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Esophagus

​This information should not be used for self-diagnosis or in place of a qualified physician's care.

Reviewed 2016​

The basics
  • Guidelines for treating this cancer have been developed by the Gastrointestinal (GI) Tumour Group.
  • For health professional information on treating this cancer, please see our Cancer Management Guidelines.
  • Other names for esophagus cancer: esophageal cancer, cancer of the esophagus.
  • The esophagus is a 10 inch long tube that connects the back of the mouth to the stomach.
  • When a person swallows, the muscles in the wall of the esophagus contract, moving food and liquids into the stomach.

What causes it and who gets it?

Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.

  • This cancer affects more men than women (3-4 times as many men as women)
  • Black people are twice as likely to develop esophagus cancer as white people
  • Cancer of the esophagus is much more common in some other countries. For example, esophagus cancer rates in Iran, northern China, India, and southern Africa are 10 to 100 times higher than in the United States.
  • The risk of developing esophagus cancer increases with age
  • Heavy use of alcohol is a risk factor
  • The use of tobacco products is a major risk factor
  • People who both smoke and drink alcohol are much more likely to develop esophagus cancer
  • Being overweight is a risk factor
  • A diet low in fruits and vegetables may increase the risk for esophagus cancer
  • Chronic irritation of the lower esophagus due to gastric reflux (backward flow of stomach acid) increases the risk of esophagus cancer
  • People with Barrett's esophagus are much more likely to develop adenocarcinoma of the esophagus
  • Exposure to the solvents used for dry cleaning may lead to a greater risk
  • There is an increased risk of squamous cell carcinoma to those exposed to burns of the esophagus. For example, exposure to lye during a suicide attempt or accidental swallowing by a child.
  • Achalasia, caustic stricture and Plummer-Vinson's syndrome are all associated with an increased risk of the squamous cell type of esophagus cancer
  • Statistics

Can I help to prevent it?

  • The risk of esophagus cancer drops with reduced use of and exposure to tobacco and cigarette smoke
  • Use alcohol in moderation
  • Include lots of fruits and vegetables in your diet and maintain a healthy weight
  • People with Barrett's esophagus can use treatments for preventing reflux (heartburn), as recommended by their doctor

Screening for this cancer

  • No effective screening program exists for this cancer yet
  • People with Barrett's esophagus should have an endoscopy at least every two years

Signs and Symptoms

  • Difficulty swallowing, at first with solid foods, but as the cancer grows, even liquids and soft foods become difficult to swallow
  • Unexplained weight loss
  • Unexplained choking
  • Pressure or burning in chest
  • Frequent bouts of indigestion or heartburn
  • Loss of appetite 
  • Hoarseness or cough
  • Painful spasms after eating
  • Vocal cord paralysis
  • Coughing up blood
  • Persistent anemia
Diagnosis & staging

Diagnosis

These are tests that may be used to diagnose this type of cancer.

  • Barium swallow test: a liquid is swallowed to help the esophagus show on x-rays. The barium drink is not radioactive.
  • Endoscopy: using a small medical camera on an endoscope (tube) to see inside the esophagus without surgery
  • Biopsy: surgery to take a sample of the area or growth, which is examined for cancer
  • Once a diagnosis of esophagus cancer is confirmed, then the doctors need to check and see if the cancer has spread. These are some of the tests that may be done:
    • CT scan
    • Endoscopic ultrasound of the surrounding tissue
    • Bronchoscopy may be required to see if tumour is invading patient's airway
    • Mediastinoscopy may be necessary to assess lymph nodes
    • Laparoscopy may be helpful to assess presence of intra-abdominal spread or liver involvement
    • PET scan is sometimes useful

For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section. 

Types and Stages

Types

  • Squamous cell cancer develops in the squamous cells that line the esophagus.
    • Squamous cell cancer usually develops in the middle or upper part of the esophagus.
  • Adenocarcinoma develops in the glandular cells in the lower part of the esophagus.

Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

  • T describes the site and size of the main tumour (primary) 
  • N describes involvement of lymph nodes 
  • M relates to whether the cancer has spread (presence or absence of distant metastases)
  • Stage 0 
    Very early cancer; has not spread below the lining of the first layer of esophageal tissue 
  • Stage I 
    Tumour involves inner lining only 
  • Stage II 
    Tumour may involve entire wall or may involve nodes and inner lining only 
  • Stage III 
    Tumour involves entire wall and lymph nodes 
  • Stage IV 
    Metastases (tumour has spread outside the esophagus)
Treatment

Treatment

Cancer therapies can be highly individualized – your treatment may differ from what is described below.

Treatment by stage:
  • Stage 0 
    • Surgery and/or radiation therapy
    • Some newer techniques may include mucosal stripping or possibly photodynamic therapy 
  • Stage I 
    • Surgery
    • Radiation therapy may be used to control small tumours
  • Stage II
    • A combination of radiation therapy and chemotherapy
    • Some cases are suitable for surgery
  • Stage III
    • Chemotherapy alone depending on the location, or radiation therapy in combination with chemotherapy, or radiation therapy alone
    • Insertion of feeding tube
    • Laser therapy
    • Surgery may be considered 
  • Stage IV
    • Radiation therapy or chemotherapy 

Surgery

  • Surgery is the most common treatment of cancer of the lower esophagus. Sometimes if there is a good response to chemotherapy and radiation, surgery can be avoided.
    • Esophagus surgery, called an esophagectomy, usually involves removal of the lower part of the esophagus and upper part of the stomach. Depending on the location of the tumour, sometimes the entire esophagus is removed.
    • The healthy part of the esophagus is reconnected to the stomach.
    • Lymph nodes near the esophagus may also be removed.
  • With tumours that cannot be treated by surgery or further radiation, patients may have their ability to swallow restored by the insertion of a special tube, called an esophageal stent.
  • A feeding tube may occasionally be inserted in the stomach to ensure that the patient is getting enough food.

Radiation Therapy

  • Radiation therapy combined with chemotherapy is the major treatment for cancers of the mid and upper esophagus.
  • Radiation therapy may be used alone when chemotherapy is not considered appropriate.
  • If surgery is not possible, radiation may be useful in providing relief of symptoms.

Chemotherapy

  • Chemotherapy is combined with radiation or used alone.
  • There are several different chemotherapy drugs and combinations; an oncologist will help plan the best protocol for a patient.
  • Chemotherapy may sometimes be used to relieve symptoms and prolong survival in people with advanced cancer.

Photodynamic/ Laser Therapy

  • Photodynamic therapy uses a drug to make the area sensitive to light, then a special light is shined on the area to kill visible cells.
  • Laser treatment or photodynamic therapy may be used to open a blockage and relieve dysphagia (difficulty swallowing). This usually needs to be repeated every six weeks.

Follow-up after Treatment

  • Guidelines for follow-up after treatment are covered on our website.
  • You will be returned to the care of your family physician or specialist for regular followup. If you do not have a family physician, please discuss this with your BC Cancer Agency oncologist or nurse.
  • Follow-up testing is based on your type of cancer and your individual circumstances.
  • Life after Cancer focuses on the issues that cancer survivors can face.
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