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Esophageal Cancer

Esophageal cancer is cancer that develops in the esophagus, the muscular tube that connects the throat to the stomach. The esophagus, located just behind the trachea, is about 10 to 13 inches in length and allows food to enter the stomach for digestion. The wall of the esophagus is made up of several layers and cancers generally start from the inner layer and grow out.

Nearly always fatal, esophageal cancer usually develops in men over age 60. This disease occurs worldwide, but incidence varies geographically. It is most common in Japan, China, the Middle East, and parts of South Africa.

Causes

The cause of esophageal cancer is unknown, but predisposing factors include chronic irritation caused by heavy smoking and excessive use of alcohol, stasis-induced inflammation, and nutritional deficiency. Esophageal tumors are usually fungating and infiltrating. Most arise in squamous cell epithelium; a few are adenocarcinomas; fewer still are melanomas and sarcomas.

Signs and symptoms

Early esophageal cancer may not cause any symptoms. As the cancer progresses, it usually causes one or more of the following symptoms:

• Difficult or painful swallowing or difficulty swallowing only solid foods (called dysphagia or odynophagia)
• Pain in the chest or between the shoulder blades
• Frequent heartburn or acid reflux
• Severe weight loss
• Hoarseness or chronic cough
• Vomiting
• Coughing up blood

Other conditions can cause these symptoms. If you experience any of these, you should see your doctor. If you have chest pain or vomit blood, seek medical attention immediately.

Diagnosis

X-rays of the esophagus, with barium swallow and motility studies, reveal structural and filling defects and the esophagus, punch and brush biopsies, and an exfoliative cytologic test confirm esophageal tumors.

Treatment

Whenever possible, treatment includes resection to maintain a passageway for food. This may require such radical surgery as esophagogastrectomy with jejunal or colonic bypass grafts. Palliative surgery may include a feeding gastrostomy. Other therapies consist of radiation, chemotherapy with cisplatin, and the insertion of prosthetic tubes to bridge the tumor and alleviate dysphagia.

Treatment complications

Complications of treatment may be severe. Surgery may precipitate an anastomotic leak, a fistula, pneumonia, and empyema. Rarely, radiation may cause esophageal perforation, pneumonitis and pulmonary fibrosis, or myelitis of the spinal cord. Prosthetic tubes may dislodge and perforate the mediastinum or erode the tumor.

Prevention

Avoiding smoking and reducing or eliminating alcohol consumption may help reduce the risk of developing squamous cell cancer of the esophagus.

Surveillance EGD (esophagogastroduodenoscopy) and biopsy in people with Barrett's esophagus may lead to early detection and improved survival. People with symptoms of severe reflux should seek medical attention.

People diagnosed with Barrett's esophagus should see a gastroenterologist (gastrointestinal specialist) at least every year.