Esophageal Cancer

Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus. Esophageal cancer starts at the inside lining of the esophagus and spreads outward through the other layers as it grows. Smoking, heavy alcohol use, and Barrett’s esophagus can affect the risk of developing esophageal cancer.

The prognosis and treatment options depend on the stage of the cancer (whether it affects part of the esophagus, involves the whole esophagus, or has spread to other places in the body); the size of the tumor and the patient’s general health.

Our patients with esophageal cancer are treated at the Moores Gastrointestinal Cancer Unit. See the Gastrointestinal Cancer Unit for more information.

You can also review the tabs at top of this page for information on esophageal cancer symtpoms and risks, diagnosis, and treatment.

Symptoms

The most common symptoms of esophageal cancer are difficulty in swallowing or the sticking of food before it gets into the stomach. Individuals may also notice weight loss, pain with swallowing, regurgitation of food, coughing with blood or hoarseness.

Risks

Although the exact cause of esophageal cancer is not known, physicians have been able to identify several risk factors:

• Heavy alcohol use
• Smoking
• Obesity
• Esophageal conditions, such as Barrett esophagus (associated with long term acid reflux from the stomach) and achalasia (a benign esophageal disease)
• Exposure to silica dust

The American Cancer Society suggests avoiding tobacco and excessive alcohol use to substantially reduce the risk of developing esophageal cancer. Also exercise and a healthy, high-fiber diet.

An endoscopic examination is usually the first step in determining esophageal cancer. While the patient is sedated in this outpatient procedure, a thin, flexible endoscope (with a light and video camera on the end) is passed through the mouth and down the esophagus.  Endoscopic ultrasound (EUS) has a central role in determining the extent, or stage of the cancer.  With EUS, the physician uses high-energy sound waves to bounce off internal tissues or organs and make echoes that form a picture of tumors within the esophagus. Additional tests, such as a CT or PET scan, may be ordered to determine the spread of the cancer.

Stages of esophageal cancer

• Stage 0 (Carcinoma in Situ): abnormal cells are found in the innermost layer of tissue.
• Stage I: Cancer has formed and spread beyond the innermost layer of tissue to the next layer of tissue in the esophagus wall.
• Stage IIA: Cancer has spread to the layer of esophageal muscle or to the outer wall of the esophagus.
• Stage IIB: Cancer may have spread to any of the first three layers of the esophagus and to nearby lymph nodes.
• Stage III: cancer has spread to the outer wall of the esophagus and may have spread to tissues or lymph nodes near the esophagus.
• Stage IVA:  Cancer has spread to nearby or distant lymph nodes.
• Stage IVB: Cancer has spread to distant lymph nodes and/or organs in other parts of the body.

Treatment is tailored to each individual, depending upon the location and extent of the disease. Options include chemotherapy (drugs), radiation therapy, endoscopic procedures or surgery.  Your doctor may also recommend a combination of these, such as chemotherapy or radiation given before or after surgery to shrink the tumor size.

If esophageal cancer is diagnosed at a very early stage (such as with Barrett’s esophagus with high grade dysplasia or superficial esophageal cancer), endoscopic mucosal resection (EMR) can remove large superficial areas of the esophagus lining endoscopically. Additionally, there are ways to thermally coagulate the surface of the esophagus to treat those tumors, a procedure called balloon thermal ablation, or BARRX. UCSD is the only center in San Diego doing the BARRX procedure.

Surgical options

• Esophagectomy, where the affected parts of the esophagus and nearby lymph nodes are removed, while the remaining esophagus is reconnected, or
• Esophagogastrectomy, where part of the esophagus is removed along with nearby lymph nodes and part of the stomach, while the remaining esophagus is reattached
• Minimally invasive esophagectomy.

Chemotherapy

Both standard chemotherapeutic treatments and innovative clinical trials are available for patients. Chemotherapy is used alone or in combination with radiation or surgery to help provide the best possible treatment outcome.

Our comprehensive approach to the management of esophageal cancer insures that you have the best option for your particular condition.