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What is Esophageal Cancer?
Esophageal cancer is the uncontrolled growth of abnormal cells in the esophagus, which is a flexible tube connecting the throat to the stomach. Generally between 10 and 13 inches long, the esophagus contracts when one swallows, to push food down into the stomach. Mucus helps move this process along.
Ninety percent of esophageal cancers are one of two types: squamous cell or adenocarcinoma. Squamous cell refers to cancers that originate in the cells that line the esophagus; adenocarcinoma begins in the part of the esophagus that joins the stomach.
Symptoms of Esophageal Cancer
Some people do not notice any symptoms until late in the disease. However, symptoms may include:
- Difficulty swallowing
- Hoarseness or long-lasting cough
- Regurgitating blood
- Weight loss with unknown cause
- Pain in the throat or back
Causes of Esophageal Cancer
The causes are not fully understood, but scientists have discovered several likely contributing factors. These include:
- Advancing age. People over age 60 are more likely to develop the disease.
- Gender. This cancer is more common in men than women.
- Tobacco use. Smoking cigarettes, cigars, pipes, or using snuff or chewing tobacco greatly increases risk. For those who both smoke and drink, the risk is highest.
- Acid reflux. When stomach acids flow back into the esophagus, irritation occurs. Over time, this irritation can lead to problems, including a condition called Barrett's esophagus, where cell changes often lead to cancer.
- Previous history of head or neck cancers.
- An unhealthy lifestyle, which means being overweight or eating a diet low in fruits, vegetables, and whole grains.
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Treatments & Services
Patients who are diagnosed with esophageal cancer have options. A BMC physician will work with the patient and their family to discuss their unique situation and all possible treatments. Factors that will be taken into consideration in determining the best treatment plan are the size and location of the tumor, the involvement of surrounding tissue, whether it has spread to other body parts, and the patient’s overall health.
Esophagectomy is the surgical removal of the esophagus. Esophagectomy typically is recommended when the cancer has not spread to other parts of your body, and is potentially curable. In esophagectomy, most of your esophagus and nearby lymph nodes are removed, your stomach then moved up and attached to the remaining portion of your esophagus.
Chemotherapy is a medication or combination of medications used to treat cancer. Chemotherapy can be given orally (as a pill) or injected intravenously (IV). When chemotherapy drugs enter the bloodstream, they destroy cancer cells. Chemotherapy is particularly useful for cancers that have metastisized, or spread. Chemotherapy attacks all quickly-dividing cells, regardless of whether they are cancerous which can cause a number of side effects, including hair loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, and low blood counts. Low blood counts can increase a patient’s risk of infection, bruising or bleeding, fatigue, and shortness of breath. The side effects of chemotherapy are generally temporary and often go away once treatment is completed. Chemotherapy regimens vary from patient to patient. They are generally repeated several times in cycles, with three to four weeks separating each cycle to allow damaged normal cells time to recover. After the first two or three sessions of chemotherapy, patients may have a CT or PET scan to see if the drug(s) is effective. If the drug(s) is not working, it may be switched out for a new drug(s).
Cryotherapy is the use of freezing diseased tissue or cells inside the body to eliminate those cells so the body can grow new, healthy ones.
Endoscopic Mucosal Resection
Endoscopic mucosal resection, or EMR, is one of the newer, more minimally invasive techniques we offer for our esophageal cancer patients who have small tumors that have not spread outside of the esophagus. It may also be beneficial for patients with Barrett's esophagus. In this simple procedure, we are able to locate, remove, and examine cancerous or precancerous lesions of the esophagus.
Sometimes esophageal cancer blocks the airway or presses on it and makes breathing difficult. Stent placement is one way to improve breathing and swallowing and to ease pain and discomfort. Stents are small tubes - usually made of mesh, metal or plastic - that are inserted into the esophagus. For esophageal cancer patients, metal stents tend to be more effective and lead to fewer complications than plastic stents. Typically, an endoscope, an instrument that allows us to view your throat, is used to thread an expandable stent into the esophagus. Once in place, it is released, pushing the esophageal walls open. Placing a stent is less invasive than surgery, allows for quick administration of nutrients/food and is reversible, providing a good palliative option. Stents can also be used to treat obstructions in other types of cancer (such as lung cancer), as well as to facilitate blood flow in arteries.
Microwave ablation is a cancer treatment in which microwave energy is sent through a narrow, microwave antenna that has been placed inside a tumor. The microwave energy creates heat, which destroys the diseased cells and tissue. It is a newer method of treating lung cancer that can target and kill cancerous cells and relieve pain.
Photodynamic Therapy for Esophageal Cancer
Photodynamic therapy (PDT) can be used for some very small cancers or precancerous changes in the esophagus to try to eliminate disease. If the patient’s cancer is larger and causing symptoms such as difficulty swallowing or bleeding, PDT can be used to help these symptoms. Patients receive an injection of a light-sensitive drug that remains in cancer cells longer than in healthy cells.
Radiation uses special equipment to deliver high-energy particles, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells. Radiation (also called radiotherapy, irradiation, or x-ray therapy) can be delivered internally through seed implantation or externally using linear accelerators (called external beam radiotherapy, or EBRT).
Diagnostics and Tests
There are several ways that physicians may detect esophageal cancer, after doing a medical history and physical examination:
A barium swallow (also called a contrast esophagram), is a series of x-rays of your esophagus. For the test, you will drink a barium-containing liquid, which coats the inside of the esophagus and makes its shape and contours appear on x-rays.
During a bronchoscopy, your physician will give you a sedative and then pass a small, hollow tube (bronchoscope) through your nose and throat into the main airway of the lungs. He or she can then see any abnormal areas and extract a tissue sample for analysis.
Computed Tomography (CT) Scan
CT scans use x-ray equipment and computer processing to produce 2-dimensional images of the body. The patient lies on a table and passes through a machine that looks like a large, squared-off donut. Doctors order CT scans when they want to see a two-dimensional image of the body to look for tumors and examine lymph nodes and bone abnormalities. If contrast dye is used to improve the computer image, the patient may need to avoid eating or drinking for 4 to 6 hours before the test. Patients should tell their provider before the test if they have any allergies or kidney problems.
You will receive an intravenous sedative and pain medication. Once comfortable, the physician will then examine the area using an endoscope—a lighted tube with a small camera at the end. The physician will be able to view any abnormalities and take a tissue samples (biopsies) if necessary.
Sound waves are used to generate images of the affected area of the esophagus. This helps to determine how much of the tissue has been invaded by the cancer.
Positron Emission Tomography (PET) scan
A PET scan is used to detect cellular reactions to sugar. Abnormal cells tend to react and "light up" on the scan, thus helping physicians diagnose a variety of conditions. For the PET scan, a harmless chemical, called a radiotracer, is injected into your blood stream.
Pulmonary Function Test (PFT)
To understand how well your lungs are working, your physician may order a series of pulmonary function tests. With each breath you take in and breathe out, information is recorded about how much air your lungs take in, how the air moves through your lungs and how well your lungs deliver oxygen to your bloodstream.
A stress test is used to gain more information about how your heart functions during exercise. Your physician will monitor your heartbeat and blood flow as you walk on a treadmill, and will then be able to diagnose any problems as well as plan treatment.
Clinical Associate Professor of Radiology, Boston University School of Medicine
Nuclear Medicine and Molecular Imaging
Radiology IT Officer
Clinical Associate Professor, Boston University School of Medicine
Clinical Associate Professor of Radiology, Boston University School of Medicine
Donna M. Morelli, BS