Patients with esophageal cancer often experience difficulty swallowing (dysphagia). This may progress to the point where solid foods and even liquids are difficult to consume. They also may lose weight.
Chemotherapy uses powerful drugs to destroy cancer cells. It is often given in combination with surgery or radiation therapy.
In early stages, esophageal cancer often causes few symptoms. But as it grows, tumors can narrow the throat and cause difficulty eating or drinking. The cancer can also spread to nearby lymph nodes or organs. Surgery can help relieve these symptoms and improve your chances of survival.
For small, localized tumors, doctors can sometimes remove them with a long, flexible tube called an endoscope that goes down your throat and into your esophagus. The endoscope has a camera that lets doctors see the inside of your esophagus and remove small sections of tissue with special tools. This type of surgery is called an endoscopic resection. It’s important to choose a doctor and hospital that have experience performing these surgeries. Ask your doctor how many times they’ve done this type of operation and what their success rate is.
If a tumor is larger and has spread beyond the inner lining of your esophagus, your doctor may need to remove more of your esophagus, surrounding tissue and nearby lymph nodes. This is called a resection esophagectomy. In some cases, doctors can use a portion of your stomach or small intestine to replace the diseased part of your esophagus and restore digestive function.
During surgery, doctors can also check your lymph nodes for signs of cancer. Several types of lymph nodes can be removed from your chest or neck, including the clavicle lymph nodes in the front of your chest and the spleen and thymus lymph nodes in the back of your abdomen. Your doctor may also take a sample of your blood to check for cancer cells.
If you have a serious illness like cancer, it’s important to stay close to family and friends. They can provide both emotional and practical support. They can help you get to appointments and do chores, if needed. They can also remind you to take your medicines and keep follow-up appointments. You may also find comfort in a support group for people with cancer or other illnesses.
After surgery, you may have side effects from the operation or the medicine used during treatment. Some may go away on their own or be treated with other medicines. Others may last a long time or become permanent.
The esophagus is a long, hollow tube that moves food and liquid from your throat to your stomach. It has several layers of tissue, including mucous membrane and muscle. Cancer that forms in the layer of cells lining the inside of your esophagus is called squamous cell carcinoma. Cancer that forms in the muscle of your esophagus is classified as stage III cancer. Cancer that spreads from your esophagus to other parts of your body is called metastatic disease.
Carcinogens, such as tobacco smoke or chemicals in food and drink, can cause cellular changes that lead to the development of esophageal cancer. Over time, these alterations can progress to precancerous alterations called dysplasia. Dysplasia is characterized by abnormal cell growth and changes in the structure of tissues. If untreated, high-grade dysplasia can progress to squamous cell carcinoma.
Chemotherapy uses powerful drugs to kill cancer cells and prevent them from growing. It is a common treatment for esophageal cancer and can be given before or after surgery. It can also be given as part of a combination therapy with radiation or immunotherapy.
If your cancer recurs after it has been treated, tests will be done to find out where the recurrence is and whether it is local (near the site of the original tumor) or distant (in other parts of the body). Your healthcare team will treat your recurrence with surgery and/or chemotherapy.
The types of chemotherapy that are used depend on the type and stage of esophageal cancer and other treatments you have received. You may receive chemotherapy by mouth or through an IV line. It can be delivered directly into the area of your esophagus that has cancer or into a vein in your neck or chest (intravenous chemotherapy) or into the peritoneal cavity (an organ-containing sac in the abdomen). You can also get chemotherapy into the cerebrospinal fluid that surrounds your brain and spinal cord with a thin, flexible tube called a catheter (intrathecal chemotherapy).
A recurrence of esophageal cancer that has already been treated is less likely to respond to chemotherapy than new cancer. This is because recurrent cancers have more genetic alterations that allow them to grow and multiply faster than normal cells.
In radiation therapy, your healthcare team uses powerful energy beams to destroy cancer cells. This can be done with X-rays, protons or another type of radiation. For esophageal cancer, most people have external radiation therapy, which involves lying on a table while a machine moves around you to direct the radiation to the exact spot. Your team may also place a plastic tube in your throat to keep your esophagus open during radiation therapy. This type of radiation therapy is called brachytherapy.
For some people, a combination of chemotherapy and radiation therapy is used before surgery to kill cancer cells and prevent them from coming back. This is known as pretreatment or neoadjuvant therapy. You may also have immunotherapy, a treatment that strengthens your body’s natural defense systems to fight cancer.
Your cancer care team will use special tests to find out how far the esophageal cancer has spread, which is called staging. The test results help the healthcare team create a treatment plan for you. These tests might include a chest X-ray, ultrasound, CT or magnetic resonance imaging (MRI) scan. A positron emission tomography scan (PET) scan might also be used to see if cancer has spread to other parts of your body.
If you have stage I esophageal cancer, your healthcare team will talk with you about whether or not you should have surgery. Some people with this stage of cancer have other health problems that make it hard for them to have surgery. Others choose not to have surgery. If your healthcare team recommends surgery, you will have a surgical procedure to remove the tumor and some tissue around it.
Then you will have more treatments to cure the cancer and reduce your chances of it coming back. These other treatments might include chemotherapy, immunotherapy or radiation therapy. Or, they might be palliative care to help relieve symptoms caused by the esophageal cancer or its treatment. For example, if the cancer has narrowed your esophagus, a surgeon might use an endoscope to put in a metal tube that holds the esophagus open.
The esophagus is a foot-long, hollow muscular tube that connects the back of your throat to your stomach. When you swallow, it carries food and liquids to your stomach for digestion. When cancer forms in the lining of your esophagus, it can interfere with normal function and cause pain and other symptoms.
Often, the first sign of esophageal cancer is trouble swallowing (dysphagia). It may start with difficulty eating solid foods and progress to liquids. It may be accompanied by weight loss or unintentional bleeding (hemorrhage). Some people also have an unpleasant taste in their mouth or a hoarse voice. In more advanced cases, the esophageal cancer may press against the surrounding structures, narrowing the esophagus and making it hard to breathe.
When cancer is in the early stages and has not spread, local treatments can usually cure it. These treatments involve removing the tumor along with some of the tissue around it, such as the lymph nodes and the underlying bone. The surgeon might also remove part of the stomach or other tissues nearby. This surgery is called esophagectomy.
For advanced esophageal cancer that has spread to other parts of the body, chemotherapy drugs are used to destroy any remaining cancer cells. These drugs can be given orally or intravenously, and they travel throughout your entire system to reach cancer cells wherever they are located. Your treatment team might use different kinds of drugs or combine them with other types of therapy.
At City of Hope, we offer standard chemotherapies as well as access to newly developed drugs or drug combinations through our extensive program of clinical trials. Your medical oncologist will evaluate your specific situation and recommend a course of treatment.
Radiation therapy uses high-energy X-rays to kill cancer cells in the affected area. We offer intensity-modulated radiation therapy, brachytherapy and image-guided radiation therapy at Moffitt. Our advanced equipment includes helical TomoTherapy, which allows us to precisely target the esophageal cancer and reduce exposure to healthy tissues and organs such as the heart and lungs. We are also able to perform stereotactic body radiation therapy with greater precision, which is useful when you have multiple small cancers in the esophagus or elsewhere in your body.
Many esophageal cancers don’t produce symptoms until the tumor grows large. The most common warning signs are difficulty swallowing and weight loss.
Sometimes esophageal cancer cells get into the lymph system or blood and form a tumor (metastasis) in another part of the body, such as the lung or liver. This can cause new problems, including cough and difficulty breathing.
Unlike other cancers, most esophageal cancers do not cause any symptoms in their early stages. Symptoms tend to appear after the tumor has grown larger and starts to thicken or compress the wall of the esophagus. This makes swallowing difficult because it narrows the passage in your throat. Initially, you may have difficulty with eating solid foods like meats and bread. Later, even liquids might become hard to swallow. As the problem worsens, you may change your diet by taking smaller bites and chewing more carefully. In some cases, the swallowing problems get so bad that people switch to a liquid diet or give up food altogether.
A sensation of food stuck in the throat or chest (dysphagia) is a common symptom of esophageal cancer. This feeling is similar to a heartburn episode. It can also be accompanied by pain, usually near the breastbone or just below it. You might feel this pain after a meal, between meals or at bedtime, and often when you wake up. You might also have a cough that won’t go away and a hoarse voice. In rare cases, you might vomit or choke on food.
Another symptom is trouble breathing, which happens when the esophageal cancer causes inflammation that affects your throat and lung passages. This can lead to a shortage of oxygen in your body and make you feel tired for no reason.
You might experience pain when you inhale or swallow, and this pain can be aggravated by bending, coughing or straining. Sometimes you might have a cough that won’t stop and it might even happen when you are not trying to swallow anything.
Sometimes the inflammation caused by esophageal cancer can affect your stomach as well, and this can cause you to lose weight. Regardless of the reason for your loss of weight, it is important to see a doctor right away because this can be a sign of esophageal cancer.
If you experience this symptom, the doctor will most likely order an endoscopic ultrasound to have a better look at your esophagus and the area surrounding it. They will also probably do a CT scan to check for any signs of spread of the cancer.
The esophagus is the foot-long tube that carries food from your throat to your stomach. If you have cancer in the esophagus, it may grow into a tumor that blocks your esophageal opening and causes symptoms like difficulty swallowing, a feeling that food is stuck in the chest or throat (odynophagia), unintended weight loss and chest pain or discomfort. The cancer may also spread to nearby tissue, causing symptoms such as a cough that won’t stop, blood in your vomit or spit, hoarseness and a narrowing of the passage between the windpipe and the lungs (fistula).
If you have esophageal cancer, your symptoms will probably get worse over time. The most common symptom is difficulty swallowing (dysphagia), which usually starts with solid foods and then progresses to liquids as the tumor grows and narrows your esophagus. Often, the difficulty swallowing is accompanied by a feeling that food or liquid is stuck in your throat (odynophagia). This symptom may be accompanied by chest pain or discomfort, especially when you are lying down or eating.
Your doctor will do a physical exam and ask you questions to find out if the problem is in your throat or chest. Your doctor will also order an imaging test to check for the presence of a tumor in your esophagus or for signs that it has spread to other parts of the body.
One type of imaging test used by doctors to look for esophageal cancer is called endoscopic ultrasound. During this procedure, your doctor inserts an endoscope into the mouth to reach the esophagus. The endoscope has a small ultrasound probe that bounces high-energy sound waves off internal tissues or organs to make echoes. These echoes create a picture of the tissues or organ, which your doctor can view on a screen.
Other types of imaging tests that your doctor may use to find out if you have esophageal cancer include X-rays, computed tomography (CT) scans and magnetic resonance imaging (MRI). These tests show your esophagus and surrounding tissue in detail and can help diagnose the condition.
The esophagus is the long, tube-like muscle that connects the back of your throat to the stomach. It carries food and liquids from the throat to the stomach for digestion. A tumor that grows in the esophagus can block it and cause symptoms such as difficulty swallowing, pain when swallowing or the sensation of food getting stuck in the throat (odynophagia).
Early-stage esophageal cancer usually doesn’t cause any symptoms. But as the tumor gets larger, it may begin to narrow the passage in the esophagus, making it difficult to swallow food. This can also make you feel like you have food stuck in your throat or that your throat is scratchy. You might also lose your appetite or eat less than usual. If you experience these symptoms, talk to your doctor. They will do a physical exam and order blood tests and X-rays to check for esophageal cancer or other health problems that could be causing them.
If the cancer spreads from the esophagus to other parts of your body, you’ll have different symptoms. For example, if it spreads to the bone tissue or the lymph nodes in your neck, you might experience chest pain or trouble breathing. If the cancer spreads to your liver, you might experience nausea or a feeling that you have a lump in your throat.
In addition to a physical exam, doctors will use special imaging tests to help find out how far the esophageal cancer has spread. These include CT scans, PET scans and endoscopies with biopsies.
A biopsy is a procedure where a doctor takes a small sample of tissue from the area of your body where you have a lump or bump. Your doctor will then look at the cells under a microscope to see if they are cancerous. If the esophageal cancer has reached a more advanced stage, surgery and chemotherapy might be used to treat it. These treatments can shrink tumors, stop the cancer from spreading and improve your chance of survival. Your doctor will recommend a treatment plan that fits your specific needs and goals.
Often, the first signs of colon cancer are changes in your bowel habits. These can include a feeling that your bowel isn’t emptying completely or the sensation that you haven’t passed any stool for a long time. If you notice any of these symptoms, talk to your doctor.
Abdominal pain may also occur. This symptom is common, and it can be caused by many things, such as hemorrhoids or IBS (irritable bowel syndrome). However, if the abdominal pain is severe and lasting, it could be a sign of colorectal cancer.
The most alarming symptom of colorectal cancer is blood in the stool. It can sometimes appear bright red, but it may also be dark or black. In some cases, the color of your stool is a result of a build-up of iron or certain foods, such as beets or beans.
Having a large amount of blood in the stool can cause you to lose a lot of blood, which makes you tired. If you’re losing a lot of blood, your doctor will likely order a blood test to check for anemia.
The earliest stage of colorectal cancer is polyps. Polyps and cancer don’t always cause symptoms, so it is important to get screened regularly for colorectal cancer. In some people, a tumor may grow to the point where it causes symptoms. The best way to diagnose colorectal cancer is to have a colonoscopy. This is a procedure in which a doctor inserts a thin tube called a colonoscope into your colon and rectum. During a colonoscopy, the doctor can look for tumors and remove any that are present. They can also take a sample of the tissue for testing.
Cancers that begin in the lining of the esophagus can grow and cause the esophageal walls to thicken, narrowing the space for food to pass through. This narrowing can result in difficulty swallowing, a condition called dysphagia. The cancer may also bleed into the esophagus, which can make your stool black and tarry. Blood in the stool can also cause anemia, which can make you feel tired.
Most people with esophageal cancer do not have any symptoms at first. They often do not get diagnosed until the cancer has spread to other parts of the body, which is called metastasis. This is the main reason why it is important to see your doctor if you have any unusual symptoms.
The esophagus is the long muscular tube that goes from your throat to your stomach. Cancer that begins in the esophagus is usually in the upper or middle part of the esophagus. These cancers, which are called squamous cell carcinomas, start in cells that line the inner surface of your esophagus. This type of cancer is more common in men than in women. It can be caused by chronic irritation of the esophagus from smoking and drinking alcohol. This can lead to the development of precancerous lesions, called dysplastic changes, and eventually into cancer.
Sometimes, your doctor can find signs of esophageal cancer by doing an exam. To do this, they will look down your throat and into your stomach. They may also use other tests to check for cancer, such as a barium swallow X-ray or endoscopy. For this test, you drink a liquid that coats your esophagus, which makes it show up better on an X-ray. Then the doctor passes a thin, lighted tube (an endoscope) down your throat into your esophagus to look at it. The doctor may also use a tool to get tissue or cells from your esophagus and put them under a microscope to check for cancer.
A person with esophageal cancer might also have a lump in their neck or jaw (neck pain) or have trouble breathing (chest discomfort). A doctor can use imaging tests, such as an ultrasound and CT scan, to diagnose these problems. Treatment for esophageal cancer aims to remove the tumor or prevent it from growing. To do this, a doctor might use surgery or chemotherapy.
If you have esophageal cancer, doctors use tests to find out how far it has spread. These are called staging tests.
Treatment depends on the stage of your tumor and other factors. You may get chemotherapy or radiation before surgery, at the same time as surgery, or afterwards. You can also have procedures like cryotherapy or radiofrequency ablation to treat precancers and small early cancers.
Diagnosing esophageal cancer is difficult, because symptoms are usually not obvious in the early stages. Your doctor will ask you about your symptoms and do a physical exam. If he or she suspects esophageal cancer, he or she will order imaging tests and other lab work to help diagnose the condition.
Your physician may use endoscopy to confirm a diagnosis, and will insert a thin tube into your throat to get a better look at the area. The physician may also use the scope to remove a sample of tissue (a biopsy) for lab testing. The biopsy helps determine the stage of esophageal cancer and how quickly it is growing.
A CT scan is another way to check for esophageal cancer. A CT scanner uses x-rays to make detailed, cross-sectional images of your body. Your physician may ask you to drink a liquid contrast agent that is used to highlight the area being studied.
You will have regular follow-up appointments with your healthcare team. During these visits, your team will answer any questions you have and discuss the results of your tests. If your esophageal cancer has spread to other parts of the body, your team will also discuss how the metastases are affecting your health and what treatment options might be best for you.
For esophageal cancer that has not spread to other parts of the body, your doctor might test for genetic changes that can affect how the cancer responds to chemotherapy and radiation. Your doctor might test for a gene called PD-L1 or for changes in the mismatch repair genes (MLH1, MSH2, MSH6, and PMS2). Cancers that have a lot of PD-L1 or that have MMR gene mutations might be more likely to respond to immunotherapy drugs.
If the cancer has spread to other parts of the body, a PET scan can be used to find out how far the disease has progressed. This test uses small amounts of radioactive materials to identify the location of a tumor, and a computer to create images.
Your healthcare team will also look for signs of a tumor in your lymph nodes (bean-sized collections of immune cells that surround each organ) and bones. They will also look for any spread to the brain.
Being told that you have esophageal cancer can be very stressful. You will probably have a lot of questions for your doctors. It can help to bring someone with you to your appointments to listen and support you. You can also get support from friends and family, or from a cancer charity such as Macmillan. You will need to have regular appointments with your specialist nurse and surgeon, as well as having scans and endoscopies. It can help to keep a diary of your symptoms and what happens at each appointment. Your care will be planned around your individual needs and preferences. You can discuss these with your specialist nurses and doctors. You can also see a Macmillan support worker if you want to talk about anything that is worrying you.
The first step is finding out the size of the tumor and whether it has spread. Your healthcare team will use cancer staging tests to do this. These can include endoscopy, CT scans, MRI and positron emission tomography (PET) scans. These are imaging tests that show the presence of cells and help healthcare professionals find out how far cancer has spread.
Once your team knows the stage of your esophageal cancer, they can develop a treatment plan. They might recommend surgery, chemotherapy or radiation therapy. They may also offer palliative care.
If the esophageal cancer is small, it might not need to be removed. Your surgeon might remove the cancer and surrounding tissue through a small incision in your chest or stomach. They might also use a minimally invasive surgery technique, in which they insert surgical tools through several small incisions in your chest or abdomen. This can reduce your recovery time and the chance of complications.
Chemotherapy uses powerful medicines to kill cancer cells and prevent the cancer from coming back. Your healthcare team will choose the type of chemotherapy to use based on the type of esophageal cancer you have and how much the cancer has spread. They might give you the medication orally or through a tube into your throat. You will probably need to take these medicines for several weeks or months.
Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors. It can be given alone or combined with chemotherapy. You might have this treatment in combination with surgery or as the only treatment for your esophageal cancer.
Surgery to remove your esophagus might be necessary if the cancer is advanced and has not spread to other parts of your body. It is important to get this treatment as soon as possible. The sooner your doctor can remove the cancer, the better your chances of living longer.
You might need other treatments if your esophageal cancer has spread. The goal of these treatments is to relieve your symptoms and improve your quality of life. These treatments might include radiation, chemotherapy or other medicines.
Some types of esophageal cancer can be more aggressive and harder to treat than others. This is because the cancer cells can grow faster and are more likely to come back.
The incidence of esophageal cancer has risen in recent decades, coinciding with a shift in histologic type and primary tumor location worldwide. Squamous cell carcinoma (SCC) is the predominant histology globally, but adenocarcinomas have become more prevalent in the United States and western Europe. The majority of adenocarcinomas are located in the distal esophagus.
Nutritional complications such as dysphagia, anorexia and cachexia are common in patients with esophageal cancer. These complications can lead to malnutrition, weaken the immune system and reduce healing from surgery. Patients with severe dysphagia might require nutritional support through a feeding tube. When possible, a jejunostomy tube is preferred over a gastrostomy tube for long-term nutritional support.
The diagnosis of esophageal cancer can have serious psychological and emotional impacts on patients and their families. Psychosocial support and counseling are important components of comprehensive care for these patients.
