Esophagus Cancer

The esophagus runs from your throat to your stomach. It is a muscular tube that carries food into the stomach. It is between 10 to 13 inches long and is less than an inch wide at its narrowest point. Cancer of the esophagus starts in the innermost layers and grows out, according to the American Cancer Society (ACS). (Read about "Cancer: What It Is") Close to 13,000 people will find out they have esophagus cancer each year, and about the same number of people die of this disease each year. ACS says this cancer is usually fatal because most esophagus cancers are discovered late, with the disease in an advanced state. The five year survival rate, according to ACS, is 13 percent for whites and 9 percent for African Americans. (Read about "Minority Health") While those numbers are low, they are dramatic improvements from 40 years ago when the rate was 4 percent for whites and 1 percent for African Americans.

Types of esophagus cancer

Esophagus cancer is divided into two major groups, according to the National Cancer Institute (NCI). ACS says cancers of the esophagus are almost evenly split between the two types. Squamous cell carcinomas tend to start in the upper and middle part of the esophagus but can start elsewhere in the esophagus. The second type is called adenocarcinoma. It starts in the area near the opening to the stomach and is directly related to another condition called Barrett's esophagus. Barrett's esophagus is the result of changes to the cells caused by acid reflux, or the spilling of stomach acid back into the esophagus. (Read about "GERD")

Risk factors

African Americans are 3 times more likely to have esophagus cancer than whites and men are three times more likely than women. Age is also a factor, with 45 to 70 being the high risk time period, according to ACS. In addition to the already mentioned Barrett's esophagus, other risk factors according to ACS and NCI are:

• Smoking and other tobacco use such as chewing tobacco (Read about "Quit Smoking")
• Long-term alcohol use. (Read about "Alcoholism") A combination of tobacco and alcohol use multiplies the risks.
• Irritation of the esophagus by chemicals such as lye, which is found in many strong cleaners. People who swallowed such products when they were young have a greater risk. (Read about "Poison Prevention" "Childproof Home")
• Achalasis, a condition where food does not enter the stomach and backs up into the esophagus. The esophagus expands at that point.
• Tylosis, a rare genetic disease with symptoms that include excess skin on the palms of the hands and the soles.

People who have had head or neck cancers (Read about "Head and Neck Cancers) are also at greater risk of getting esophagus cancer. Because most esophagus cancers are discovered late it is important for people to be aware of the risk factors and work with their doctor on regular screenings. A person diagnosed with Barrett's esophagus or tylosis should be vigilant.

Symptoms and diagnosis

ACS says there are no regular screening tests for esophagus cancer and in its early stages; the cancer usually does not cause symptoms. Trouble swallowing is the most common symptom as the cancer grows. Other symptoms listed by both NCI and ACS include:

• pain in the back between the shoulder blades or in the mid-chest
• unexpected weight loss
• hoarseness
• coughing up blood
• frequent episodes of hiccups

These can also be symptoms of other conditions, and should be checked by a doctor.

If cancer is suspected, there are various procedures to confirm the diagnosis. One type is a barium swallow where a set of x-rays are taken after the patient swallows barium, which coats the esophagus. (Read about "X-rays") An endoscope can be used to see into the esophagus and a sample can be taken if any abnormalities are found to confirm the presence of cancer. (Read about "Endoscopy") If an abnormal area is found, the doctor can collect cells and tissue through the endoscope for examination under a microscope. This is called a biopsy. (Read about "Biopsy") A biopsy can show cancer, tissue changes that may lead to cancer, or other conditions.

Once cancer of the esophagus is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for esophageal cancer, according to NCI:

• Stage 0 (Carcinoma in Situ)

  In stage 0 (carcinoma in situ), cancer is found only in the innermost layer of cells lining the esophagus.

• Stage I

  In stage I, cancer has spread beyond the innermost layer of cells to the next layer of tissue in the wall of the esophagus.

• Stage II

  Stage II esophageal cancer may be divided into stage IIA and stage IIB, depending on where the cancer has spread.

  • 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. Lymph nodes are small, bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease. (Read about "The Lymph System")

• Stage III

  In 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 IV

  In stage IV, cancer has spread from the esophagus to other parts of the body and may also have spread to nearby lymph nodes. Stage IV esophageal cancer may be divided into stage IVA and stage IVB, depending on where the cancer has spread.

  • 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.

Treatments

Treatments for esophagus cancer include surgery, radiation, chemotherapy and laser therapy. (Read about chemotherapy, radiation and other cancer therapies in "Cancer Treatments") Surgery is the most common treatment, according to NCI. Usually, the surgeon removes the tumor along with all or a portion of the esophagus, nearby lymph nodes and other tissue in the area. (An operation to remove the esophagus is called an esophagectomy.) The surgeon connects the remaining healthy part of the esophagus to the stomach so the patient is still able to swallow. Many treatments are used to relieve symptoms and prolong life, and success depends on how far the cancer has progressed, according to ACS.

More Cancer Information:

    Cancer Check-ups

    Cancer Support

    Cancer Treatments

    Reduce Cancer Risks

    Cancer Glossary

For a list of individual types of cancer, see Cancer: What It Is

Related Information:

    Digestive System