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Esophageal Cancer

Esophageal Cancer

• Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus.
  The esophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach. The wall of the esophagus is made up of several layers of tissue, including mucous membrane, muscle, and connective tissue. Esophageal cancer starts at the inside lining of the esophagus and spreads outward through the other layers as it grows.

Signs and symptoms

• The most common signs of esophageal cancer are painful or difficult swallowing and weight loss.
• These and other symptoms may be caused by esophageal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

  > Painful or difficult swallowing.

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  > Weight loss.

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  > Pain behind the breastbone.

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  > Hoarseness and cough.

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  > Indigestion and heartburn.

Risk factors

• Risk factors include the following:

  > Tobacco use.

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  > Heavy alcohol use.

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  > Barrett esophagus: A condition in which the cells lining the lower part of the esophagus have changed or been replaced with abnormal cells that could lead to cancer of the esophagus. Gastric reflux (the backing up of stomach contents into the lower section of the esophagus) may irritate the esophagus and, over time, cause Barrett esophagus.

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  > Older age.

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  > Being male.

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  > Being African-American.

Diagnosis

• Tests that examine the esophagus are used to detect (find) and diagnose esophageal cancer.
• The following tests and procedures may be used:

  > Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

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  > Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.

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  > Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope is inserted through the mouth or nose and down the throat into the esophagus. An esophagoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

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  > Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy is usually done during an esophagoscopy. Sometimes a biopsy shows changes in the esophagus that are not cancer but may lead to cancer.

Staging

• Stage 0 (Carcinoma in Situ)

  In stage 0, abnormal cells are found in the innermost layer of tissue lining the esophagus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

• Stage I

  In stage I, cancer has formed and spread beyond the innermost layer of tissue to the next layer of tissue in the wall of the esophagus.

• Stage II

  Stage II esophageal cancer is divided into stage IIA and stage IIB, depending on where the cancer has spread.
  > Stage IIA: Cancer has spread to the layer of esophageal muscle or to the outer wall of the esophagus.

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  > Stage IIB: Cancer may have spread to any of the first three layers of the esophagus and to nearby lymph nodes.
• Stage III

  In stage III, cancer has spread to the outer wall of the esophagus and may have spread to tissues or lymph nodes near the esophagus.

• Stage IV

  Stage IV esophageal cancer is divided into stage IVA and stage IVB, depending on where the cancer has spread.
  > Stage IVA: Cancer has spread to nearby or distant lymph nodes.

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  > Stage IVB: Cancer has spread to distant lymph nodes and/or organs in other parts of the body.
• Recurrent Esophageal Cancer

  Recurrent esophageal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the esophagus or in other parts of the body.

Treatment

• Surgery
  Surgery is the most common treatment for cancer of the esophagus. Part of the esophagus may be removed in an operation called an esophagectomy.
• Laser therapy
  Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.
• Electrocoagulation
  Electrocoagulation is the use of an electric current to kill cancer cells.
• Radiation therapy
  Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
• Chemotherapy
  Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Bladder cancer may be treated with intravesical (into the bladder through a tube inserted into the urethra) chemotherapy. The way the chemotherapy is given depends on the type and stage of the cancer being treated.