Esophageal Cancer - Symptoms & Treatment

Esophageal cancer is cancer that develops in the esophagus, the muscular tube that connects the throat to the stomach. The esophagus, located just behind the trachea, is about 10 to 13 inches in length and allows food to enter the stomach for digestion. The wall of the esophagus is made up of several layers and cancers generally start from the inner layer and grow out.

Esophageal cancer is most common in men over age 60 and is nearly always fatal. The disease occurs world­wide, but incidence varies geographically. It is most commonly found in Japan, Russia, China, the Middle East, and the Transkei region of South Africa.

Most cases (98%) arise in squamous cell epithelium, although a few are adenocarcinomas and fewer still, metanomas and sarcomas. About half the squamous cell cancers occur in the lower portion of the esophagus, 40% in the midportion, and the remaining 10% in the upper or cervical esophagus. Regardless of cell type, the prognosis for esophageal cancer is grim: 5-year survival rates are less than 5%, and most patients die within 6 months of diagnosis.

Causes

Although the cause of esophageal cancer is unknown, several predisposing factors have been identified. These include chronic irritation from heavy smoking or excessive use of alcohol; stasis-induced inflammation, as in achalasia or stricture; previous head and neck tumors; and nutritional deficiency, as in untreated sprue and Plummer-Vinson syndrome.

Signs and Symptoms

Early cancer of the esophagus is usually asymptomatic (i.e., does not cause symptoms). In as many as 50% of cases, the disease is locally advanced or has already spread (metastasized) at the time of diagnosis. Symptoms of the disease include the following:

• Coughing up blood
• Difficulty swallowing (dysphagia) or painful swallowing (odynophagia)
• Hoarseness or chronic cough
• Iron-deficiency anemia (may be diagnosed through a blood test)
• Pain in the throat, back, behind the breastbone (sternum), or between the shoulder blades
• Severe weight loss
• Vomiting

Diagnostic tests 

X-rays of the esophagus, with barium swallow and motility studies, delineate structural and filling defects and reduced peristalsis. Esophagoscopy, punch and brush biopsies, and exfoliative cytologic tests confirm esophageal tumors.

Treatment

Esophageal cancer usually is advanced when diagnosed, so surgery and other treatments can only relieve disease effects.

Palliative therapy consists of treatment to keep the esophagus open, including dilation of the esophagus, laser therapy, radiation therapy, and installation of prosthetic tubes (such as the Celestin tube) to bridge the tumor. Radical surgery can excise the tumor and resect either the esophagus alone or the stomach and esophagus. Chemotherapy and radiation therapy can slow the growth of the tumor. Gastrostomy or jejunostomy can help provide adequate nutrition. A prosthesis can be used to seal any fistula that develops. Endoscopic laser treatment and bipolar electrocoagulation can help restore swallowing by vaporizing cancerous tissue. If the tumor is in the upper esophagus, however, the laser can't be positioned properly.

Analgesics are used for pain control.

Prevention

Avoiding smoking and reducing or eliminating alcohol consumption may help reduce the risk of developing squamous cell cancer of the esophagus.

Surveillance EGD (esophagogastroduodenoscopy) and biopsy in people with Barrett's esophagus may lead to early detection and improved survival. People with symptoms of severe reflux should seek medical attention.

People diagnosed with Barrett's esophagus should see a gastroenterologist (gastrointestinal specialist) at least every year.