Commonly referred to as the “food pipe,” the esophagus is a layered muscular tube that connects the back of the throat to the stomach. Its job is to carry food and liquid from the mouth to the stomach for digestion. Cancer of the esophagus (also known as esophageal cancer) develops when malignant (cancerous) cells begin to grow in one of the tube’s layers. Esophageal cancer accounts for about 1% of all new cancer diagnoses in the United States each year.
"External beam radiation is one of the modalities used to treat esophageal cancer," says Kimberly Johung, MD, a Yale Medicine radiation oncologist. At Yale Medicine, all patients with esophageal cancer receive personalized care from a team of specialists including surgical oncologists, medical oncologists, radiation oncologists and gastroenterologists who meet weekly at a multidisciplinary tumor board conference to discuss each patient's care plan. "Patients are also considered for clinical trials, which along with other research endeavors aim to improve outcomes after a diagnosis of esophageal cancer," says Dr. Johung.
What are the types of esophageal cancer?
There are two main types of esophageal cancer:
- Squamous cell carcinomas, which develop in cells lining the surface of the esophagus
- Adenocarcinomas, which originate in mucus-secreting gland cells within the esophagus
What are risk factors for esophageal cancer?
The two main risk factors—especially for squamous cell carcinomas—are tobacco use and heavy alcohol consumption.
Acid reflux is also a risk factor because it can cause damage of the lower portion of the esophagus, which can lead to Barrett’s esophagus, a precancerous condition, and increase risk of adenocarcinomas. With Barrett’s esophagus, more acid-resistant cells replace normal esophageal cells found in the stomach and intestines and can become increasingly abnormal over time.
Being male is a risk factor as well, and men are about four times more likely than women to develop esophageal cancer.
How is esophageal cancer diagnosed?
A patient complaining of the above symptoms is typically first seen by a gastroenterologist, a doctor specializing in treating digestive system conditions.
The gastroenterologist may perform an endoscopy, a procedure in which a camera is used to look down the esophagus.
If a mass is seen, a biopsy is typically performed in which a tissue sample is extracted from the suspicious mass and analyzed under a microscope to determine whether it is cancerous.
If the cells are malignant (cancerous), the patient usually has imaging tests such as a computerized tomography (CT) scan of the chest and abdomen and/or a positron emission tomography (PET) scan of the full body to see whether the cancer has spread.
An endoscopic ultrasound may also be recommended to determine how deep the tumor sits in the esophageal wall and thus determine the stage of the cancer. (Cancer is typically given a stage, from 0 to IV, depending on how advanced the cancer is and whether it has spread.)
After diagnostic tests are completed, the patient will likely see a thoracic surgeon, a medical oncologist and a radiation oncologist for treatment.
How is esophageal cancer treated?
Early-stage esophageal cancer, still at the surface of the esophageal lining, may require a surgery to remove part of the esophagus called an esophagectomy (performed by a thoracic surgeon). These tumors at the surface of the esophageal lining may also be removed by a minimally invasive process called endoscopic mucosal resection.
Late-stage esophageal cancer, deeper in the wall of the esophagus, is typically treated first with radiation combined with chemotherapy. Several potential regimens exist, and each patient’s care plan is different.
External-beam radiation is used to treat esophageal cancer. A linear accelerator machine aims high-energy X-rays at the cancer site to damage and kill cancer cells and shrink tumors.
Following the five-week course of radiation and chemotherapy, patients healthy enough for surgery often undergo an esophagectomy.
If the cancer has spread, chemotherapy is the preferred method of treatment and radiation is not used.
What are potential side effects of radiation therapy?
Side effects of radiation treatment for esophageal cancer may temporarily increase symptoms caused by the cancer and include:
- Difficulty swallowing solid foods and possibly liquids
- Weight loss due to eating difficulties
- Pain in the center of the chest
What is the prognosis for patients with esophageal cancer?
Survival rates for esophageal cancer largely depend on the stage of the cancer and whether it has spread beyond the esophagus.
People with early-stage cancers restricted to the esophagus generally have significantly better five-year survival rates than people with advanced cancers that have spread.
How is Yale Medicine’s approach to treating esophageal cancer unique?
At Yale Medicine, patients with esophageal cancer receive personalized care from a team of dedicated clinicians committed to using the most innovative treatment methods backed by the latest evidence-based research.
Every case is discussed by a multidisciplinary tumor board—comprising gastrointestinal cancer specialists including surgeons, medical oncologists, radiation oncologists, radiologists and pathologists—which meets weekly to discuss cases to formulate the best treatment plan for each patient.
Yale Medicine is also a key player in the search for improved esophageal cancer treatments, taking part in clinical trials and contributing research to national studies.
Yale Medicine is also a regional leader in esophagectomies. Data show that patients who undergo surgery for esophageal cancer at medical centers that perform a high volume of those procedures have better outcomes than those whose surgeries are performed at centers doing lower-volumes of those surgeries.