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Esophageal Cancer

Alternate Names

  • cancer of the esophagus

Definition

Cancer of the esophagus is a tumor that grows in the lining of the esophagus. The esophagus is the tube connecting the mouth and upper throat to the stomach.

What is going on in the body?

The esophagus carries swallowed food to the stomach using a coordinated muscular effort. There is a muscular sphincter between the esophagus and the stomach. Esophageal cancer can start anywhere along the lining of the esophagus. It begins in the inside lining, then grows through the muscular wall of the esophagus. It can spread to other parts of the body through the blood or lymphatic system.

Risks

What are the causes and risks of the disease?

There appear to be many causes and risk factors for esophageal cancer. Certain conditions, if present for a long time, increase a person's risk for esophageal cancer.
These conditions include:
  • achalasia, a condition in which the esophagus muscle cannot relax
  • Barrett's esophagus, a pre-cancerous pattern of damage to the lining of esophagus caused by long-term gastroesophageal reflux disease (GERD)
  • diverticuli, or pouches in the lining of the esophagus
  • lye or burn-related damage
  • tylosis, a genetic skin problem
People who smoke cigarettes, chew tobacco, and drink alcohol are at a higher risk for this cancer. It is also thought that chronic and recurring irritation can increase the risk of esophageal cancer. These irritations include drinking very hot liquids, eating pickled foods, and being exposed to environmental toxins.
Esophageal cancer is rarely seen in people younger than 25 years old. The disease is more common in men than in women. It is seen more often in African Americans than in Caucasians. Overall, esophageal cancer is relatively uncommon in the United States. In some parts of Asia it is the second most common cancer, accounting for as much as 50% of all cancer deaths.

Prevention

What can be done to prevent the disease?

The best way to prevent esophageal cancer is to avoid tobacco and alcohol.
People who have Barrett's esophagus need aggressive treatment of their GERD to prevent esophageal cancer. Treatment for GERD may include the following:
  • fundoplication, a surgical procedure that strengthens the esophageal sphincter
  • GI stimulants that empty the stomach faster, such as metoclopramide
  • H2 blockers, such as cimetidine, ranitidine, and famotidine
  • proton pump inhibitors, such as omeprazole, lansoprazole, or rabeprazole
People with Barrett's esophagus may have regular endoscopies, which use a lighted tube to examine the esophagus. Biopsies, which involve removing a small piece of tissue, are sometimes needed. These screenings may detect an esophageal cancer early, when it is most treatable.

Diagnosed

How is the disease diagnosed?

Diagnosis of esophageal cancer begins with a medical history and physical exam. The healthcare professional may order an endoscopy of the esophagus. If a tumor is seen, a biopsy is done. If the tumor is found to be cancerous, a staging work-up is done.
This includes a physical exam, blood tests, and CAT scans of the chest and abdomen. This will give an indication of the size of the tumor. It will also show any metastasis to the chest, lymph nodes, lungs, or liver.

Long Term Effects

What are the long-term effects of the disease?

Esophageal cancer is a deadly disease. The 5-year survival rate is poor, even with aggressive treatment. It often recurs, despite surgery, chemotherapy, and radiation therapy.

Other Risks

What are the risks to others?

Esophageal cancer is not contagious. It poses no risk to others.

Treatments

What are the treatments for the disease?

Persons who have metastases that cannot be cured with surgery may still benefit from radiation therapy or chemotherapy. Radiation does not help if the cancer has spread to the liver or lungs.
Chemotherapy has short-term benefit for cancer that has spread to other parts of the body. It can be combined with radiation therapy. It involves toxic drugs, and the potential benefit must be balanced with the side effects.
Surgery of the esophagus can be complicated. It may involve removing the esophagus and lymph nodes in the chest, and sometimes a portion of the stomach. Another part of the lower bowel or stomach can be pulled up and attached to the remaining upper end of the esophagus. This allows the person to continue swallowing.
An individual needs to be in relatively good health to tolerate this extensive surgery. Whether preoperative chemotherapy and radiation therapy can improve the cure rate with this extensive surgery is controversial and under study.

Side Effects

What are the side effects of the treatments?

Following are some of the side effects of radiation:
  • burning of the skin
  • damage to the heart or lungs
  • irritation of the esophagus
  • loss of appetite
  • more difficulty swallowing
  • nausea
Side effects of chemotherapy include the following:
  • anemia, a low red blood cell count
  • diarrhea
  • hair loss
  • increased susceptibility to infection
  • irritation of the mouth and intestines
  • nausea and vomiting
Surgery alone is associated with a 5% to 10% mortality rate. Side effects include bleeding, infection, and reactions to anesthesia.

After Treatment

What happens after treatment for the disease?

It may take several months to recover from treatment. The person who may be cured can live a relatively normal lifestyle. He or she may not be able to eat certain foods, and also may not be able to absorb iron and vitamins as well as before. Most people, if they survive, do not have long-term effects from chemotherapy or radiation.

Monitor

How is the disease monitored?

Esophageal cancer is monitored with physical exams, lab tests, endoscopies, chest X-rays, and CT scans or MRIs. Any new or worsening symptoms should be reported to the healthcare professional.

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