There are two types of cancer that form in tissues that line the esophagus: squamous cell carcinoma and adenocarcinoma.
Squamous Cell Carcinoma
Squamous cell carcinoma forms in the squamous cells, thin flat cells that line the esophagus. This type of cancer is most often found in the upper and middle part of the esophagus, but can occur anywhere along the esophagus. It is also called epidermoid carcinoma.
Adenocarcinoma begins in glandular cells, cells in the lining of the esophagus that produce and release fluids such as mucus. Adenocarcinomas usually form in the lower part of the esophagus, near the stomach.
Symptoms of Esophageal Cancer
At a very early stage, esophageal cancer may not show any symptoms and will only be detected during an upper endoscopy and biopsy.
At more advance stages, the following symptoms can be present:
- Dysphagia (difficulty swallowing)
- Weight loss, fatigue, weakness, loss of appetite
- Odynophagia (painful swallowing)
- Hoarseness (change in voice)
- Mass in the neck (due to enlarged lymph nodes)
- Pain behind the breast bone
- Blood in the stool (bleeding from the tumor into the intestines)
Diagnosis and Staging of Esophageal Cancer
A chest x-ray, barium swallow, esophagoscopy and biopsy are used to diagnose 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 determine if the cancer has spread is called staging, which is important in planning treatment. Some of the tests used to diagnose esophageal cancer are also used to stage the disease, including MRI, CT scan and PET scan.
Endoscopy and Surgical Treatment for Esophageal Cancer
A variety of treatments are available for patients with esophageal cancer. Some are standard; others are being tested in clinical trials. Surgery is the most common treatment for cancer of the esophagus.
Endoscopic Mucosal Resection
With this endoscopic technique, the part of the lining of the esophagus
which contains abnormal or cancerous cells is removed. This technique is
used in a selected group of patients with esophageal cancer with only small
areas of superficial tumor or high-grade dysplasia (abnormal cells in the
lining of the esophagus).
Following endoscopic mucosal resection,
patients need to be followed very carefully with serial endoscopies and
biopsies to assure that there is no residual tumor (tumor left behind) or recurrence
of tumor growth in the esophagus.
Part of the esophagus may be removed in an operation called an esophagectomy. Your surgeon will connect the remaining healthy part of the esophagus to the stomach to allow for swallowing of food.
Lymph nodes near the esophagus may also be removed and checked for cancer. If the esophagus is partly blocked by the tumor, an expandable metal stent may be placed inside the esophagus to help keep it open.
Minimally Invasive Esophagectomy
This approach is performed by making small incisions in the abdomen and in the chest for removal of the esophagus. The stomach is most commonly used for esophageal replacement.
To restore swallowing, the stomach is then connected to the remaining part of the esophagus in the chest or in the neck via a neck incision, a procedure called gastric pull-up. Studies have shown that this procedure can be performed with less morbidity and comparable oncologic results, compared to a standard esophagectomy.
Radiation therapy, or radiotherapy, involves the use of high-energy rays to destroy cancer cells. Radiation therapy is commonly used to reduce the size of a tumor prior to surgery. In patients with squamous cell carcinoma located in the upper part of the esophagus, radiation therapy in combination with chemotherapy is used for definitive treatment.
Radiosurgery delivers radiation directly to the tumor with little damage to healthy tissue. It may be used to treat certain tumors in patients who cannot have surgery. A course of radiation therapy depends on the type and stage of cancer being treated.
A plastic tube may be inserted into the esophagus to keep it open during radiation therapy. The procedure is called intraluminal intubation and dilation.
Chemotherapy involves the use of drugs to destroy cancer cells. Chemotherapy is commonly used to reduce the size of a tumor prior to surgery or to destroy any tumor cells in the lymph nodes following surgery. In patients with squamous cell carcinoma located in the upper part of the esophagus, chemotherapy in combination with radiotherapy is used for definitive treatment.
Laser Therapy and Electrocoagulation
Laser therapy uses a laser beam to kill cancer cells. Electrocoagulation involves the use of an electric current.