Esophageal Cancer: Symptoms, Causes, Treatment

What are the symptoms of esophageal cancer?

Esophageal cancer often does not cause symptoms in its early stages. As the cancer progresses, symptoms may include:

Difficulty swallowing (dysphagia): This is the most common symptom of esophageal cancer. Initially, it may occur with solid foods and then progress to liquids.
Unintentional weight loss: This can occur as a result of difficulty swallowing and decreased appetite.
Chest pain or discomfort: This may be felt behind the breastbone or in the back. It may worsen when swallowing.
Indigestion or heartburn: These symptoms are common and can be caused by many conditions, but they may also occur in esophageal cancer.
Chronic cough: Some people may develop a chronic cough or hoarseness.
Vomiting: This may include vomiting blood, which can appear bright red or black and may resemble coffee grounds.
Fatigue: This can result from anemia due to blood loss from the cancer.

It’s important to note that these symptoms can be caused by conditions other than esophageal cancer. However, if you experience any persistent or troubling symptoms, especially if you are at increased risk for esophageal cancer (such as a history of smoking, heavy alcohol use, or Barrett’s esophagus), it’s important to see your doctor for evaluation.

What are the causes of esophageal cancer?

Esophageal cancer occurs when cells in the esophagus develop changes (mutations) in their DNA. These mutations cause cells to grow and divide abnormally, leading to the formation of a tumor. The exact cause of these DNA mutations is often unknown, but several factors can increase the risk of developing esophageal cancer:

Smoking: Smoking tobacco, especially over a long period of time, significantly increases the risk of esophageal cancer.
Heavy alcohol use: Excessive alcohol consumption can irritate and damage the cells in the esophagus, increasing the risk of cancer.
Gastroesophageal reflux disease (GERD): Chronic acid reflux, where stomach acid backs up into the esophagus, can cause changes in the lining of the esophagus (Barrett’s esophagus), which increases the risk of esophageal cancer.
Obesity: Being overweight or obese increases the risk of esophageal cancer, possibly due to increased pressure on the abdomen and chronic inflammation.
Diet: A diet low in fruits and vegetables and high in processed meats, smoked foods, and nitrosamines (found in some foods and beverages) may increase the risk of esophageal cancer.
Achalasia: A rare disorder where the lower esophageal sphincter does not relax properly, leading to difficulty swallowing, may increase the risk of esophageal cancer.
Radiation therapy: Previous radiation treatment to the chest or upper abdomen, often used to treat other cancers, can increase the risk of developing esophageal cancer later in life.
Age and gender: Esophageal cancer is more common in people over 55 and is more common in men than women.
Family history: Having a close relative (parent, sibling, or child) with esophageal cancer may increase your risk.
Other factors: Certain medical conditions, such as tylosis, Plummer-Vinson syndrome, and human papillomavirus (HPV) infection, may also increase the risk of esophageal cancer.

It’s important to note that having one or more risk factors does not mean you will develop esophageal cancer, but it does increase your risk. Conversely, some people with esophageal cancer have no known risk factors.

How is the diagnosis of esophageal cancer made?

The diagnosis of esophageal cancer typically involves a combination of imaging tests, endoscopic procedures, and biopsy. Here is an overview of the diagnostic process:

Medical history and physical exam: Your doctor will review your medical history and symptoms and perform a physical examination.
Imaging tests: Imaging tests such as a barium swallow, CT scan, PET scan, or endoscopic ultrasound (EUS) may be used to visualize the esophagus and surrounding structures and to determine the size and extent of the cancer.
Endoscopy: A thin, flexible tube with a camera (endoscope) is passed through the mouth and into the esophagus to examine the lining of the esophagus and to obtain a biopsy if a suspicious area is found.
Biopsy: During endoscopy, a biopsy may be taken from any suspicious areas. A biopsy involves removing a small sample of tissue for examination under a microscope to determine if cancer cells are present.
Staging: If esophageal cancer is confirmed, further tests may be done to determine the stage of the cancer, which helps guide treatment decisions. This may include additional imaging tests and procedures.
Additional tests: Depending on the individual case, other tests such as blood tests, bronchoscopy (to look at the airways), or laparoscopy (to examine the abdomen) may be done to further evaluate the extent of the cancer.

Once a diagnosis is confirmed and the stage of the cancer is determined, a treatment plan can be developed. Treatment options for esophageal cancer may include surgery, chemotherapy, radiation therapy, or a combination of these treatments, depending on the stage and location of the cancer.

What is the treatment for esophageal cancer?

The treatment for esophageal cancer depends on the stage and location of the cancer, as well as the patient’s overall health and preferences. The primary treatments for esophageal cancer are:

Surgery: Surgery is often the primary treatment for early-stage esophageal cancer. The goal is to remove the tumor and any affected tissue, along with a margin of healthy tissue around it. There are several types of surgery:
- Endoscopic mucosal resection (EMR): Removes the tumor and a small amount of surrounding tissue through an endoscope.
- Transhiatal esophagectomy: Removes the tumor and a portion of the esophagus through an incision in the chest or abdomen.
- Thoracoscopic esophagectomy: Removes the tumor and a portion of the esophagus through small incisions in the chest.
Chemotherapy: Chemotherapy may be used in combination with surgery or radiation therapy to:
- Shrink the tumor before surgery
- Kill any remaining cancer cells after surgery
- Relieve symptoms such as dysphagia (difficulty swallowing)
Radiation therapy: Radiation therapy uses high-energy beams to kill cancer cells. It may be used:
- Alone to treat early-stage cancer
- In combination with chemotherapy to treat more advanced cancer
- To relieve symptoms such as dysphagia or pain
Combination therapy: Chemotherapy and radiation therapy may be combined to increase the effectiveness of treatment.
Palliative care: For patients with advanced esophageal cancer, palliative care focuses on managing symptoms, improving quality of life, and providing emotional support.

Other treatments that may be used in conjunction with these primary treatments include:

Endoscopic therapy: Endoscopy can be used to remove tumors or insert stents to keep the esophagus open.
Laser therapy: Laser light is used to destroy cancer cells or relieve symptoms.
Photodynamic therapy: A light-sensitive medication is injected into the bloodstream, and then exposed to light, which damages cancer cells.
Targeted therapy: Medications that target specific genetic mutations or molecular pathways may be used to treat esophageal cancer.

It’s essential to note that each patient’s treatment plan is unique and will depend on their individual situation. Patients with esophageal cancer should consult with a multidisciplinary team of healthcare professionals, including surgeons, oncologists, radiation therapists, and other specialists, to determine the best course of treatment for their specific needs.

What is the life expectancy of esophageal cancer?

The life expectancy of esophageal cancer patients depends on several factors, including the stage and location of the cancer, the patient’s overall health, and the effectiveness of treatment.

Overall survival rates:

For patients with localized esophageal cancer (stage I or II), the 5-year survival rate is around 40-50%.
For patients with regional esophageal cancer (stage III), the 5-year survival rate is around 20-30%.
For patients with distant esophageal cancer (stage IV), the 5-year survival rate is around 5-10%.

Survival rates by stage:

Stage I: The 5-year survival rate is around 60-80%.
Stage II: The 5-year survival rate is around 40-60%.
Stage III: The 5-year survival rate is around 20-40%.
Stage IV: The 5-year survival rate is around 5-15%.

Factors that affect survival rates:

Location of the tumor: Tumors in the lower third of the esophagus tend to have a worse prognosis than those in the upper third.
Size of the tumor: Larger tumors tend to have a worse prognosis.
Presence of lymph node involvement: If cancer has spread to lymph nodes, the prognosis is generally worse.
Patient’s overall health: Patients with poor overall health may have a worse prognosis.

Newer treatments and emerging therapies:

Immunotherapy, such as pembrolizumab, has shown promising results in treating advanced esophageal cancer.
Targeted therapies, such as gefitinib and erlotinib, have also shown promise in treating advanced esophageal cancer.
Clinical trials are ongoing to investigate new treatments and combination therapies for esophageal cancer.

It’s essential for patients with esophageal cancer to work closely with their healthcare team to develop a personalized treatment plan and monitor their progress regularly. With advances in treatment and early detection, many patients with esophageal cancer can achieve long-term remission or even cure.