Facts
Esophageal cancer starts in the inner layer of the esophagus, a 10-inch long, hollow, muscular tube that connects the throat to the stomach. (The walls of the esophagus contract to push food down into the stomach when you swallow.) If the cancer spreads, it can affect lymph nodes, blood vessels, the lungs, liver, stomach, and other parts of the body.
There are two major types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. Other types of esophageal cancers exist, but are very rare. Squamous cells line the esophagus. Squamous cell carcinoma usually grows in the upper and middle part of the esophagus. Adenocarcinoma begins in the glandular tissue in the lower part of the esophagus at the junction between the esophagus and the stomach.
Treatment is similar for both of these types.
Esophageal cancer is three to four times more common among men than women. African-Americans are more likely to have squamous cell cancer of the esophagus, but not necessarily adenocarcinoma.
Other risk factors include obesity and longstanding gastroesophageal reflux disease (risk factors for adenocarcinoma)
Symptoms
According to the American Society of Clinical Oncology, symptoms for esophageal cancer are similar to conditions other than cancer. However, you should alert your doctor if you are experiencing any of these symptoms for a prolonged period of time:
- Difficulty and pain with swallowing, particularly when eating meat, bread, or raw vegetables (As the tumor grows, it can block the pathway to the stomach. Even liquid may be painful to swallow.)
- Pressure or burning in the chest
- Indigestion or heartburn
- Vomiting
- Frequent choking on food
- Unexplained weight loss
- Coughing or hoarseness
- Pain behind the breastbone or in the throat
Diagnosis
After your doctor has given you a thorough examination, there are several tests that may be performed to help make the diagnosis: an esophagram, upper endoscopy, endoscopic ultrasound, and possibly a bronchoscopy.
Esophagram – For this test, you will swallow a liquid containing barium and then a your doctor will take a series of X-rays. The barium coats the surface of the esophagus, making tumors or other abnormalities easier to see on the X-ray. If there is an abnormality, doctors may order an upper endoscopy and biopsy to determine if cancer is present.
Upper endoscopy (also called esophagus-gastric-duodenoscopy, or EGD). This test allows the doctor to see the lining of the esophagus. A thin, flexible tube with a light and video camera, called an endoscope, is passed down the throat into the esophagus. If an abnormality is found, a biopsy will be performed to determine if it is cancerous or not. An endoscopy can also help expand the blocked area, so that food can temporarily pass through until treatment can begin.
Endoscopic ultrasound. This procedure is often done at the same time as the upper endoscopy. During an ultrasound, sound waves provide a picture of structures inside the body. During an endoscopic ultrasound, a transducer (the machine that produces the sound waves) is inserted into the esophagus through the mouth. The ultrasound can identify if the tumor invades the wall of the esophagus, how deep the tumor is, and whether lymph nodes are involved.
Bronchoscopy. Similar to an upper endoscopy, the doctor passes a thin, flexible tube with a light on the end into the mouth or nose, down through the windpipe, and into the breathing passages of the lungs. A bronchoscopy may be performed if a patient’s tumor is located in the upper two-thirds of the esophagus to determine if the tumor is invading the person’s airway, including the trachea (windpipe) and bronchial tree (area where the windpipe branches out into the lungs).
Biopsy. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The tissue sample removed during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).
(Information provided by the American Society of Clinical Oncology).
Imaging tests
These imaging tests may be used before treatment begins to see if cancer has spread beyond the esophagus.
CT scans create a three-dimensional picture of the inside of the body with an X-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. A CT scan can check for the spread of cancer in the lungs, liver, and other organs.
Magnetic resonance imaging (MRI) uses magnetic fields to produce detailed images of the body. A contrast medium may be injected into your vein to create a clearer picture.
Positron emission tomography (PET) scan creates pictures of organs and tissues inside the body using a radioactive substance that is injected into and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by the scanner, which produces the images.