Esophageal Cancer

Esophageal cancer is an abnormal growth of cancerous (malignant) cells in the part of the body that moves food and liquids from the mouth to the stomach (esophagus).

What are the causes?

The exact cause of esophageal cancer is not known.

What increases the risk?

• Being older than 55 years of age.
• Being of male gender.
• Using any tobacco products, including cigarettes, cigars, and chewing tobacco.
• Excessive alcohol use. The more alcohol you drink, the higher your risk.
• Eating a diet that is low in fruits and vegetables.
• Being overweight or obese.
• Having a damaged esophagus due to exposure to poisons (toxins).
• Having a history of other types of cancer.
• Having conditions that cause damage or irritation to the esophagus. These conditions include:
  • Acid reflux.
  • Barrett's esophagus.
  • Achalasia.
  • Tylosis.
  • Plummer–Vinson syndrome.
  • HPV (human papillomavirus).

What are the signs or symptoms?

• Difficulty swallowing.
• Chest or back pain.
• Unintentional weight loss, or losing weight without trying.
• Tiredness (fatigue).
• Hoarse voice.
• Coughing. This may include coughing up blood.
• Vomiting. This may include vomiting up blood.
• Hiccups.
• Stool (feces) that looks black or tarry due to bleeding into the esophagus.
• Bone pain.

How is this diagnosed?

• A physical exam and your medical history.
• A procedure in which a tube with a light and camera on the end of it (endoscope, bronchoscope, or laryngoscope) is used to examine your throat and esophagus. This can also be done to check if cancer has spread to other areas, such as the lungs. Tissue samples may be removed (biopsy) and examined for cancer cells.
• A procedure in which you swallow a solution called barium and then X-rays are done to evaluate the esophagus (barium swallow). The barium shows up well on X-rays, making it easier for your health care provider to see possible problems.
• Imaging tests such as X-rays, CT scans, PET scans, or MRI scan.

If you are found to have cancer, it will be assessed (staged) to determine how severe it is and how much it has spread.

How is this treated?

• Surgery. Surgery may be done to:
  • Remove small tumors within the esophagus.
  • Remove part of the esophagus (esophagectomy).
  • Remove part of the esophagus and the upper portion of the stomach (esophagogastrectomy).
• Medicines that kill cancer cells (chemotherapy).
• Radiation therapy, which involves the use of high-energy rays that kill cancer cells.
• Medicines that target specific parts of cancer cells and the area around them to block the growth and spread of the cancer. This is called targeted therapy and can help limit damage to healthy cells.
• Immunotherapy, which involves the use of medicines that help your body's disease-fighting system (immune system) fight the cancer cells.
• A procedure to remove part of the inner lining of the esophagus (endoscopic mucosal resection).
• A procedure in which you are given IV medicine and then an endoscope is used to shine a special type of light onto the esophagus to destroy the cancer cells. This is called photodynamic therapy.
• A procedure in which a small balloon is inflated in the esophagus (radiofrequency ablation). The balloon uses an electric current to heat and destroy the cells in the lining of the esophagus.

Follow these instructions at home:

Lifestyle

• Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.
• Do not drink alcohol.

General instructions

• Try to eat regular, healthy meals. Some of your treatments might affect your appetite and your ability to swallow. If you are having problems eating or if you do not have an appetite, meet with a dietitian.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Consider joining a support group for people who have been diagnosed with esophageal cancer.
• Work with your cancer care team to manage any side effects of treatment.
• Keep all follow-up visits. This is important.

Where to find more information

• American Cancer Society: www.cancer.org
• National Cancer Institute (NCI): www.cancer.gov

Contact a health care provider if:

• You have more problems swallowing or eating.
• You have new fatigue or weakness.
• You continue to lose weight unintentionally.
• You have a fever.

Get help right away if:

• You have pain that suddenly gets worse.
• You have trouble breathing.
• You vomit blood or black material that looks like coffee grounds.
• You have black stools.
• You faint.

Summary

• Esophageal cancer is an abnormal growth of cancerous (malignant) cells in the part of the body that moves food and liquids from the mouth to the stomach (esophagus).
• During diagnosis, a tube with a light and camera on the end of it (endoscope, bronchoscope, or laryngoscope) may be used to examine your throat and esophagus.
• Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.
• Work with your cancer care team to understand treatment options and manage any side effects of treatment.