Last year, about 18,000 new cases of esophageal cancer were diagnosed. The lifetime risk of developing esophageal cancer is less than 1%, and it represents only 1.1% of all new cancer diagnoses in the U.S., according to the National Institutes of Health. However, it is the tenth leading cause of cancer death in the country. Survival rates are much higher when esophageal cancer is found early and has not spread. It is more common in men than in women, and in people older than age 55. More than 34,000 people in the U.S. are currently living with esophageal cancer.
Esophageal cancer occurs when abnormal cells form in the tissues that line the esophagus (swallowing tube that passes from the throat to the stomach). Cancer that begins in the flat cells lining the esophagus, usually in the upper and middle esophagus, is called squamous cell carcinoma or epidermoid carcinoma. Cancer that begins in glandular or secretory cells that make and release mucus and other fluids is called adenocarcinoma. Adenocarcinomas usually form in the lower esophagus near the stomach, where fluids are concentrated.
People who use tobacco products, drink excessive alcohol, have chronic reflux, or suffer from Barrett esophagus, a condition in which abnormal cell growth occurs in the lining of the lower esophagus, are at greater risk for esophageal cancer.
Pain or difficulty swallowing, sometimes accompanied by pain behind the breastbone, hoarseness or coughing, indigestion, or unexplained weight loss may suggest signs of esophageal cancer. A physical exam and chest x-ray may help diagnose esophageal cancer, but a barium swallow or upper GI series requiring patients to drink a metallic liquid prior to x-rays can help identify abnormal findings. An esophagoscopy inserts a thin tube with a light and camera through the mouth or nose and down the throat to view the entire esophagus. It may also be equipped to biopsy, or remove tissue samples for later inspection under a microscope to find cancer cells or other abnormal tissues. If the esophagus and stomach are scoped, the procedure is known as an upper endoscopy.
If cancer in the esophagus is found, an esophagectomy, or surgery to remove the cancerous tissue, is the most common treatment. Sometimes surgeons can reconnect the healthy part of the esophagus to the stomach using intestinal tissue or plastic implants so patients can still swallow. If a tumor is blocking a patient’s esophagus, a firm tube or stent may be placed inside to allow swallowing. A firm tube may also be implanted in the esophagus to keep it open during radiation therapy; this procedure is known as intraluminal intubation and dilation.
External radiation therapy, using high-energy x-rays outside the body to target cancer cells, or internal radiation therapy, implanting needles, seeds, wires, or catheters in or near the cancer, may help treat esophageal cancer. Chemotherapy uses drugs by mouth or injected into the bloodstream to stop the growth of cancer cells. Chemoradiation combines both approaches. In some cases, intense, narrow laser beams or light-activated chemical treatment (photodynamic therapy) may be used to kill cancer cells.
A 2015 study in Lancet Oncology suggested that the outpatient chemoradiotherapy regimen FOLFOX (fluorouracil, leucovorin and oxaliplatin) was cheaper, easier, and less toxic than older chemoradiotherapy approaches, although both regimens provided equal survival rates for inoperable esophageal cancer.
The Esophageal Cancer Awareness Association provides online advice and links to regional support for esophageal cancer patients, survivors, and their families.