Esophageal Cancer

Causes

Cancer is when cells in the body split without control or order. These cells form a growth or tumor. Cancer growths invade nearby tissues and can spread to other parts of the body. It is not clear exactly what causes these problems. It is likely a mix of genes and the environment.

The cell changes in EC may be caused by irritants such as:

• Tobacco
• Alcohol
• Stomach acid from acid reflux

Risk Factors

EC is more common in men and people aged 50 years and older.

Other things that raise the risk of EC are:

• Gastroesophageal reflux (GERD)
• Barrett esophagus
• Smoking and other tobacco use
• Excess alcohol use
• Human papillomavirus (HPV) infection
• Obesity
• Damaged esophagus

Symptoms

Symptoms of EC may not happen until later. When symptoms happen, they may include:

• Problems swallowing
• Weight loss
• Lack of hunger
• Heartburn
• Pain from swallowing
• Persistent cough
• Hoarse voice

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. This may be enough for the doctor to suspect EC. Other tests may include:

• Blood tests
• Imaging tests such as:
  • Upper GI endoscopy with biopsy —Examination of esophagus with a lighted scope. Tissue samples will be taken and tested.
  • CT scan
  • PET/CT scan

The exam and test results will help find the stage of cancer. EC is staged from 0 to 4. Stage 0 is a very localized cancer. Stage 4 is a spread to other parts of the body. The doctor will also look at the grade of the cancer. Low grade cancers tend to grow and spread slower than higher grade cancers.

Treatment

Treatment is based on the stage of the EC. It may include one or more methods.

Surgery may be used for earlier stage cancers. It may be the only treatment, or it may be done with radiation therapy or chemotherapy. It includes:

• Esophagectomy—part or all of the esophagus is removed using a scope or open incision
• Lymph node removal—nearby lymph nodes are removed with esophagectomy

Some treatments can be done through a scope passed down the throat and into the esophagus. Some may be used to treat early stage cancers or pre-cancers. Others are used to ease symptoms for more advanced EC that cannot be removed. They may include:

• Endoscopic mucosal resection— the inner lining of the esophagus is removed
• Photodynamic therapy—uses a drug and a laser light to kill the cancer cells
• Ablation—uses heat or laser to kill cancer or precancer cells, or to help open the esophagus
• Esophageal stent—a device is placed to help keep the esophagus open

Radiation therapy may be used to kill cancer cells and shrink tumors. It may be used with chemotherapy for people who cannot have surgery. It may include:

• External—radiation directed at the esophagus from outside the body
• Internal—radioactive materials are placed in the esophagus in or near the cancer cells

Chemotherapy (chemo) uses drugs to kill cancer cells. It may be taken by mouth, shots, or IV. Chemo is often given with radiation therapy.

Radiation therapy and/or chemotherapy may be used:

• After surgery—to kill any cancer cells left behind
• Before surgery—to shrink the cancer
• For advanced cancers—to shrink the tumor and ease symptoms, but not cure the cancer

Other treatments for EC may include:

• Targeted therapy—drugs that target cancer cells
• Immunotherapy—drugs that help the body fight cancer

Prevention

To help lower the risk of getting EC:

• Do not smoke or use other tobacco products.
• If you smoke, talk to the doctor about ways to quit .
• Limit alcohol. This means 2 drinks or less a day for men and 1 drink or less a day for women.
• Eat a healthful diet. Eat fruits, vegetables, and other foods that are high in fiber. Limit dairy, processed foods, and red meat.
• Exercise regularly—Aim for 30 minutes of activity on most days of the week.
• Get medical treatment for GERD or Barrett esophagus.
• Maintain a healthy weight.

EC is often found in later stages. People who have risk factors, especially GERD or Barrett esophagus, should talk to their doctor about screening tests.