoscopy) and biopsy in people with Barrett’s esophagus may lead to early detection and improved survival. People with symptoms of severe reflux should seek medical attention.

People diagnosed with Barrett’s esophagus should see a gastroenterologist (gastrointestinal specialist) at least every year.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.