What is Esophageal Cancer?

What is Esophageal Cancer?

The esophagus is a muscular tube connecting the throat's back to your stomach—a passageway for food and liquids. Esophageal cancer occurs when abnormal cells, starting in the esophagus lining, divide and multiply. These abnormal cells can eventually form cancerous tumors.

Cancers of the esophagus are rare, making up an estimated 1% of cancer cases in the United States. However, they are common worldwide. But symptoms can be elusive, making esophageal cancer harder to catch in its early stages.

Types of Esophageal Cancer

Types

The lining of the esophagus is comprised of squamous cells. Esophageal cancer can develop in this cell type. However, the normal squamous cells can be replaced by cells that resemble, in part, what is found in the small intestine. This is called Barrett's esophagus. Doctors define esophageal cancer types and recommend courses of treatment based on what cells were affected.

There are two primary types of esophageal cancer:

  • Squamous cell carcinoma - This form of cancer begins in the squamous cells—the flat, thin cells lining the esophagus. Squamous cell carcinoma is the most common type of esophageal cancer worldwide and has been linked to heavy tobacco and alcohol use, as well as deficiencies in certain vitamins and minerals.
  • Adenocarcinoma - This type of cancer forms in Barrett's esophagus, typically located in the lower part of the esophagus. Adenocarcinoma is the most common type of esophageal cancer in the United States. Individuals with chronic acid reflux and obesity may be at higher risk for the condition.

Stages of Esophageal Cancer

Stages

Esophageal cancer is grouped into stages (I-IV). The stage depends on the size and location of the tumor, if the lymph nodes are involved, and whether or not the cancer has spread elsewhere in the body.

Esophageal cancer staging is classified as:

  • Stage I - Cancerous cells are found only in the esophagus lining, and the tumor size is small
  • Stage II - Cancer is found in the outer or muscle layer of the esophagus, and the tumor has grown in size
  • Stage III - Cancer has developed in the inner muscle layer or the connective wall of the esophagus and may have spread to nearby lymph nodes
  • Stage IV - The cancer has spread to other lymph nodes beyond the ones nearby and to other organs within the body (e.g. lung, liver, abdominal cavity, bone marrow). This is also referred to as advanced cancer.

Esophageal tumors have a grading system dependent on the behavior, appearance, and growth of the cells:

  • Low-grade tumor - This type of esophageal tumor is comprised of normal-looking cells that are slow-growing
  • High-grade tumor - This type of esophageal tumor is made up of abnormally-shaped cells. High-grade tumors can grow, divide, and can spread faster than low-grade tumors.

Signs & Symptoms of Esophageal Cancer

Symptoms

In its early stages, esophageal tumors may not cause any symptoms. But as the abnormal tissue develops further, people may experience the following signs of esophageal cancer:

  • Difficulty swallowing
  • Unintended weight loss
  • Pressure, burning, or pain in the chest area
  • Worsening heartburn
  • Hoarseness or coughing
  • Regurgitation of food
  • Coughing or vomiting up blood
  • Unexplained anemia
  • Blood-tinged stool

What Causes Esophageal Cancers?

Causes

The biology and genetics of esophageal cancers are being increasingly understood, and researchers at Columbia University are world leaders in this area. Mutations in tumor-promoting genes (oncogenes), tumor suppressor genes, and microenvironmental cues cause esophageal cancers.

Risk Factors for Esophageal Cancer

Risk Factors

Certain habits and conditions can cause chronic irritation and changes in the esophageal cells and can increase cancer risk. Different risk factors are linked to squamous esophageal cancer and adenocarcinoma esophageal cancer. Esophageal squamous cancer risk factors can include:

  • Tobacco use - Cigarettes, pipes, cigars, and chewing tobacco, etc.
  • Alcohol abuse
  • Vitamin and mineral deficiencies
  • Age - People over the age of 60 are more likely to develop esophageal cancer
  • Family history
  • Sex - Men are twice as likely to develop the disease than women

Esophageal adenocarcinoma cancer risk factors can include:

  • Gastroesophageal reflux disease (GERD) - Acid from the stomach travels back up to the esophagus, causing irritation and discomfort
  • Barrett's esophagus - Caused by ongoing acid reflux, cells in the lower end of the esophagus become irritated and prone to developing abnormalities
  • Tobacco use
  • Obesity
  • Age - People over the age of 60 are more likely to develop esophageal cancer
  • Family history
  • Sex - Men are eight times more likely to develop the disease than women

Monitoring high risk patients

Some esophageal cancers start with damage caused by chronic acid reflux. NewYork-Presbyterian has special noninvasive or endoscopic programs to monitor and treat people at increased risk of cancer due to gastroesophageal reflux disease (GERD) or Barrett's esophagus. The Jay Monahan Center and our advanced endoscopy programs provide surveillance services. Our nuanced nutrition programs help patients minimize GERD, reducing their risk of Barrett's esophagus and lowering their chance of developing esophageal cancer.

Prevention

Prevention

While anyone can develop esophageal cancer, there are steps you can take and habits to break that may reduce your risk, including:

  • Quit tobacco use - Including cigarettes, cigars, vapes, pipes, and chewing tobacco
  • Drink alcohol in moderation or abstain completely
  • Maintain a healthy weight
  • Exercise regularly
  • Eat a healthy diet— Less processed meats and more fruits and vegetables
  • Report symptoms – Tell your doctor if you experience heartburn, chest pain, breathing difficulties, or other symptoms of esophageal cancer
  • Seek treatment – Get medical care for conditions such as Gastroesophageal reflux disease (GERD), Barrett's esophagus, or other conditions that can increase your risk
Get Care

Trust NewYork-Presbyterian for Esophageal Cancer Care

At NewYork-Presbyterian, our top-rated doctors and specialized oncologists provide unparalleled care for gastrointestinal cancers. Our knowledgeable and compassionate cancer care teams will use state-of-the-art technology to determine a diagnosis and treatment plan just for you.

If you are experiencing signs and symptoms of esophageal cancer, or have a condition linked to being at higher risk of developing the disease, reach out to us for an appointment today.