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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.
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.
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.
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.
Thoracic Surgery Nurse Practitioners
Tobacco dependence, sleep-disordered breathing
Lung cancer, chronic respiratory failure, noninvasive mechanical ventilation, neuromuscular disease
Lung cancer, lung nodule evaluation
Molecular imaging, oncology imaging, cardiology imaging, neurology imaging, and cross sectional imaging
Donna M. Morelli, BS