Esophageal Cancer

Overview

Esophageal cancer refers to the development of malignant (cancerous) cells in the tissues lining the esophagus. The esophagus is a muscular tube that connects the throat to the stomach, and its primary function is to transport food and liquids from the mouth to the stomach.

Usually, the cells that line the inside of the esophagus are where esophageal cancer develops. It can occur anywhere along the esophagus and is more common in men than in women.

Esophageal cancer is the sixth most frequent cause of cancer-related deaths globally, with incidence rates varying by region. Factors such as alcohol and tobacco use, certain dietary habits, and obesity may contribute to higher prevalence in specific populations.

Signs and Symptoms

In the early stages, esophageal cancer may not produce noticeable symptoms, leading to late diagnoses. When symptoms do appear, they may include:

• Difficulty swallowing (dysphagia)
• Unintentional weight loss
• Chest pain, pressure, or burning
• Worsening indigestion or heartburn
• Coughing or hoarseness

Those with Barrett’s esophagus—a precancerous condition caused by chronic acid reflux—have a higher risk of esophageal cancer. Patients with Barrett’s esophagus may consider regular screening. Talk to your doctor about the risks and benefits of screening if you have this condition.

Causes

The exact cause of esophageal cancer is unknown, but it occurs when DNA mutations cause cells in the esophagus to grow and divide uncontrollably, forming a tumor that may spread to nearby tissues or organs. Risk factors include:

• Tobacco and alcohol use: Long-term smoking and heavy drinking significantly raise the risk.
• Gastroesophageal reflux disease (GERD): Chronic acid reflux can damage the esophageal lining.
• Barrett’s esophagus: A complication of GERD that increases cancer risk.
• Obesity: Increases the risk of adenocarcinoma.
• Age and gender: More common in older adults and men.

Types of Esophageal Cancer

• Adenocarcinoma: Begins in glandular cells in the lower esophagus, often linked to Barrett’s esophagus.
• Squamous cell carcinoma: Develops in the flat cells lining the upper and middle parts of the esophagus, associated with smoking and alcohol use.

Diagnosis

Diagnosis involves a combination of approaches, including:

• Medical history and physical exam
• Endoscopy: A flexible tube with a camera to examine the esophagus
• Barium swallow: X-ray imaging after drinking a contrast solution
• CT scan: To check for spread
• Biopsy: Tissue samples taken during endoscopy to detect cancer cells

Treatment

Treatment depends on the cancer’s stage and overall health of the patient. Options include:

• Surgery: Removal of the affected esophagus and lymph nodes; the remaining esophagus may be connected to the stomach.
• Radiation therapy: High-energy rays to destroy cancer cells, used before or instead of surgery.
• Chemotherapy: Anti-cancer drugs used before, after, or in place of surgery for advanced cases.
• Targeted therapy and immunotherapy: Focused on specific cancer cell mechanisms or boosting immune response.
• Endoscopic submucosal dissection (ESD): For very early-stage cancer removal.
• Endoscopic mucosal resection (EMR): Removal of tumors in the esophageal lining.
• Endoscopic laser therapy: Used to relieve symptoms when tumors block the esophagus.

Esophageal cancer is among the ten most common cancers worldwide and is one of the most difficult to treat, often because symptoms appear only after the disease has advanced. In many cases, there is no cure, and the focus shifts to improving quality of life and extending survival.

Facing a diagnosis with no cure can be emotionally overwhelming. Healthcare providers are trained to offer both medical and emotional support and may refer patients to mental health professionals for additional help.