Malignant Esophageal Disease (Esophageal Cancer) | Saint John’s Cancer Institute

The Rate of Esophageal Cancer Continues to Increase in Western Countries Due to the Epidemic of Gastro-Esophageal Reflux Disease.

The esophagus links the mouth to the stomach, forming an important part of the body’s digestive system. Although esophageal cancers make up a small percentage of all cancers diagnosed annually, one form, esophageal adenocarcinoma, is increasing at a faster annual rate than any other cancer. It is diagnosed most frequently in an advanced state.

Causes of Esophageal Cancer

It is not clear what causes esophageal cancer. It is known that esophageal cancer occurs when cells in your esophagus develop errors (mutations) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells form a tumor in the esophagus that can grow to invade nearby structures and spread to other parts of the body.

Types of Esophageal Cancer

Esophageal cancer is classified according to the type of cells that are involved. The type of esophageal cancer you have helps determine your treatment options.

Adenocarcinoma

Adenocarcinoma begins in the cells of mucus-secreting glands in the esophagus. Adenocarcinoma occurs most often in the lower portion of the esophagus. Adenocarcinoma is the most common form of esophageal cancer in the United States, and it affects primarily white men.

Squamous cell carcinoma

The squamous cells are flat, thin cells that line the surface of the esophagus. Squamous cell carcinoma occurs most often in the middle of the esophagus. Squamous cell carcinoma is the most prevalent esophageal cancer worldwide.

Other Rare Types

Rare forms of esophageal cancer include choriocarcinoma, lymphoma, melanoma, sarcoma and small cell cancer.

Please consult a physician if you experience any of the following symptoms:

Painful or difficulty swallowing (solid foods first, then soft foods and eventually liquids)
Significant unintentional weight loss
Hoarseness and cough
Indigestion and heartburn
Pressure, pain or burning in the chest
Having swallowed food come back up (regurgitation)

It’s thought that chronic irritation of your esophagus may contribute to the DNA changes that cause esophageal cancer.

Factors that cause irritation in the cells of your esophagus and increase your risk of esophageal cancer include:

Smoking and heavy alcohol use
Having bile reflux
Having difficulty swallowing because of an esophageal sphincter that won’t relax (achalasia)
Drinking very hot liquids
Eating few fruits and vegetables
Having gastroesophageal reflux disease (GERD)
Being obese
Having precancerous changes in the cells of the esophagus (Barrett’s esophagus)
Undergoing radiation treatment to the chest or upper abdomen
Cancer in another part of the body
Swallowing lye or other chemicals
Plummer-Vinson syndrome (esophageal web)
Poor nutrition or a lack of trace minerals, particularly selenium

Tests and procedures used to diagnose and stage esophageal cancer include:

Using a scope to examine your esophagus (endoscopy). During endoscopy, your doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your esophagus. Using the endoscope, your doctor examines your esophagus, looking for cancer or areas of irritation.
Collecting a sample of tissue for testing (biopsy). Your doctor may use a special scope passed down your throat into your esophagus (endoscope) to collect a sample of suspicious tissue (biopsy). The tissue sample is sent to a laboratory to look for cancer cells.
Barium swallow. The patient drinks a special liquid (barium), which travels through the body and outlines the cancer when X-rayed.
Endoscopic ultrasound. This allows the doctor to see if a mass has spread into the wall of the esophagus or nearby organs, and to determine if any lymph node spread has occurred.
Computed tomography (CT) scan. This is to see if the tumor has spread to other organs, such as the liver or lungs.
Positron emission tomography (PET) scan. This allows the doctor to see if the tumor has spread to other organs.

Once the staging process has been completed, the treatment options can be tailored to the patient’s circumstances. Your cancer’s stage helps determine your treatment options.

Esophageal Cancer Staging:

Stage I. This cancer occurs in the superficial layers of cells lining your esophagus.
Stage II. The cancer has invaded deeper layers of your esophagus lining and may have spread to nearby lymph nodes.
Stage III. The cancer has spread to the deepest layers of the wall of your esophagus and to nearby tissues or lymph nodes.
Stage IV. The cancer has spread to other parts of your body

You can take steps to reduce your risk of esophageal cancer. For instance:

Quit smoking. If you smoke, talk to your doctor about strategies for quitting. Medications and counseling are available to help you quit. If you don’t use tobacco, don’t start.
Drink alcohol in moderation, if at all. If you drink, limit yourself to no more than one drink daily if you’re a woman or two drinks daily if you’re a man.
Eat more fruits and vegetables. Add a variety of colorful fruits and vegetables to your diet.
Maintain a healthy weight. If you are overweight or obese, talk to your doctor about strategies to help you lose weight. Aim for a slow and steady weight loss of 1 or 2 pounds a week.