What Is Esophageal Cancer?

There are two main types of esophageal cancer. What type you have depends on what kind of cell the cancer starts in:

• Esophageal adenocarcinoma is the most common type of esophagus cancer in the United States.

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   It begins in the mucus-producing glandular cells of the esophagus. This type of cancer is usually found in the lower third of the organ.
• Squamous cell carcinoma begins in squamous cells, or the thin, flat cells lining the inside of the esophagus.

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   While this type of cancer can occur anywhere along the esophagus, it is usually found in the neck region and upper two-thirds of the chest cavity.

• Difficulty swallowing
• Chest pain when swallowing

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• Unexplained weight loss
• Hiccups

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• Vomiting

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• Chronic cough
• Hoarseness
• Black stool (caused by bleeding in the esophagus)

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• Indigestion and heartburn
• Pneumonia
• Anemia, or low levels of red blood cells, causing fatigue and weakness

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• Male sex
• Older age
• Tobacco use (in any form)
• Alcohol use
• Frequently drinking very hot beverages
• Barrett’s esophagus, which develops when acid reflux or heartburn damages the inner lining of the esophagus

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• Gastroesophageal reflux disease, or GERD, which increases your risk for Barrett’s esophagus

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• Having obesity
• Physical inactivity
• Poor nutrition or a diet high in processed meats

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• Exposure to or ingestion of certain chemicals, including lye
• Human papillomavirus (HPV) infection

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• Achalasia, a disease that causes food and secretions to collect at the bottom of the esophagus
• Plummer-Vinson syndrome, a disease that obstructs the upper esophagus, trapping food and causing irritation
• History of lung, mouth, or throat cancers
• Certain genetic conditions, including tylosis (Howel-Evans syndrome), Bloom syndrome, Fanconi anemia, and familial Barrett’s esophagus

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Upon confirming you have esophageal cancer, your provider will conduct one or more tests to stage the cancer or determine how far it has spread. Additional tests may include:

• Endoscopic ultrasonography, an endoscopy combined with an ultrasound, which produces images using high-frequency sound waves

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• Barium swallow, a procedure that involves drinking a solution containing barium, which coats the inside of your esophagus and appears clearly in X-ray images

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• CT (computerized tomography) scans that produce cross-sectional pictures of your body

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• PET (positron emission tomography) scans that help identify tissue in the body undergoing high metabolism, which may be indicative of cancer

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• MRI (magnetic resonance imaging) scans, which produce detailed images of the body’s soft tissues

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There are various treatment options available for esophageal cancer. The stage and extent of your cancer, the size of your tumor, where it’s located, and your personal preferences determine your treatment plan.

Surgery

Radiation Therapy

Radiation therapy, typically used along with chemotherapy, can be a treatment option for those who cannot have or do not want to have surgery, or in conjunction with surgery.

Radiation therapy may also be recommended:

• Before surgery to shrink the size of the tumor and make it easier to remove
• After surgery to kill leftover cancer cells
• As a palliative treatment to reduce symptoms from advanced esophageal cancer, such as pain, bleeding, and trouble swallowing

• External beam radiation therapy (EBRT) is used more commonly for esophageal cancer and involves destroying cancer cells with radiation produced from a machine outside of the body.

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• Brachytherapy involves the use of an endoscope to place radioactive material close to the tumor.

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  The radiation only travels short distances so it has little effect on nearby normal tissues. Brachytherapy is typically used as a palliative treatment for advanced esophageal cancer.

Medication Options

There are several types of drug therapies available to treat esophageal cancer, including:

• Chemotherapy Like radiation therapy, chemo drugs such as paclitaxel (Taxol) and irinotecan (Camptosar) are used before surgery, after surgery, or to relieve symptoms in advanced esophageal cancer.

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   These drugs can cause a range of mild-to-severe side effects such as hair loss, increased risk for infections, and nerve damage.
• Targeted Drug Therapy Sometimes used with chemotherapy, these drugs target specific changes in cells that cause cancer.

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   For example, trastuzumab (Herceptin) zeros in on cancer cells with too much of the protein HER2 on their surface while ramucirumab (Cyramza) blocks a protein called VEGF that tumors need to make new blood vessels. Each targeted drug has its own set of side effects, some of which can be serious.
• Immunotherapy This treatment aims to help the body’s immune system more effectively find and destroy cancer cells, such as by using immune checkpoint inhibitors, drugs that target specific proteins that cancer cells use to evade the immune system.

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   Examples include pembrolizumab (Keytruda), nivolumab (Opdivo), and ipilimumab (Yervoy). Because these intravenous drugs affect the immune system, they can cause some life-threatening side effects affecting the lungs, intestine, kidneys, and other organs.

• Avoiding tobacco and alcohol use
• Maintaining a physically active lifestyle and healthy body weight
• Eating a balanced diet rich in fruits and vegetables
• Getting treated for GERD and Barrett’s esophagus

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• Drinking beverages after they have cooled
• Avoiding foods that trigger acid reflux, such as fried food, processed snacks like potato chips, and tomato-based sauces
• Eating high-fiber foods such as whole grains, root vegetables, and green vegetables

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• Eating small, more frequent meals

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• Staying physically active
• Maintaining a healthy weight

But survival rates can be further broken down by how far the cancer has spread:

• 48 percent for localized cancer that’s only growing in the esophagus
• 28 percent for regional cancer that has spread beyond the esophagus to nearby lymph nodes or tissues
• 5 percent for distance cancer that has spread to organs or lymph nodes away from the main tumor

• Your age and sex
• Your overall health
• How early in the disease course you were diagnosed
• How quickly the tumor is growing
• How the cancer responds to treatment
• Lifestyle factors

• Esophageal obstruction, making it difficult to swallow
• Aspiration, the inadvertent inhalation of food or liquids into the lungs, which can lead to pneumonia, lung abscesses, or acute respiratory distress syndrome
• Bleeding in the esophagus
• Fistulas connecting the esophagus to the trachea or bronchi, leading to pneumonia, lung abscesses, or sepsis
• Perforations in the esophagus that can cause sepsis and even death
• Malnutrition
• Anxiety and depression

Several conditions are linked to an increased risk of esophageal cancer, including:

• Barrett’s esophagus
• GERD
• Achalasia
• Plummer-Vinson syndrome

• Esophageal cancer is most common in older adults and men, with survival rates varying depending on the stage at diagnosis and personal health factors.
• Early detection of esophageal cancer is crucial for improving survival rates, so if you experience persistent swallowing difficulties or other symptoms, seek medical attention promptly.
• Managing risk factors, such as quitting smoking, maintaining a healthy diet, and treating acid reflux, can significantly reduce the likelihood of developing this cancer.
• Cancer treatments, including those for esophageal cancer, are continuously advancing and can improve your quality of life.