Esophageal Cancer

Esophageal cancer is cancer arising from the esophagus—the food pipe that runs between the throat and the stomach.

Signs & Symptoms:

• Difficulty in swallowing
• Weight loss
• Pain when swallowing
• A hoarse voice
• Enlarged lymph nodes (glands) around the collarbone
• Persistent dry cough
• Possibly coughing up or vomiting blood

Risk Factors:

• Drinking alcohol
• 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
• Smoking

Common Types:

• Squamous cell carcinoma (often abbreviated to ESCC)
• Esophageal adenocarcinoma (EAC)

Diagnosis:

• Medical history and physical exam
• Barium swallow
• Computed Tomography (CT or CAT) Scan
• Magnetic Resonance Imaging (MRI) Scan
• Positron Emission Tomography (PET) Scan
• Endoscopy
• Upper Endoscopy
• Endoscopic Ultrasound
• Bronchoscopy
• Thoracoscopy and Laparoscopy

• Stage 0
  A stage 0 tumor is not true cancer. It contains abnormal cells called high-grade dysplasia and is really a type of pre-cancer
• Stage 1
  In this stage the cancer has grown into some of the deeper layers of the esophagus wall (past the innermost layer of cells) but has not reached the lymph nodes or other organs
• Stage 2
  Stage 2 includes cancers that have grown into the main muscle layer of the esophagus or into the connective tissue on the outside of the esophagus. This stage also includes some cancers that have spread to 1 or 2 nearby lymph nodes
• Stage 3
  Stage 3 includes some cancers that have grown through the wall of the esophagus to the outer layer, as well as cancers that have grown into nearby organs or tissues. It also includes most cancers that have spread to nearby lymph nodes
• Stage 4
  Stage 4 esophageal cancer has spread to distant lymph nodes or to other distant organs

Prevention:

• Avoid alcohol
• Avoid cigarette smoking
• Maintain body weight
• Eat right
• Control / Treat Gastroesophageal Reflux Disease (GERD)

Management:

Treatment options depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Treatment plan may also include treatment for symptoms and side effects, an important part of cancer care

• Surgery
  Surgery is the removal of the tumor and surrounding tissue during an operation.  Surgery has traditionally been the most common treatment for esophageal cancer. However, currently, surgery is used as the main treatment only for patients with early-stage esophageal cancer.

  In addition to surgery to treat the disease, surgery may be used to help patients eat and relieve symptoms caused by the cancer. This is called supportive or palliative surgery.

• Radiation Therapy
  Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation treatment is given directly inside the body, it is called internal radiation therapy or brachytherapy. For esophageal cancer, this involves temporarily inserting a radioactive wire into the esophagus using an endoscope.
• Chemotherapy
  Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide.
• Targeted therapy
  Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.
• Photodynamic therapy
  Photodynamic therapy is a palliative or supportive option used to make swallowing easier, especially for people who cannot or choose not to have surgery, radiation therapy, or chemotherapy. In photodynamic therapy, a light-sensitive substance is injected into the tumor and stays longer in cancer cells than in healthy cells. A light is then aimed at the tumor, destroying the cancer cells. Although photodynamic therapy may relieve swallowing problems for a short period of time, it does not cure esophageal cancer.
• Electrocoagulation
  This type of palliative treatment helps kill cancer cells by heating them with an electric current. This is sometimes used to help relieve symptoms by removing a blockage caused by the tumor.
• Cryotherapy
  This is a type of palliative treatment that uses an endoscope with a probe attached that can freeze and remove tumor tissue. It can be used to reduce the size of a tumor to help a patient swallow better.
• Metastatic esophageal cancer
  If cancer has spread to another location in the body, it is called metastatic cancer. Metastatic cancer requires multi-disciplinary approach with treatment options being a combination of surgery +/- chemotherapy +/- radiation therapy.