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Esophageal Cancer: Symptoms, Diagnosis and Treatment

  • Abnormal DNA changes can cause cancer to develop on the inner wall of the esophagus
  • Symptoms include trouble swallowing, weight loss, and weakness
  • Treatment includes surgery, chemotherapy, and radiation therapy
  • Involves medical oncology, Gastroenterology, Yale Cancer Center, and Therapeutic Radiology

Overview

When you swallow, food goes straight to the esophagus—a long tube that connects the throat (pharynx) to the stomach. The esophagus uses muscle power to transport food and liquid in a matter of seconds.

Sometimes, cancer will develop on the inner wall of the esophagus, after a change in the DNA causes abnormal cells to grow. About 18,000 new cases of esophageal cancer occur in the United States each year, most of them in men.

Like other gastrointestinal cancers, esophageal cancer can be hard to detect until it’s become advanced.

“Unfortunately, in some patients, the symptoms can be minimal or, in rare cases, not present,” says Cary Caldwell, MD, a Yale Medicine gastroenterologist and an associate clinical professor of medicine at Yale School of Medicine. “In the vast majority of patients, however, there is a presentation of gastroesophageal reflux or heartburn, dysphagia [or difficulty swallowing], and in advanced cases, there can be weight loss.”

Treatment depends on how far the disease has spread, but usually includes a combination of chemotherapy, radiation therapy and surgery.

What are the types of esophageal cancer, and who’s at risk?

There are two main types of esophageal cancer—adenocarcinoma (which begins in glandular cells) and squamous-cell carcinoma (which begins in squamous cells). For both types, cigarette smoking is an important risk factor. There’s a strong link between esophageal adenocarcinoma and long-term gastroesophageal reflux disease (GERD), also known as acid reflux or heartburn. Occasionally, GERD can permanently change the lining of the esophagus, leading to a condition known as Barrett esophagus. People with this condition have an increased risk of developing adenocarcinoma, as do people with obesity. Esophageal squamous-cell carcinoma has been associated with certain lifestyle factors, like excessive alcohol consumption, an unhealthy diet, poor oral hygiene and intake of hot beverages. Possible genetic causes are still being explored.

What are the symptoms of esophageal cancer?

One of the earliest symptoms of esophageal cancer is difficulty swallowing. As the tumor grows and starts to block the esophagus, swallowing becomes painful and eventually impossible, causing regurgitation of food and liquids. Since patients with advanced disease have trouble eating, they may also notice weight loss and weakness. Not uncommonly, patients wait before seeing a doctor, often for as long as a year; by that time, the tumor has become advanced. That’s why it’s important to see a doctor whenever problems with swallowing arise.

How is esophageal cancer diagnosed?

Doctors perform several key tests to check for suspected esophageal cancer.

  • Endoscopy (or esophagogastroduodenoscopy). Doctors perform this test by inserting a long, flexible tool, which has a tiny light or camera, into the esophagus to look for tumors. The same tool may also be used to take samples of abnormal tissue for microscopic analysis.
  • Diagnostic imaging . During a procedure called a “barium swallow,” the patient drinks a liquid that contains barium. It coats and outlines the inner wall of the esophagus so that it can be better seen on an X-ray image.

As doctors learn more about genes that are associated with esophageal cancer, they may begin to perform DNA tests for diagnosis. 

How is esophageal cancer treated?

Most treatment plans start with a combination of chemotherapy and radiation therapy. If the cancer is still a threat, surgery is performed. The standard surgical procedure is esophagectomy, or removal of all or part of the esophagus. When the tumor is in the upper esophagus, the removed portion may be replaced with a length of small intestine to restore swallowing function. This type of grafting is called anastomosis. When the tumor is in the lower esophagus, the stomach may be moved up and reconnected to the esophagus to restore gastrointestinal function. 

What is unique about Yale Medicine’s approach to esophageal cancer?

In the Gastrointestinal Cancers Program at Yale Cancer Center, at Smilow Cancer Hospital, a team of doctors—including radiologists, gastroenterologists, medical oncologists and radiation oncologists—collaborate to give people with esophageal cancer the individualized care they need. Because our doctors are also scientists, they are researching genetic factors as well as ways to treat cancer and diseases that put people at risk for it, bringing cutting-edge knowledge from the lab to the patient.