Esophageal Cancer

What is esophageal cancer?

Esophageal cancer is a growth of abnormal cells in the tube that connects your throat to your stomach. This tube is called the esophagus.

Most often people who get cancer of the esophagus are middle-aged or older. It is more common in men than in women. African-Americans are also more likely to get this kind of cancer.

How does it occur?

The cause of cancer of the esophagus is not known.

You are more at risk for esophageal cancer if you:

• drink a lot of alcohol
• smoke or chew tobacco
• have had long-term reflux (backup) of fluid from the stomach into the lower esophagus (hiatal hernia).
• are overweight.

What are the symptoms?

Symptoms include:

• Trouble swallowing that feels like food is stuck in your throat or behind your breastbone. First, you may have trouble swallowing solid foods. Later, soft foods may be hard to swallow. Eventually you may have trouble swallowing even liquids.
• A burning feeling when food is swallowed.
• Heartburn when you drink hot liquids.
• Pain behind the breastbone that does not go away.
• Unexpected weight loss.

As the tumor grows, your esophagus gets narrower. Symptoms in later stages of the cancer may include drooling, spitting up pieces of undigested food, and weight loss. Lung infections caused by liquids spilling over into your windpipe (trachea) are common. You may also have hoarseness and coughing if other tissues near the esophagus are affected by the cancer.

How is it diagnosed?

Your healthcare provider will review your health history, ask about your symptoms, and examine you. Tests for esophageal cancer include:

• A barium swallow X-ray allows your healthcare provider to watch a thick liquid (barium) move from your esophagus to your stomach. It can help show the size, shape, and location of the cancer.
• A procedure called an endoscopy will be done. After you are given a drug to make you sleepy, a slim flexible tube with a tiny camera is inserted through your mouth so your provider can look at the inside of your esophagus.
• A sample of tissue will be removed from the area of the esophagus that appears abnormal. The tissue is examined for the presence of cancer. This test is called a biopsy and is done during the endoscopy.
• Blood tests and other X-rays and scans of the chest and abdomen will be done to see if the disease has spread beyond the esophagus.

How is it treated?

Treatment depends on the size and location of the cancer, your age, and your general health. You may be treated with surgery, radiation therapy, chemotherapy, or a combination of these treatments.

• Surgery may remove part of the esophagus and nearby lymph nodes. It can cure a few people whose cancer has not spread beyond the esophagus. For others it may not be a cure but it can ease some symptoms.
• Radiation therapy uses high-energy radiation to kill cancer cells. It is often used to relieve pain and shrink the tumor to make swallowing easier.
• Chemotherapy uses special anticancer drugs to kill cancer cells and shrink tumors. They are usually given as an injection into a vein.

Combining surgery with other treatments such as chemotherapy or radiation therapy may help some people live longer and with fewer symptoms.

How long will the effects last?

The chance of long-term survival from cancer of the esophagus is usually poor. The chance of cure may be better if the cancer is found early. If you have any of the symptoms and are at a high risk for this disease, see your healthcare provider. This cancer is usually not diagnosed until symptoms appear during the later stages of the disease, and the cancer can spread easily. However, better treatments have helped increase the life span and comfort of people with this disease.

How can I take care of myself?

Talk to your healthcare provider if you have concerns about your illness and treatments. Ask about side effects you may have from treatments. You may want to make a list of questions at home and take it with you when you visit your provider. Ask a friend to go with you who can listen, too. If you don't understand something, ask your provider to explain it. Take notes if you need to.

The following guidelines may help control your symptoms:

• Eat small meals and eat more often.
• Follow your healthcare provider's advice about healthy foods you should eat to keep your strength and to help heal your body after treatment.
• If you are a heavy drinker or smoker, talk to your provider about quitting.
• Get plenty of rest and sleep.
• Take pain medicine as prescribed.
• Join a cancer support group.

For more information, contact your local chapter of the American Cancer Society or call 800-ACS-2345. The National Cancer Institute (800-4-CANCER) is another resource. You may also visit their Web sites at http://www.cancer.org or http://www.cancer.gov.

How can I prevent esophageal cancer?

There is no sure way to prevent this kind of cancer. You can reduce your risk of getting it if you don't smoke and if you drink only a moderate amount of alcohol. To catch any problems early, have regular checkups and be aware of any changes in your body. If you suffer from long-standing heartburn, see your healthcare provider because this may be a symptom of a Barrett's esophagus, which can turn into cancer of the esophagus.