Esophageal cancer

Alternative names

Cancer - esophagus

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.