Jane DoeWhat is esophageal cancer?
Esophageal cancer starts in the cells of the esophagus. The esophagus is a hollow, muscular tube that carries food and drink from the back of the mouth to the stomach. It is located behind the windpipe and in front of the spine. When you swallow, the muscles of the esophagus contract to push food down into the stomach. The point where the esophagus joins the stomach is called the gastroesophageal (GE) junction. The muscle at the junction opens to allow food to enter the stomach. This muscle normally keeps stomach acid from flowing back up into the esophagus and causing heartburn.
Cancer of the esophagus can start anywhere along the length of the esophagus. There are two main types of esophageal cancer. Each develops in a different kind of cell.
- Squamous cell carcinoma starts in the squamous cells that line the esophagus. These cancers are usually found in the upper and middle part of the esophagus.
- Adenocarcinoma starts in the glandular cells in the lower part of the esophagus.
Types of Esophageal Cancer
There are two main types of esophageal cancer. Both types are diagnosed, treated, and managed in similar ways.
The two most common types are named for how the cancer cells look under a microscope. Both types begin in cells in the inner lining of the esophagus:
Adenocarcinoma of the esophagus
This type is usually found in the lower part of the esophagus, near the stomach. In the United States, adenocarcinoma is the most common type of esophageal cancer. It's been increasing since the 1970s.
Squamous cell carcinoma of the esophagus
This type is usually found in the upper part of the esophagus. This type is becoming less common among Americans. Around the world, however, squamous cell carcinoma is the most common type.
Symptoms of Esophagus Cancer
Early esophageal cancer may not cause symptoms. As the cancer grows, the most common symptoms are:
- Food gets stuck in the esophagus, and food may come back up
- Pain when swallowing
- Pain in the chest or back
- Weight loss
- Heartburn
- A hoarse voice or cough that doesn't go away within 2 weeks
These symptoms may be caused by esophageal cancer or other health problems. If you have any of these symptoms, you should tell your doctor so that problems can be diagnosed and treated as early as possible.
Causes of Esophagus Cancer
When you get a diagnosis of cancer, it's natural to wonder what may have caused the disease. Doctors can seldom explain why one person develops esophageal cancer and another doesn't. However, we do know that people with certain risk factors are more likely than others to develop esophageal cancer. A risk factor is something that may increase the chance of getting a disease.
Studies have found the following risk factors for esophageal cancer:
Age 65 or older
Age is the main risk factor for esophageal cancer. The chance of getting this disease goes up as you get older. In the United States, most people are 65 years of age or older when they are diagnosed with esophageal cancer.
Being male
In the United States, men are more than three times as likely as women to develop esophageal cancer.
Smoking
People who smoke are more likely than people who don't smoke to develop esophageal cancer.
Heavy drinking
People who have more than 3 alcoholic drinks each day are more likely than people who don't drink to develop squamous cell carcinoma of the esophagus. Heavy drinkers who smoke are at a much higher risk than heavy drinkers who don't smoke. In other words, these two factors act together to increase the risk even more.
Diet
Studies suggest that having a diet that's low in fruits and vegetables may increase the risk of esophageal cancer. However, results from diet studies don't always agree, and more research is needed to better understand how diet affects the risk of developing esophageal cancer.
Obesity
Being obese increases the risk of adenocarcinoma of the esophagus.
Acid reflux
Acid reflux is the abnormal backward flow of stomach acid into the esophagus. Reflux is very common. A symptom of reflux is heartburn, but some people don't have symptoms. The stomach acid can damage the tissue of the esophagus. After many years of reflux, this tissue damage may lead to adenocarcinoma of the esophagus in some people.
Barrett esophagus
Acid reflux may damage the esophagus and over time cause a condition known as Barrett esophagus. The cells in the lower part of the esophagus are abnormal. Most people who have Barrett esophagus don't know it. The presence of Barrett esophagus increases the risk of adenocarcinoma of the esophagus. It's a greater risk factor than acid reflux alone. Many other possible risk factors (such as smokeless tobacco) have been studied. Researchers continue to study these possible risk factors.
Treatment for Esophagus Cancer
People with esophageal cancer have several treatment options. The options are surgery, radiation therapy, chemotherapy, or a combination of these treatments. For example, radiation therapy and chemotherapy may be given before or after surgery.
The treatment that's right for you depends mainly on the following:
- Surgery
- Radiation Therapy
- Chemotherapy
Surgery
There are several types of surgery for esophageal cancer. The type depends mainly on where the cancer is located. The surgeon may remove the whole esophagus or only the part that has the cancer. Usually, the surgeon removes the section of the esophagus with the cancer, lymph nodes, and nearby soft tissues. Part or all of the stomach may also be removed. You and your surgeon can talk about the types of surgery and which may be right for you.
The surgeon makes incisions into your chest and abdomen to remove the cancer. In most cases, the surgeon pulls up the stomach and joins it to the remaining part of the esophagus. Or a piece of intestine may be used to connect the stomach to the remaining part of the esophagus. The surgeon may use either a piece of small intestine or large intestine. If the stomach was removed, a piece of intestine is used to join the remaining part of the esophagus to the small intestine.
During surgery, the surgeon may place a feeding tube into your small intestine. This tube helps you get enough nutrition while you heal. Information about eating after surgery is in the Nutrition section.
You may have pain for the first few days after surgery. However, medicine will help control the pain. Before surgery, you should discuss the plan for pain relief with your health care team. After surgery, your team can adjust the plan if you need more relief.
Radiation Therapy
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.
Radiation therapy may be used before or after surgery. Or it may be used instead of surgery. Radiation therapy is usually given with chemotherapy to treat esophageal cancer.
Doctors use two types of radiation therapy to treat esophageal cancer. Some people receive both types:
- External radiation therapy: The radiation comes from a large machine outside the body. The machine aims radiation at your cancer. You may go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks.
- Internal radiation therapy (brachytherapy): The doctor numbs your throat with an anesthetic spray and gives you medicine to help you relax. The doctor puts a tube into your esophagus. The radiation comes from the tube. Once the tube is removed, no radioactivity is left in your body. Usually, only a single treatment is done.
Side effects depend mainly on the dose and type of radiation. External radiation therapy to the chest and abdomen may cause a sore throat, pain similar to heartburn, or pain in the stomach or the intestine. You may have nausea and diarrhea. Your health care team can give you medicines to prevent or control these problems.
Also, your skin in the treated area may become red, dry, and tender. You may lose hair in the treated area. A much less common side effect of radiation therapy aimed at the chest is harm to the lung, heart, or spinal cord.
Chemotherapy
Most people with esophageal cancer get chemotherapy. Chemotherapy uses drugs to destroy cancer cells. The drugs for esophageal cancer are usually given through a vein (intravenous). You may have your treatment in a clinic, at the doctor's office, or at home. Some people need to stay in the hospital for treatment.
Chemotherapy is usually given in cycles. Each cycle has a treatment period followed by a rest period.
The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drug can also harm normal cells that divide rapidly:
- Blood cells: When chemotherapy lowers the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of drug. There also are medicines that can help your body make new blood cells.
- Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may change in color and texture.
- Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems.
Other possible side effects include a skin rash, joint pain, tingling or numbness in your hands and feet, hearing problems, or swollen feet or legs. Your healthcare team can suggest ways to control many of these problems. Most go away when treatment ends.
You can't change the fact that you have had cancer. What you can change is how you live the rest of your life -- making choices to help you stay healthy and feel as well as you can. This can be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even start during cancer treatment.
Making healthier choices
For many people, a diagnosis of cancer helps them focus on their health in ways they may not have thought much about in the past. Are there things you could do that might make you healthier? Maybe you could try to eat better or get more exercise. Maybe you could cut down on the alcohol, or give up tobacco. Even things like keeping your stress level under control may help. Now is a good time to think about making changes that can have positive effects for the rest of your life. You will feel better and you will also be healthier.
Eating better
If treatment caused weight changes or eating or taste problems, do the best you can and keep in mind that these problems usually get better over time. You may find it helps to eat small portions every 2 to 3 hours until you feel better. You may also want to ask your cancer team about seeing a dietitian, an expert in nutrition who can give you ideas on how to deal with these treatment side effects.
One of the best things you can do after cancer treatment is put healthy eating habits into place. You may be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight, eating a healthy diet, and limiting your alcohol intake may lower your risk for a number of types of cancer, as well as having many other health benefits.
Rest, fatigue, and exercise
If you were sick and not very active during treatment, it is normal for your fitness, endurance, and muscle strength to decline. Any plan for physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis twice a week. If you haven't exercised in a few years, you will have to start slowly – maybe just by taking short walks.
If you are very tired, you will need to balance activity with rest. It is OK to rest when you need to. Sometimes it's really hard for people to allow themselves to rest when they are used to working all day or taking care of a household, but this is not the time to push yourself too hard. Listen to your body and rest when you need to. (For more information on dealing with fatigue, please see Fatigue in People With Cancer and Anemia in People With Cancer.)
Keep in mind exercise can improve your physical and emotional health.
- It improves your cardiovascular (heart and circulation) fitness.
- Along with a good diet, it will help you get to and stay at a healthy weight.
- It makes your muscles stronger.
- It reduces fatigue and helps you have more energy.
- It can help lower anxiety and depression.
- It can make you feel happier.
- It helps you feel better about yourself.
