The esophagus is a muscular tube that is responsible for moving food from the throat to the stomach. Esophageal cancer occurs when a malignant (cancerous) tumor forms in the esophagus lining. As it grows it can affect the deep tissues and muscle of the esophagus. A tumor can appear anywhere along the length of the esophagus, but in the United States they’re most common toward the bottom.
There are two common forms of esophageal cancer:
- Squamous cell carcinoma occurs when the cancer starts in the flat, thin cells that make up the lining of the esophagus. This form most often appears in the top or middle of the esophagus, but it can appear anywhere.
- Adenocarcinoma occurs when cancer starts in the glandular cells of the esophagus that are responsible for production of fluids such as mucus. Adenocarcinomas are most common in the lower portion of the esophagus.
The cause of esophageal cancer, like most cancers, is not yet known. It’s believed to be related to abnormalities in the DNA of the cells related to the esophagus. The abnormal cells develop mutations that cause them to multiply more rapidly than normal cells. These abnormal cells typically don’t die when they should. This causes them to accumulate and become tumors.
Experts believe that irritation of the cells of the esophagus contributes to the development of cancer. Some habits and conditions that can cause irritation include:
- consuming alcohol
- having a reflux disorder such as gastroesophageal reflux disease (GERD)
- being overweight
- not eating enough fruits and vegetables
- having Barrett’s esophagus (a damaged esophageal lining due to GERD)
According to the National Cancer Institute, men are three times as likely to develop esophageal cancer as women. The cancer is more common in African Americans than in other races. Your chances of developing esophageal cancer increase with age. If you’re over the age of 45, your risk may be higher.
During the early stages of esophageal cancer, you probably won’t experience any symptoms. As your cancer progresses, you might experience:
- weight loss without trying
- frequent choking while eating
- food coming back up the esophagus
- chest pain
Some of the testing methods for diagnosing esophageal cancer include:
- the use of an instrument called an endoscope. A camera attached to a tube goes down your throat and allows your doctor to view the lining of your esophagus to check for abnormalities and irritation.
- an X-ray taken after you ingest a chemical called barium that allows your physician to see the lining of your esophagus. This is known as a barium swallow.
- a biopsy. This is a process in which a sample of the suspicious tissue is removed with the help of an endoscope and sent to a lab for testing
If cancer has not spread to other parts of your body, your doctor might recommend surgery. Alternately, your physician may feel that chemotherapy or radiation therapy would be the best course of action. Sometimes, these treatments are done to prepare for surgery. These therapies used to shrink tumors in the esophagus so that they can be removed more easily with surgery.
If your cancer has not grown past the superficial layers of the esophagus, your doctor can remove your tumor using an endoscope. In more serious cases, a portion of your esophagus and sometimes the lymph nodes around it are removed. The tube is rebuilt with tissue from your stomach or large intestine. In severe cases, a portion of the top of the stomach may be removed as well.
Side effects of surgery include bleeding, leaking in the area where the rebuilt esophagus was attached to the stomach, and infection.
Chemotherapy employs drugs to attack cancerous cells. Chemotherapy may be used before or after surgery. It sometimes accompanies the use of radiation therapy. Chemotherapy has a host of side effects. Most are related to the fact that the drugs used also kill healthy cells. Your side effects will vary depending on the drugs your doctor uses, They can include hair loss, nausea, and vomiting.
Radiation therapy uses beams of radiation to kill cancer cells. Radiation may be administered externally with the use of a machine or internally with a device placed near the tumor (brachytherapy). Radiation is commonly used along with chemotherapy. Some radiation side effects include skin that looks sunburned and pain or difficulty when swallowing.
If your esophagus is obstructed as a result of cancer, your doctor may implant a stent, or tube made of metal, into your esophagus to keep it open. Photodynamic therapy, which involves injecting your tumor with a photosensitive drug that attacks the tumor when exposed to light, is also sometimes used.
Unfortunately, there is usually no cure for esophageal cancer. If your cancer has not spread outside your esophagus, your chances of survival may improve following surgery.
Although there is no sure way to prevent esophageal cancer, there are a few steps you can take to lower your risk. Avoiding smoking or chewing tobacco is key. Limiting your consumption of alcohol is thought to lower your risk as well. Eating a diet with lots of fruits and vegetables and maintaining a healthy weight may also be effective ways to avoid esophageal cancer.
Written by: Carmella Wint and Marijane Leonard
Medically reviewed by George Krucik, MD