Esophageal Cancer

What is esophageal cancer?

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.

The American Cancer Society estimates that 14,550 Americans will be newly diagnosed with esophageal cancer during 2006, and 13,770 deaths are expected.

Other facts about esophageal cancer include the following:

• Esophageal cancer is three times more common among men than among women.
• Esophageal cancer is three times more common among African Americans than among Caucasians.
• Some countries such as Iran, northern China, India, and southern Africa have rates that are 10 to 100 times greater than that in the United States.

What causes esophageal cancer?

No one knows exactly what causes esophageal cancer. At the top of the esophagus is a muscle, called the sphincter, that releases to let food or liquid go through. The lower part of the esophagus is connected to the stomach. Another muscle is located at this connection that opens to allow the food to enter the stomach. This muscle also works to keep food and juices from the stomach from backing into the esophagus. When these juices do back up, reflux, commonly known as heartburn, occurs.

Long-term reflux can change the cells in the lower end of the esophagus. This condition is known as Barrett's esophagus. If these cells are not treated, they are at much higher risk of developing into cancer cells.

What are the different types of esophageal cancer?

There are two main types of esophageal cancer.

The most common type of esophageal cancer, known as adenocarcinoma, develops in the glandular tissue in the lower part of the esophagus, near the opening of the stomach.

Squamous cell carcinoma grows in the cells that form the top layer of the lining of the esophagus, known as squamous cells. This type of cancer can grow anywhere along the esophagus.

Treatment for both types of esophageal cancer is similar.

What are the symptoms of esophageal cancer?

Often, an early stage of esophageal cancer has no symptoms. Symptoms do not appear until the disease is more advanced. The following are the most common symptoms of esophageal cancer. However, each individual may experience symptoms differently. Symptoms may include:

• difficult or painful swallowing
  A condition known as dysphagia, this is the most common symptom of esophageal cancer. This gives a sensation of having food lodged in the chest, and persons with dysphagia often switch to softer foods to help with swallowing.
• pain in the throat or back, behind the breastbone or between the shoulder blades
• severe weight loss
  Many persons with esophageal cancer lose weight unintentionally because they are not getting enough food.
• hoarseness or chronic cough
• vomiting
• coughing up blood

The symptoms of esophageal cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

There is no routine screening examination for esophageal cancer, however, persons with Barrett's esophagus should be examined often since they are at greater risk for developing the disease.

What are the risk factors for esophageal cancer?

The following factors can put an individual at greater risk for developing esophageal cancer:

• age
  The risk increases with age, with persons over the age of 60 being at greatest risk for developing esophageal cancer.
• gender
  Men have a three times greater risk of developing esophageal cancer than women.
• tobacco use
  Using any form of tobacco raises the risk of esophageal cancer. The longer tobacco is used, the greater the risk, with the greatest risk among persons who have indulged in long-term drinking with tobacco use. Scientists believe that these substances increase each other's harmful effects, making persons who do both especially susceptible to developing the disease.
• alcohol use
  Chronic and/or long-term heavy drinking is another major risk factor for esophageal cancer.
• Barrett's esophagus
  Long-term irritation from reflux, commonly known as heartburn, changes the cells at the end of the esophagus. This is a pre-cancerous condition, which raises the risk of developing adenocarcinoma of the esophagus.
• diet
  Diets low in fruits and vegetables and certain vitamins and minerals can increase risk for this disease.
• other irritants
  Swallowing caustic irritants such as lye and other substances can burn and destroy cells in the esophagus. The scarring and damage done to the esophagus can put a person at greater risk for developing cancer.
• medical history
  Certain diseases, such as achalasia, a disease in which the bottom of the esophagus does not open to release food into the stomach, and tylosis, a rare, inherited disease, increase the risk of esophageal cancer. In addition, anyone who has had other head and neck cancers has an increased chance of developing a second cancer in this area, which includes esophageal cancer.
• obesity
  

How is esophageal cancer diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for esophageal cancer may include the following:

• chest x-ray - a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• upper GI (gastrointestinal) series (Also called barium swallow.) - a diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.
• esophagogastroduodenoscopy (Also called EGD or upper endoscopy.) - a procedure that allows the physician to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the physician to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).
  
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• computed tomography scan (CT or CAT scan) - diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• endoscopic ultrasound - this imaging technique uses sound waves to create a computer image of the inside of the esophagus and stomach. The endoscope is guided into the mouth and throat, then into the esophagus and the stomach. As in standard endoscopy, this allows the physician to view the inside of this area of the body, as well as insert instruments to remove a sample of tissue (biopsy).
• thoracoscopy and laparoscopy - these methods allow the physician to examine the lymph nodes inside the chest or abdomen with a hollow, lighted tube, and remove these nodes for further testing.

What are the stages of esophageal cancer?

When esophageal cancer is diagnosed, tests will be performed to determine how much cancer is present, and if the cancer has spread from the colon to other parts of the body. This is called staging, and is an important step toward planning a treatment program. The National Cancer Institute defines the following stages for esophageal cancer: