There are two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma.

Squamous cell carcinoma is a condition in which abnormal squamous cells (the thin, flat cells that make up part of the mucous membrane that lines the esophagus) divide and spread uncontrollably. Though at one time squamous cell carcinomas were responsible for nearly 90% of all esophageal cancers, they now make up less than 50% of esophageal cancers.

Adenocarcinomas occur in glandular tissue and not in squamous tissue. Before an adenocarcinoma can develop, glandular cells must replace an area of squamous cells, as in the case of Barrett’s esophagus. This transformation is most common in the lower esophagus, which is the site of most adenocarcinomas.

Risk Factors for Esophageal Cancer

• Age: Nearly half of esophageal cancer patients are older than 70, with approximately three quarters of all esophageal patients between the ages of 55 and 85
• Sex: Men are at three times the risk for esophageal cancer as women
• Race: African Americans are twice as likely to suffer from esophageal cancer as Caucasians
• Medical Conditions: People suffering from Barrett’s esophagus or GERD are typically at increased risk for the adenocarcinoma variety of esophageal cancer
• Lifestyle:
  • Those who smoke cigarettes or consume large amounts of alcohol on a regular basis are at increased risk for this type of cancer
  • Obesity is a risk factor
  • A diet that is lacking in fruits and vegetables is a risk factor

Signs and Symptoms of Esophageal Cancer

The most common symptom of esophageal cancer is a difficulty swallowing (also known as dysphagia) accompanied by a sensation of food being stuck in the throat or chest. Approximately half of all esophageal cancer patients also experience some sort of weight loss due to this inability to swallow properly.

Less common symptoms include hoarseness, hiccups and bloody stools – though it should be noted that all of these symptoms may indicate non-cancerous conditions as well.

Diagnosis of Esophageal Cancer

In most cases, the possibility of esophageal cancer is discovered due to the appearance of one or more symptoms (see Signs and Symptoms of Esophageal Cancer, above). Diagnosis without symptoms is rare and usually accidental, occurring when a patient is undergoing a test for other medical problems. Unfortunately, there is no early detection screening for esophageal cancer at this time. Because of this, it is important for those who are at increased risk for the disease to undergo testing regularly.

These tests may include:

• Biopsy – A sample of tissue is removed from the patient and examined to determine whether or not it is cancerous.
• Upper Endoscopy – This allows a physician to look inside the esophagus, stomach, and duodenum (part of the small intestine). During an upper endoscopy, the patient swallows a thin lighted tube called an endoscope, which transmits an image to a television monitor, so the physician can examine the lining of these organs. A biopsy may be performed during this procedure.
• Barium Swallow – This test is designed to examine the upper digestive tract using x-ray imaging. Because this part of the body is not normally visible to x-rays, the patient swallows barium, a liquid that can be seen by x-rays, to temporarily coat the digestive tract and make it show up on an x-ray image.

Treatment Options

Surgery – depending on the stage of esophageal cancer, surgery may be used to remove the cancerous tissue and some of the surrounding tissue in a procedure known as an esophagectomy. Surgery may also be combined with other treatments such as chemotherapy and/or radiation therapy.

Chemotherapy – involves using drugs to treat malignant esophageal conditions. In addition to utilizing traditional chemotherapy, we may offer patients the opportunity to access new chemotherapy protocols alone or in combination with standard therapy.

Radiation therapy – is the use of high-energy radiation to destroy cancer cells. It is commonly used as a primary therapy in patients whose health is too poor to undergo surgery. Radiation therapy can be performed using a beam generated by an external device or by placing radioactive pellets, also known as “seeds,” into the tumor itself in a procedure known as brachytherapy. Brachytherapy is particularly useful in shrinking tumors so patients can swallow more easily.