Esophageal cancer is a malignant (cancerous) tumor of the esophagus, the muscular tube that moves food from the mouth to the stomach.

See also: Barrett's esophagus

Esophageal cancer is relatively uncommon in the United States, and occurs most often in men over 50 years old. It affects less than 5 in 100,000 people. There are two main types of esophageal cancer --squamous cell carcinoma and adenocarcinoma. These two types look different from each other under the microscope.

Squamous cell esophageal cancer is associated with smoking and alcohol consumption. The rate of this disease in the United States has remained mostly the same, while the rate of adenocarcinoma of the esophagus has risen dramatically.

Barrett's esophagus, a complication of gastroesophageal reflux disease (GERD), is a risk factor for the development of adenocarcinoma of the esophagus.

Risk factors for adenocarcinoma of the esophagus include male gender, obesity, poor nutrition, and smoking.

• Backwards movement of food through the esophagus and possibly mouth (regurgitation)
• Chest pain unrelated to eating
• Difficulty swallowing solids or liquids
• Heartburn
• Vomiting blood
• Weight loss

Tests used to help diagnose esophageal cancer may include:

• Barium swallow
• Esophagogastroduodenoscopy (EGD) and biopsy
• Chest MRI or thoracic CT (usually used for helping to determine the stage of the disease)
• PET scan (sometimes useful for determining the stage of disease, and whether surgery is possible)

Stool sample testing may show signs of hidden (occult) blood in the stool.

When esophageal cancer is only in the esophagus and has not spread elsewhere, surgery is the treatment of choice. The goal of surgery is to remove the cancer. Sometimes chemotherapy, radiation, or a combination of the two may be used instead of surgery, or to make surgery easier to perform.

If the patient cannot tolerate surgery or the cancer has spread to other organs, chemotherapy or radiation may be used to help reduce symptoms. This is called palliative therapy. In such circumstances, however, the disease is usually not curable.

Other treatments that may be used to improve a patient's ability to swallow include endoscopic dilation of the esophagus (sometimes with placement of a stent), or photodynamic therapy. In photodynamic therapy, a special drug is injected into the tumor, which is then exposed to light. The light activates the medicine that attacks the tumor.

The stress of illness can often be eased by joining a support group of people who share common experiences and problems. See cancer - support group.

Esophageal cancer is a very difficult disease to treat. When the cancer has not spread outside the esophagus, surgery may improve chances of survival.

Radiation therapy is used instead of surgery in some cases where the cancer has not spread outside the esophagus.

For patients whose cancer has spread, cure is generally not possible and treatment is directed toward relief of symptoms.

• Difficulty swallowing
• Pneumonia
• Severe weight loss resulting from not eating enough
• Spread of the tumor to other areas of the body

Call your health care provider if you have difficulty swallowing with no known cause and it does not get better, or if you have other symptoms of esophageal cancer.

The following may help reduce your risk of squamous cell cancer of the esophagus:

• Avoid smoking
• Limit or eliminate alcoholic drinks

People with symptoms of severe reflux should seek medical attention.

Screening with EGD and biopsy in people with Barrett's esophagus may lead to early detection and improved survival. People diagnosed with Barrett's esophagus should see a gastroenterologist (digestive system specialist) at least every year.

Kleinberg LR, Forastier AA, Heitmiller RF. Cancer of the esophagus. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004; chap 77.

Esophageal Cancer. NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network, Inc. 2008. Accessed July 22, 2008.