Table of Contents
Esophageal Cancer Definition
Adenocarcinoma is the more common form and nearly always originates near the esophageal entry to the STOMACH. Esophageal adenocarcinoma is nearly always a progression of BARRETT’S ESOPHAGUS, a condition in which the tissue structure of the esophagus changes to resemble that of the intestines. Adenocarcinoma can develop only in this altered tissue. Squamous cell carcinoma can develop anywhere along the esophagus and is more common in people who smoke.
However, smoking, particularly in combination with excessive ALCOHOL consumption, is a major risk factor for either form of esophageal cancer. People who have untreated GASTROESOPHAGEAL REFLUX DISORDER (GERD) or ACHALASIA also face increased risk, as these conditions expose the esophagus to repeated irritation and INFLAMMATION. Though five-year survival rates have increased fourfold since the 1960s, esophageal cancer remains among the most deadly cancers because it shows few symptoms until the cancer is quite advanced.
Symptoms of Esophageal Cancer and Diagnostic Path
The most common symptom is difficulty swallowing (dysphagia), particularly the sensation of food getting stuck when swallowing. Other symptoms include unintentional weight loss and sensations that are a combination of pressure and DYSPEPSIA (heartburn). Unfortunately these symptoms are vague enough that many people can ignore them or perceive them as insignificant, allowing the cancer to progress undetected.
The diagnostic path may include BARIUM SWALLOW, a series of X-rays to visualize the upper gastrointestinal tract, and ENDOSCOPY, in which the gastroenterologist directly views the esophagus using a flexible, lighted scope. Endoscopy allows biopsy of suspicious tissue. Procedures to help determine how far the cancer has spread include endoscopic ULTRASOUND, COMPUTED TOMOGRAPHY (CT) SCAN, MAGNETIC RESONANCE IMAGING (MRI), and POSITRON EMISSION TOMOGRAPHY (PET) SCAN.
Esophageal Cancer Treatment Options and Outlook
The findings of the diagnostic procedures determine treatment options, which include
- Surgery to remove the cancerous portion of the esophagus and nearby tissue; this treatment is most effective when the cancer remains confined to the area of the esophagus where it originated. The surgeon then pulls the stomach up to connect it to the shortened esophagus, or uses a segment of intestine (called a graft) to construct a replacement for the removed section.
- RADIATION THERAPY to kill the cancerous cells; this treatment typically shrinks but does not eliminate the cancer, providing relief from swallowing difficulties.
- CHEMOTHERAPY attacks cancer cells throughout the body; this treatment is most effective when the cancer has spread to other locations in the body.
Treatment often combines these approaches. Each approach has significant risks and side effects. As with all cancers, early detection significantly improves the effectiveness of treatment.
Risk Factors and Preventive Measures
The key risk factors for esophageal cancer are Barrett’s esophagus and a combination of smoking and excessive alcohol consumption. Preventive measures to reduce the risk factors for esophageal cancer include
- SMOKING CESSATION
- moderation in ALCOHOL consumption
- WEIGHT LOSS AND WEIGHT MANAGEMENT
- management of chronic conditions that irritate the esophagus, notably GERD
- regular esophageal endoscopy for people who have Barrett’s esophagus