Esophageal Cancer: Introduction
What is cancer?
Cancer starts when cells in the body change (mutate) and grow out of control. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them and die when your body doesn't need them any longer.
Cancer is made up of abnormal cells that grow even though your body doesn't need them. In most cancers, the abnormal cells grow to form a lump or mass called a tumor. If cancer cells are in the body long enough, they can grow into (invade) nearby areas. They can even spread to other parts of the body (metastasize).
What is esophageal cancer?
Esophageal cancer is cancer that starts in the cells that make up the lining of your esophagus.
Understanding the esophagus
The esophagus is a tube that's part of the digestive tract. It carries food and liquid from your mouth to your stomach. In adults, it’s about 10 to 13 inches (25 to 33 centimeters) long. The esophagus is behind the windpipe (trachea) and in front of your spine.
When you swallow, the esophagus tightens and relaxes. This causes “waves” along the tube. This motion moves food down into your stomach. Glands in the esophagus make mucus to keep the lining moist and make swallowing easier.
The wall of the esophagus has many layers that include connective tissue and muscle. The innermost lining is called the mucosa. It is made up mainly of thin, flat cells called squamous cells.
If stomach acid backs up into the lower part of the esophagus (acid reflux) over a long time, the squamous cells can be replaced by glandular cells. These cells make mucus and other fluids to try to protect the lower part of the esophagus. This change is called Barrett's esophagus.
The lower end of the esophagus connects to the stomach at the gastroesophageal junction (GEJ).
What are the types of esophageal cancer?
There are 2 main types of esophageal cancer:
Adenocarcinoma. These are cancers that start in glandular cells. In the U.S. and other Western countries, most esophageal cancers are adenocarcinomas. These cancers normally start in the lower third of the esophagus where gland cells have replaced squamous cells. (This is what happens in Barrett's esophagus.)
Squamous cell carcinoma. These cancers start in squamous cells. This type of cancer can start anywhere along the esophagus.
There are other types of esophageal cancer, but they are very rare.
How esophageal cancer grows and spreads
Adenocarcinoma of the esophagus often starts in people with Barrett's esophagus. Still, most people with Barrett's esophagus never get esophageal cancer.
Over time, the gland cells that replace the squamous cells can develop dysplasia. This is when glandular cells start to look abnormal and grow in an abnormal way. Esophageal dysplasia is a precancer. If not treated, over time these cells can become cancer.
Both types of esophageal cancer start in the inner lining of the esophagus. As these cancers grow, they often narrow the opening in the center of the esophagus. (This opening is called the lumen.) This can cause problems with swallowing.
The cancer can also grow outward, through the layers of the esophagus to nearby tissues. These include nearby lymph nodes and the windpipe. Once the cancer has grown outside the esophagus, it can also spread to other parts of your body. It may spread to other organs, like your spine, liver, or lungs.
Talk with your healthcare provider
If you have questions about esophageal cancer, talk with your healthcare provider. They can help you understand more about this cancer.
Esophageal Cancer: Symptoms
What are the symptoms of esophageal cancer?
Esophageal cancer often doesn’t cause symptoms in its early stages, when it's small and hasn't spread. When this cancer does cause symptoms, they’re often like those you might have with other health issues, such as indigestion.
Early symptoms of esophageal cancer might be:
Trouble swallowing. Swallowing dry solid foods, such as meat, bread, or raw vegetables may be especially hard.
- Pain when swallowing
Pressure or burning in your chest (behind your breastbone)
A feeling that food is stuck in your throat
As esophageal cancer gets worse and the tumor grows, symptoms can become more severe. You may have:
Trouble swallowing liquids
Trouble swallowing saliva
- Black stool, which is caused by bleeding in the esophagus
When to see your healthcare provider
Many of these symptoms can be caused by other health problems. It’s important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have esophageal cancer or some other problem that may need to be treated.
Esophageal Cancer: Treatment Choices
There are many treatment choices for esophageal cancer. Which may work best for you? It depends on a number of factors. These include the type, size, location, and stage of your cancer. Factors also include your age, overall health, side effects, and your preferences.
Learning about your treatment choices
You may have questions and concerns about your treatment choices. You may also want to know how you’ll feel, how your body will look and work after treatment, and if you’ll have to change your normal activities.
Your healthcare provider is the best person to answer your questions. Your provider can tell you what your treatment choices are, how well they’re expected to work, and what the risks and side effects are. Your healthcare provider may suggest a specific treatment. Or you may be offered more than one choice and have to decide on which you’d like to use. It can be hard to make this decision. It's important to take the time you need to make the best decision.
Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your choices. You may want to get a second opinion before deciding on your treatment plan. And you may want to involve your family and friends in this process.
Understanding the goals of treatment for esophageal cancer
For some esophageal cancers, the goal of treatment is to cure the cancer. If a cure isn’t possible, you may get treatment to help shrink the tumor. Or treatment may keep it under control for as long as possible. Treatment can also improve your quality of life. It does this by helping to control the problems caused by the cancer, like bleeding or trouble swallowing. The goals of treatment include:
Removing or destroying the cancer in the esophagus
Removing or destroying tumors in other parts of your body
Killing or stopping the growth or spread of esophageal cancer cells
Preventing or delaying the cancer's return
Easing symptoms from the cancer. These can include pain, trouble swallowing, or pressure on other organs.
Types of treatment for esophageal cancer
Many kinds of treatment can be used for esophageal cancer. You may get a combination of different treatments. The treatments used depend on a number of factors, such as:
The type of esophageal cancer
Where the cancer is in the esophagus
The stage (extent) of the cancer (how big it is and if it has spread)
Your overall health
Your concerns and preferences
Some of the most common treatments used are listed below.
This is the most common treatment for early stage esophageal cancer, especially if it's in the lower part of the esophagus. Surgery may cure the cancer at this stage because the cancer is small and only in the esophagus.
Even when the cancer can’t be cured, surgery might be used to help ease symptoms caused by the tumor, like pain or bleeding. It can also be done to put in a feeding tube if you're not able to swallow.
This treatment is most often used along with chemotherapy, either before or after surgery. Radiation and chemotherapy before surgery can help shrink a tumor. This can make it easier to take out. After surgery, radiation and chemotherapy can kill cancer cells that might be left. It may also be used as part of the main treatment in people who can't have surgery. It may be used to help relieve symptoms in people with advanced cancer, too.
Chemotherapy and targeted therapy
For esophageal cancer, chemotherapy is often used with radiation. It may be used before or after surgery. Or it may be part of the treatment for people who can't have surgery.
Targeted therapy medicines work differently from standard chemotherapy medicines. Targeted therapy may be useful for some people. These medicines target certain gene changes in the cancer cells. (Your cancer cells will be tested to see if they have these changes.)
Both of these treatments can be used to treat cancers that have spread beyond the esophagus.
These treatments are done using an endoscope. This is a thin, flexible, lighted tube that's put in your mouth and slid into your esophagus. Endoscopic treatments can be used to help relieve symptoms caused by the cancer. These include using photodynamic therapy, freezing (cryotherapy), a laser, or an electric current (electrocoagulation) to kill cancer cells in your esophagus. An endoscope can also be used to put in a stent. This is a small metal tube that's put in to keep your esophagus open.
Your healthcare provider may suggest treatments that help ease your symptoms, but don’t treat the cancer. This is called palliative care. It's often used with other treatments. For instance, pain medicine can be a palliative treatment.
Or your healthcare provider may suggest that you get only palliative care if they believe that treatments are likely to cause you more harm than good.
Immunotherapy medicines help your body's natural immune system find and kill cancer cells. Medicines called immune checkpoint inhibitors may be used to treat advanced esophageal cancer. These medicines are given through intravenous infusion. These medicines may be given alone or with chemotherapy or targeted therapy.
Clinical trials for new treatments
Researchers are always looking for new ways to treat esophageal cancer. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.
Talking with your healthcare provider
Thinking about treatment choices may seem overwhelming. Ask how you can learn more about your choices. Talk with your healthcare team and loved ones. Make a list of questions. Think about the benefits, risks, and side effects of each choice. Talk about your concerns with your healthcare provider before making a decision.