Esophageal Cancer


General Information

What is esphageal cancer?

Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus. The esophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach. The wall of the esophagus is made up of several layers of tissue, including mucous membrane, muscle, and connective tissue. Esophageal cancer starts at the inside lining of the esophagus and spreads outward through the other layers as it grows.

The two most common forms of esophageal cancer are named for the type of cells that become malignant (cancerous):

Squamous cell carcinoma: Cancer that forms in squamous cells, the thin, flat cells lining the esophagus. This cancer is most often found in the upper and middle part of the esophagus, but can occur anywhere along the esophagus. This is also called epidermoid carcinoma.

Adenocarcinoma: Cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the esophagus produce and release fluids such as mucus. Adenocarcinomas usually form in the lower part of the esophagus, near the stomach.

Smoking, heavy alcohol use, and Barrett's esophagus can affect the risk of developing esophageal cancer. Risk factors include the following:

-Tobacco use.
-Heavy alcohol use.
-Barrett's esophagus: A condition in which the cells lining the lower part of the esophagus have changed or been replaced with abnormal cells that could lead to cancer of the esophagus. Gastric reflux (the backing up of stomach contents into the lower section of the esophagus) may irritate the esophagus and, over time, cause Barrett's esophagus.
-Older age.
-Being male.
-Being African-American.

The most common signs of esophageal cancer are painful or difficult swallowing and weight loss. These and other symptoms may be caused by esophageal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

-Painful or difficult swallowing.
-Weight loss.
-Pain behind the breastbone.
-Hoarseness and cough.
-Indigestion and heartburn.

Tests that examine the esophagus are used to detect (find) and diagnose esophageal cancer.
The following tests and procedures may be used:

Chest x-ray: Brief exposure of the chest to radiation to produce an image of the chest and its internal structures.

Barium swallow: X-rays of the esophagus are taken after the patient drinks a solution that contains barium. The barium coats the esophagus and outlines it on the x-ray. This procedure is also called an esophagram.

Esophagoscopy: The inside of the esophagus is viewed with an esophagoscope (a thin, lighted tube). The esophagoscope is passed through the mouth and down the throat into the esophagus. Before the test, a local anesthetic (a medication that causes temporary loss of feeling) is applied to the throat so no pain is felt. This test is usually done in a doctor's office.

Biopsy: Cells, tissues, or fluid are removed and viewed under a microscope to see if cancer cells are present. The biopsy is usually done during an esophagoscopy. Sometimes a biopsy shows changes in the esophagus that are not cancer but may lead to cancer.

Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether it affects part of the esophagus, involves the whole esophagus, or has spread to other places in the body), the size of the tumor, and the patient's general health.

When esophageal cancer is found very early, there is a better chance of recovery. Esophageal cancer is often in an advanced stage when it is diagnosed. At later stages, esophageal cancer can be treated but rarely can be cured. Taking part in one of the clinical trials being done to improve treatment should be considered.

Stages of Esophageal Cancer

After esophageal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the esophagus or to other parts of the body.
The process used to find out if cancer cells have spread within the esophagus or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. The following tests and procedures may be used in the staging process:

Bronchoscopy: A procedure in which a thin, lighted tube is inserted through the nose or mouth into the trachea (windpipe) and bronchi (air passages that lead to the lungs). This allows the inside of the trachea, bronchi, and lungs to be examined.

Chest x-ray: Brief exposure of the chest to radiation to produce an image of the chest and its internal structures.

Laryngoscopy: A procedure in which the doctor examines the larynx (voice box) with a mirror or with a laryngoscope (a thin, lighted tube).

CT scan (CAT scan): A CT scan creates a series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.

EUS (endoscopic ultrasound): An endoscope (a thin, lighted tube used to look at tissues inside the body) is used to bounce high-energy sound waves off internal tissues and organs and change the echoes into pictures called sonograms. This is also called endosonography.
Thoracoscopy: An endoscope is inserted through an incision in the chest wall to examine the inside of the chest.

Laparoscopy: A laparoscope (a thin, lighted tube) is inserted through an incision in the abdominal wall to view the organs and remove tissue samples.

PET scan (positron emission tomography scan): A PET scan creates a picture showing the location of tumor cells in the body. A substance called radionuclide glucose (sugar) is injected into the patient through a vein and the PET scanner rotates around the patient to create the picture. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells. The use of PET for staging esophageal cancer is being studied in clinical trials.

The following stages are used for esophageal cancer:

Stage 0 (Carcinoma in Situ)
In stage 0 (carcinoma in situ), cancer is found only in the innermost layer of cells lining the esophagus.

Stage I
In stage I, cancer has spread beyond the innermost layer of cells to the next layer of tissue in the wall of the esophagus.

Stage II
Stage II esophageal cancer may be divided into stage IIA and stage IIB, depending on where the cancer has spread.

Stage IIA: Cancer has spread to the layer of esophageal muscle or to the outer wall of the esophagus.

Stage IIB: Cancer may have spread to any of the first three layers of the esophagus and to nearby lymph nodes. Lymph nodes are small, bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.

Stage III
In stage III, cancer has spread to the outer wall of the esophagus and may have spread to tissues or lymph nodes near the esophagus.

Stage IV
In stage IV, cancer has spread from the esophagus to other parts of the body and may also have spread to nearby lymph nodes. Stage IV esophageal cancer may be divided into stage IVA and stage IVB, depending on where the cancer has spread.

Stage IVA: Cancer has spread to nearby or distant lymph nodes.

Stage IVB: Cancer has spread to distant lymph nodes and/or organs in other parts of the body.

Recurrent Esophageal Cancer
Recurrent esophageal cancer is cancer that has recurred (come back) after it has been treated. Recurrent esophageal cancer may come back in the esophagus or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with esophageal cancer.
Different types of treatment are available for patients with esophageal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Five types of standard treatment are used:

Surgery
Surgery is the most common treatment for cancer of the esophagus. Part of the esophagus may be removed in an operation called an esophagectomy. The doctor will connect the remaining healthy part of the esophagus to the stomach so the patient can still swallow. A plastic tube or part of the intestine may be used to make the connection. Lymph nodes near the esophagus may also be removed and viewed under a microscope to see if they contain cancer. If the esophagus is partly blocked by the tumor, an expandable metal stent (tube) may be placed inside the esophagus to help keep it open.

Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. A plastic tube may be inserted into the esophagus to keep it open during radiation therapy. This is called intraluminal intubation and dilation.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Laser therapy
Laser therapy is the use of a powerful beam of light to kill cancer cells.

Electrocoagulation
Electrocoagulation is the use of an electric current to kill cancer cells.

Other types of treatment are being tested in clinical trials.

Patients have special nutritional needs during treatment for esophageal cancer.
Many people with esophageal cancer find it hard to eat because they have difficulty swallowing. The esophagus may be narrowed by the tumor or as a side effect of treatment. Some patients may receive nutrients directly into a vein. Others may need a feeding tube (a flexible plastic tube that is passed through the nose or mouth into the stomach) until they are able to eat on their own.

Treatment Options By Stage

Stage 0 Esophageal Cancer (Carcinoma in Situ)
Treatment of stage 0 esophageal cancer (carcinoma in situ) is usually surgery.

Stage I Esophageal Cancer
Treatment of stage I esophageal cancer may include the following:

1.Surgery.
2.Clinical trials of chemotherapy plus radiation therapy, with or without surgery.
3.Clinical trials of new therapies used before or after surgery.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage II Esophageal Cancer
Treatment of stage II esophageal cancer may include the following:

1.Surgery.
2.Clinical trials of chemotherapy plus radiation therapy, with or without surgery.
3.Clinical trials of new therapies used before or after surgery.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage III Esophageal Cancer
Treatment of stage III esophageal cancer may include the following:

1.Surgery.
2.Clinical trials of chemotherapy plus radiation therapy, with or without surgery.
3.Clinical trials of new therapies used before or after surgery.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Stage IV Esophageal Cancer
Treatment of stage IV esophageal cancer may include the following:

1.External or internal radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
2.Laser surgery or electrocoagulation as palliative therapy to relieve symptoms and improve quality of life.
3.Chemotherapy.
4.Clinical trials of chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Recurrent Esophageal Cancer
Treatment of recurrent esophageal cancer may include the following:

1.Use of any standard treatments as palliative therapy to relieve symptoms and improve quality of life.
2.Clinical trials of new therapies used before or after surgery.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.





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