Esophageal cancer — Comprehensive overview covers symptoms, causes, treatment of cancer of the esophagus.
Esophageal cancer is cancer that occurs in the esophagus — a long, hollow tube that runs from your throat to your stomach. Your esophagus helps move the food you swallow from the back of your throat to your stomach to be digested.
Esophageal cancer usually begins in the cells that line the inside of the esophagus. Esophageal cancer can occur anywhere along the esophagus. More men than women get esophageal cancer.
Esophageal cancer is the sixth most common cause of cancer deaths worldwide. Incidence rates vary within different geographic locations. In some regions, higher rates of esophageal cancer may be attributed to tobacco and alcohol use or particular nutritional habits and obesity.
The esophagus is a muscular tube that connects your mouth and your stomach. Rings of muscle contract and relax to allow food and liquids to pass through the upper and lower portions.
Signs and symptoms of esophageal cancer include:
Early esophageal cancer typically causes no signs or symptoms.
Make an appointment with your doctor if you have any persistent signs and symptoms that worry you.
If you've been diagnosed with Barrett's esophagus, a precancerous condition caused by chronic acid reflux, your risk of esophageal cancer is higher. Ask your doctor what signs and symptoms to watch for that may signal that your condition is worsening.
Screening for esophageal cancer may be an option for people with Barrett's esophagus. If you have Barrett's esophagus, discuss the pros and cons of screening with your doctor.
It's not exactly clear what causes esophageal cancer.
Esophageal cancer occurs when cells in the esophagus develop changes (mutations) in their DNA. The changes 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.
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. Types of esophageal cancer include:
It's thought that chronic irritation of your esophagus may contribute to the changes that cause esophageal cancer. Factors that cause irritation in the cells of your esophagus and increase your risk of esophageal cancer include:
As esophageal cancer advances, it can cause complications, such as:
You can take steps to reduce your risk of esophageal cancer. For instance:
Tests and procedures used to diagnose esophageal cancer include:
Once a diagnosis of esophageal cancer is confirmed, your doctor may recommend additional tests to determine whether your cancer has spread to your lymph nodes or to other areas of your body.
Tests may include:
Your doctor uses the information from these procedures to assign a stage to your cancer. The stages of esophageal cancer are indicated by Roman numerals that range from 0 to IV, with the lowest stages indicating that the cancer is small and affects only the superficial layers of your esophagus. By stage IV, the cancer is considered advanced and has spread to other areas of the body.
The cancer staging system continues to evolve and is becoming more complex as doctors improve cancer diagnosis and treatment. Your doctor uses your cancer stage to select the treatments that are right for you.
An upper gastrointestinal endoscopy involves inserting a flexible, lighted tube called an endoscope down your throat and into your esophagus. A tiny camera on the end of the endoscope lets your doctor examine your esophagus, stomach and the beginning of your small intestine, called the duodenum.
What treatments you receive for esophageal cancer are based on the type of cells involved in your cancer, your cancer's stage, your overall health and your preferences for treatment.
Surgery to remove the cancer can be used alone or in combination with other treatments.
Operations used to treat esophageal cancer include:
Esophageal cancer surgery carries a risk of serious complications, such as infection, bleeding and leakage from the area where the remaining esophagus is reattached to the stomach.
Surgery to remove your esophagus can be performed as an open procedure using large incisions or with special surgical tools inserted through several small incisions in your skin (laparoscopically). How your surgery is performed depends on your individual situation and your surgeon's particular approach to managing it.
Treatments for esophageal obstruction and difficulty swallowing (dysphagia) can include:
Chemotherapy is drug treatment that uses chemicals to kill cancer cells. Chemotherapy drugs are typically used before (neoadjuvant) or after (adjuvant) surgery in people with esophageal cancer. Chemotherapy can also be combined with radiation therapy.
In people with advanced cancer that has spread beyond the esophagus, chemotherapy may be used alone to help relieve signs and symptoms caused by the cancer.
The chemotherapy side effects that you experience depend on which chemotherapy drugs you receive.
Radiation therapy uses high-energy beams, such as X-rays and protons, to kill cancer cells. Radiation typically will come from a machine outside your body that aims the beams at your cancer (external beam radiation). Or, less commonly, radiation can be placed inside your body near the cancer (brachytherapy).
Radiation therapy is most often combined with chemotherapy in people with esophageal cancer. It's typically used before surgery, or occasionally after surgery. Radiation therapy is also used to relieve complications of advanced esophageal cancer, such as when a tumor grows large enough to stop food from passing to your stomach.
Side effects of radiation to the esophagus include sunburn-like skin reactions, painful or difficult swallowing, and damage to nearby organs, such as the lungs and heart.
Combining chemotherapy and radiation therapy may enhance the effectiveness of each treatment. Combined chemotherapy and radiation may be the only treatment you receive, or combined therapy can be used before surgery. But combining chemotherapy and radiation treatments increases the likelihood and severity of side effects.
Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die. For esophageal cancer, targeted drugs are usually combined with chemotherapy for advanced cancers or cancers that don't respond to other treatments.
Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body's disease-fighting immune system might not attack cancer because the cancer cells produce proteins that make it hard for the immune system cells to recognize the cancer cells as dangerous. Immunotherapy works by interfering with that process. For esophageal cancer, immunotherapy might be used when the cancer is advanced, cancer has come back or the cancer has spread to other parts of the body.
One operation used to treat esophageal cancer is esophagectomy. During esophagectomy, your surgeon removes the portion of your esophagus that contains the tumor, along with a portion of the upper part of your stomach, and nearby lymph nodes. The remaining esophagus is reconnected to your stomach. Usually this is done by pulling the stomach up to meet the remaining esophagus.
Complementary and alternative therapies may help you cope with the side effects of cancer and cancer treatment. For instance, people with esophageal cancer may experience pain caused by cancer treatment or by a growing tumor. Your doctor can work to control your pain by treating the cause or with medications. Still, pain may persist, and complementary and alternative therapies may help you cope.
Ask your doctor whether these options are safe for you.
Coping with the shock, fear and sadness that come with a cancer diagnosis can take time. You may feel overwhelmed just when you need to make crucial decisions. With time, each person finds a way of coping and coming to terms with the diagnosis.
Until you find what brings you the most comfort, consider trying to:
Find someone to talk to. You might have a close friend or family member who's a good listener. Or talk to a counselor, medical social worker, or pastoral or religious counselor.
Consider joining a support group for people with cancer. You may find strength and encouragement in being with people who are facing the same challenges you are. Ask your doctor, nurse or social worker about groups in your area. Or try online message boards, such as those available through the American Cancer Society.
If your family doctor suspects you have esophageal cancer, you may be referred to a number of doctors who will help evaluate your condition. Your health care team may include doctors who:
To get the most from your appointment, it's a good idea to be well prepared. Here's some information to help you get ready, and to know what to expect from your doctor.
Preparing a list of questions will help you make the most of your time with your doctor. For esophageal cancer, some basic questions to ask your doctor include:
Don't hesitate to ask any other questions that occur to you during your appointment.
Mayo Clinic doctors will work with you to review all of your treatment options and choose the treatment that best suits your needs and goals.
The range of treatments offered to people with esophageal cancer includes chemotherapy, radiation therapy, proton beam therapy, and minimally invasive and traditional operations, such as esophagectomy.