Esophageal cancer is cancer that develops in the esophagus, the muscular tube connecting the throat and the stomach. Esophageal cancer is divided into two types: squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma is usually diagnosed in the upper and middle esophagus, whereas adenocarcinoma is most often found in the lower part of the esophagus, near the stomach.
The most common signs of esophageal cancer are pain or difficulty when swallowing, a painful or sore throat, and weight loss. Hoarseness or cough, indigestion and heartburn, or pain behind the breastbone also may be present.
Chronic gastroesophageal reflux disease and/or Barrett's esophagus, smoking, heavy and/or long-term alcohol use, malnutrition, and obesity, are risk factors for esophageal cancer. In addition, men are at greater risk because they are more likely than women to smoke and abuse alcohol.
Tests used to diagnose this condition include chest x-ray, a barium swallow, and an esophagoscopy. For a barium swallow, patients drink a liquid barium solution, and as it flows through the esophagus and into the stomach, x-rays are taken to check for abnormalities. In esophagoscopy, an endoscope (a thin lighted tube equipped with a light and tiny camera) is inserted through the mouth or nose and down the throat to view the esophagus. Small tissue biopsies may be taken through the scope.
Other diagnostic techniques include narrow band imaging and capsule endoscopy. In narrow band imaging, a modified blue light is used to examine the esophagus with a special endoscope to obtain extremely detailed views of the esophagus. In capsule endoscopy, patients swallow a "pill" containing a tiny camera that takes pictures of the esophagus and upper stomach as it travels downward. It is later excreted.
Esophageal cancer is usually treated with surgery, radiation, and chemotherapy. Small tumors that are in the top layers of the esophagus lining are removed with endoscopic mucosal resection (EMR), which is a performed using a thin flexible tube that is inserted in the mouth, down the throat, and into the esophagus.
If a diseased portion of the esophagus needs to be removed, laparoscopic esophagectomy may be used over traditional open surgery, especially when it is in the earliest stages. This technique is minimally invasive and results in shorter recovery time, a smaller incision and scar, fewer risks associated with open surgery, and better overall results.
Photodynamic therapy (PDT) is used to open up esophageal blockages or treat small, shallow tumors in patients who cannot tolerate open surgery. In PDT, a drug is administered intravenously and preferentially absorbed by cancer cells over a few days. Using an endoscope, the lesion is exposed to a certain wavelength of light that kills the cancer cells and also acts indirectly to damage the tumor's blood supply.
Chemotherapy may be used alone or in combination with radiation before surgery to reduce the size of the tumor. A newer form of radiation called brachytherapy delivers a high, pinpointed dose of radiation to the tumor cells, while sparing surrounding healthy tissue.