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

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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