Esophagus Cancer

The esophagus runs from your throat to your stomach. It is a muscular tube that carries food into the stomach. It is between 10 to 13 inches long and is less than an inch wide at its narrowest point. Cancer of the esophagus starts in the innermost layers and grows out, according to the American Cancer Society (ACS). Close to 13,000 people will find out they have esophagus cancer each year, and about the same number of people die of this disease each year. ACS says this cancer is usually fatal because most esophagus cancers are discovered late, with the disease in an advanced state. The five year survival rate, according to ACS, is 13 percent for whites and 9 percent for African Americans. While those numbers are low, they are dramatic improvements from 40 years ago when the rate was 4 percent for whites and 1 percent for African Americans.

Types of esophagus cancer

Esophagus cancer is divided into two major groups, according to the National Cancer Institute (NCI). ACS says cancers of the esophagus are almost evenly split between the two types. Squamous cell carcinomas tend to start in the upper and middle part of the esophagus but can start elsewhere in the esophagus. The second type is called adenocarcinoma. It starts in the area near the opening to the stomach and is directly related to another condition called Barrett's esophagus. Barrett's esophagus is the result of changes to the cells caused by acid reflux, or the spilling of stomach acid back into the esophagus.

Risk factors

African Americans are 3 times more likely to have esophagus cancer than whites and men are three times more likely than women. Age is also a factor, with 45 to 70 being the high risk time period, according to ACS. In addition to the already mentioned Barrett's esophagus, other risk factors according to ACS and NCI are:

  • Smoking and other tobacco use such as chewing tobacco
  • Long-term alcohol use. A combination of tobacco and alcohol use multiplies the risks.
  • Irritation of the esophagus by chemicals such as lye, which is found in many strong cleaners. People who swallowed such products when they were young have a greater risk.
  • Achalasis, a condition where food does not enter the stomach and backs up into the esophagus. The esophagus expands at that point.
  • Tylosis, a rare genetic disease with symptoms that include excess skin on the palms of the hands and the soles. People who have had head or neck cancers are also at greater risk of getting esophagus cancer. Because most esophagus cancers are discovered late it is important for people to be aware of the risk factors and work with their doctor on regular screenings. A person diagnosed with Barrett's esophagus or tylosis should be vigilant.

Symptoms and diagnosis

ACS says there are no regular screening tests for esophagus cancer and in its early stages; the cancer usually does not cause symptoms. Trouble swallowing is the most common symptom as the cancer grows. Other symptoms listed by both NCI and ACS include:

  • pain in the back between the shoulder blades or in the mid-chest
  • unexpected weight loss
  • hoarseness
  • coughing up blood
  • frequent episodes of hiccups

These can also be symptoms of other conditions, and should be checked by a doctor.

If cancer is suspected, there are various procedures to confirm the diagnosis. One type is a barium swallow where a set of x-rays are taken after the patient swallows barium, which coats the esophagus. An endoscope can be used to see into the esophagus and a sample can be taken if any abnormalities are found to confirm the presence of cancer. If an abnormal area is found, the doctor can collect cells and tissue through the endoscope for examination under a microscope. This is called a biopsy. A biopsy can show cancer, tissue changes that may lead to cancer, or other conditions.

Once cancer of the esophagus is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment.

Treatments

Treatments for esophagus cancer include surgery, radiation, chemotherapy and laser therapy and electrocoagulation, which uses an electric current to kill cancer cells. Surgery is the most common treatment, according to NCI. Usually, the surgeon removes the tumor along with all or a portion of the esophagus, nearby lymph nodes and other tissue in the area. (An operation to remove the esophagus is called an esophagectomy.) The surgeon connects the remaining healthy part of the esophagus to the stomach so the patient is still able to swallow. Many treatments are used to relieve symptoms and prolong life, and success depends on how far the cancer has progressed, according to ACS.

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

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