Esophageal Cancer: Frequently Asked Questions
Here are some answers to frequently asked questions about esophageal cancer.
What is the esophagus?
The esophagus is a muscular tube. It’s part of the digestive tract.
The esophagus connects the throat to the stomach. It’s behind the windpipe and in front of the spine. When you swallow, the esophagus tightens and contracts. This causes "waves" to push food down into your stomach. Glands in the esophagus make mucus to keep the tube moist and make swallowing easier.
What is esophageal cancer?
Cancer occurs when cells grow out of control. Esophageal cancer is when cells grow out of control in the esophagus. Cancer can develop in any part of the esophagus. It typically starts in the inner lining. It may spread along and into the esophagus wall. If it spreads, it usually shows up first in the lymph nodes, windpipe (trachea), and large blood vessels in your chest. Then it may spread into other parts of your body. These can include your lungs or liver.
What are the different types of esophageal cancer?
There are two main types of esophageal cancer. They include:
Adenocarcinoma. This occurs in the gland cells. These are also called adenoid cells. These cells make mucus and other fluids. They are usually found in the stomach. But they can move up into the lower part of your esophagus, replacing squamous cells. In the United States and other Western countries, this type of esophageal cancer is more common than squamous cell carcinoma.
Squamous cell carcinoma. This is cancer that starts in the flat cells of the esophagus. These cells line the entire esophagus. Less than half of all cancers in the esophagus start in the squamous cells.
What is Barrett's esophagus?
Sometimes fluid from the stomach backs up into the lower esophagus. This is called reflux or gastroesophageal reflux disease (GERD). Over time, reflux may cause the cells in the lower esophagus to change. This condition is called Barrett's esophagus. In some cases, this issue leads to esophageal cancer.
What are the risk factors for esophageal cancer?
Certain factors can make one person more likely to get esophageal cancer than another person. These are called risk factors. Smoking cigarettes and drinking alcohol are the two biggest known risk factors for this type of cancer. They put you at highest risk for esophageal cancer. Other risk factors include being older, being a man, being obese, and having reflux or Barrett's esophagus.
What are the symptoms of esophageal cancer?
Often, there are no symptoms in the early stages of esophageal cancer. Symptoms might not show up until the disease is more advanced. Early symptoms often feel like indigestion or heartburn. As a result, many people ignore those symptoms. The most common symptom is trouble swallowing. At first, the trouble is with dry, solid foods. These can include bread, muffins, or chicken. In time, it can become hard to swallow liquids. You may also feel pressure or burning when swallowing. You may feel like food is stuck in your throat or chest. You might lose weight without trying because you're eating less. Other symptoms can include choking, vomiting, coughing, hoarseness, and pain in your throat or breastbone. You may notice a lump on your neck or collarbone, or under your arm.
How is esophageal cancer diagnosed?
Your healthcare provider will ask questions about your health and family history and risk factors. He or she will also do a physical exam to check for signs of the disease. To view your esophagus, he or she may order either or both of these tests:
Barium swallow (upper GI series). A special X-ray test where your healthcare provider watches you swallow a liquid.
Upper endoscopy. In this test, your healthcare provider places a flexible, lighted tube with a tiny video camera on the end (endoscope) into your esophagus.
During the endoscopy, your healthcare provider can take a sample of any unusual tissue. This is called a biopsy. He or she can check the sample for cancer cells.
Should everyone get a second opinion for esophageal cancer?
Many people with cancer get a second opinion from another healthcare provider. There are many reasons to get a second opinion:
Not feeling comfortable with the treatment decision
Being diagnosed with a rare type of cancer
Having several options for how to treat the cancer
Not being able to see a cancer expert
Many people have a hard time deciding which treatment to have. It may help to have a second healthcare provider look at the diagnosis and treatment options before starting treatment. A short delay in treatment usually will not lower the chance that it will work. Some health insurance companies even require that a person with cancer seek a second opinion. Some insurance companies will pay for a second opinion.
How can someone get a second opinion for esophageal cancer?
There are many ways to get a second opinion:
Ask a primary care healthcare provider. He or she may be able to suggest a specialist. This may be a surgeon, gastroenterologist, medical oncologist, or radiation oncologist. Sometimes these healthcare providers work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.
Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities. These include cancer centers and programs supported by the National Cancer Institute
Seek other options. Check with a local medical society, a nearby hospital or medical school, or a support group to get names of healthcare providers who can give you a second opinion. Or ask other people who've had esophageal cancer for their recommendations.
How is esophageal cancer treated?
Surgery is the most common treatment for early stage cancers. The goal is to take out the tumor. If that isn't possible, then the goal is to ease your symptoms. These are some other treatments that are used:
Photodynamic therapy (PDT) and other laser therapies
Some of these treatments may be used together. For instance, radiation and chemo may be done to shrink the tumor. You may have this either before or instead of surgery, or to kill any cancer cells that are left after surgery. The choice of treatment depends on how much the cancer has spread. It also depends on your overall health and personal preferences.
What are clinical trials?
Clinical trials are studies of new kinds of treatments. Some trials are specific to cancer. Healthcare providers do clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are ones that work better or have fewer side effects than the current treatments. People in clinical trials may get a treatment before the U.S. Food and Drug Administration (FDA) has approved it. Joining a trial helps researchers learn more about cancer and how to help future cancer patients. Clinical trials are especially helpful for people with esophageal cancer, as it is currently a cancer that is often hard to treat well.
What's new in esophageal cancer research?
Cancer research should give you hope. Experts around the world are learning more about what causes esophageal cancer. They are looking for and studying ways to prevent it. They are also finding better ways to detect and treat this disease.
Studies are being done to improve survival rates in people with this cancer who are treated with certain medicines. Newer radiation therapies may also be helpful.
March 21, 2017
Alteri, Rick, MD,Gersten, Todd, MD