Esophageal Cancer

There are two primary types of cancer of the esophagus: squamous cell carcinoma and adenocarcinoma. These two cancers account for about 4% of cancer deaths within the United States every year.

Squamous cell carcinoma occurs with wide variation in geography, with South Carolina, Washington, D.C., and Alaska having the highest rates. This particular cancer occurs more frequently in black males. The exact cause of this cancer is not known, but it does appear to be related to ingested substances such as alcohol, tobacco, nitrosamines, and vitamin deficiencies.

One squamous cell carcinoma symptom is difficulty swallowing, which may be progressive from meats to soft foods and then liquids or saliva.

An endoscopic image of esophageal adenocarcinoma as seen at the gastroesophageal junction.

 

Chest pain, weight loss, painful swallowing, and excessive salivation may also be symptoms. Barium X-rays may suggest the presence of a cancer, but an upper endoscopy is usually used to obtain tissue for proof and to dilate narrowed areas for temporary relief of difficulty swallowing.

Once cancer of the esophagus is suspected, other studies such as CT scans or endoscopic ultrasound may be performed to find out how extensive the disease is. If the disease is localized to the esophagus and is superficial, surgery is usually performed. In those patients with small superficial cancers who are not surgical candidates, the cancer may be removed by injecting saline into the wall of the esophagus and removing the tissue through the endoscope. Treatment may also include using chemicals to make the cancer cells sensitive and then exposing them to light (photodynamic therapy).

Laser treatment has been used more commonly in the past for patients who had advanced disease or could not tolerate surgery. Another form of heat may be applied to the cancer from a tumor probe or a tissue coagulator. On occasion, injections of alcohol may be used to slow cancerous tissue.

Chemotherapy combined with radiation to the esophagus has been used with success to improve the ability to swallow. This combination may also be given to patients who are good surgical candidates but have cancer that goes deep into or through the esophageal wall or involves local lymph nodes. After treatment, surgery can be reconsidered.

Radiation treatment by itself is used usually only if the cancer is very advanced. A wire tube (stent) may be placed across the narrowed area of the esophagus to improve swallowing or to close off a hole if the tumor has spread to connect the esophagus with the airway (tracheoesophageal fistula). Stents are used for patients with advanced disease or for those who cannot tolerate surgery or the chemotherapy/radiation combination. This may also be offered to those patients who don't want surgery or chemotherapy.

Adenocarcinoma of the esophagus is felt to arise primarily in those who have developed Barrett's esophagus. The symptoms and treatment are similar for squamous cell carcinoma, although some believe that radiation therapy is less effective.

Cancer-Related Terms

One of the bewildering aspects of a cancer diagnosis is the many words that are used to describe the condition. Here are a few that we thought you should know:

• Carcinoma — an early form of cancer that has not spread, or a pre-cancer
• Dysplasia — the earliest form of a pre-cancerous lesion
• Histology — microscopic study of the anatomy of cells
• Malignant — a medical condition that becomes progressively worse
• Metastasis — term used to indicate that a disease has spread to another organ
• Neoplasm — term used for an abnormal mass. (A tumor is a neoplasm.)
• Staging — the extent to which a cancer has developed or spread