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Esophageal Cancer Symptoms, Causes, and Treatment.

Esophageal cancer is one of the most common causes of cancer deaths worldwide. Enter here to find out everything about it.

The esophagus is a long and hollow tube that connects the mouth to the stomach. Esophageal cancer is a disease that may mimic other diseases making it difficult to notice at the beginning. Nonetheless, it is one of the top leading causes of cancer deaths worldwide.

Within this article, you will find answers to some of the most common questions about this disease, like the stages, what can mimic this disease, and many more. Among these questions, there will be answers, like the risk factors and the possible outcomes for these patients.

By reading this article, you will obtain critical insights about esophageal or esophagus cancer, its symptoms, how to diagnose it, and the treatment options. Therefore, please continue reading this article to get pearls on this specific topic by a doctor’s hand.

What is the Esophagus?

The esophagus is a hollow and muscular tube that connects the throat to the stomach. It lies between the trachea or windpipe and the spine or vertebral column.

On average, it has a longitude of 25 to 33 cm in adults. It is a crucial component of the gastrointestinal tract. The tube allows the food to travel from the mouth to the stomach for further digestion. 

Digestive, System, Human, Digestion, Labelled, Diagram
Digestive System
Source

The esophagus is not always open; it has two special muscular rings that only open when they sense food or liquid coming their way. These rings are the upper esophageal sphincter and the lower esophageal sphincter. The first one is right at the beginning of the esophagus, and the other is at the lower esophagus, near the esophagogastric junction.

The lower sphincter also helps to prevent the acid reflux or return of stomach acids and digestive juices. If this sphincter fails, it can cause a disease that receives the name of gastroesophageal reflux disease

Composition of the Esophagus

The esophagus has several layers as it is just not a simple tube. To be exact, the esophagus wall divides itself into 4 layers, and one of them divides itself into three. The layers are the following:

  • Mucosa layer: It is the most internal layer of the esophagus, and it divides into three.
    • Epithelium: The most inner layer of the esophagus. It is made of flat, thin cells that receive the name of squamous cells. It is where most of the esophagus cancers start.
    • Lamina propria: Connective tissue layer under the epithelium.
    • Muscularis mucosa: It is a thin muscle layer under the two previous layers.
  • Submucosa: It is a layer of connective tissue that contains blood vessels, nerves, and glands that secrete mucus.
  • Muscularis propria: A thick muscle layer contracts in a coordinated way to push down the food from the mouth to the stomach.
  • Adventitia: The outermost layer of the esophagus that covers it and is made of connective tissue.
A hand-drawn sketch by Dr. Christensen from the University of Michigan Medical School for the laboratory sessions he conducted in the Medical Histology Course for first-year medical students.
Source

What are the statistics related to esophageal cancer?

On recent data, the American Cancer Society estimates that for 2021 there will be nearly 20,000 new cases of esophageal cancer. These will divide into 15,000 new cases in men and 4,000 in women. Also, there are estimates that around 15,000 people will die of the disease. This is a type of cancer that is considerably more common in men rather than women. The risk of contracting this disease is about 1 in 125 men and 1 in 417 women.

Esophageal cancer is the seventh leading cause of cancer death in males in the United States. However, the rates of esophageal cancer have been stable through the last years and even experiencing a subtle drop. This disease accounts for approximately 3 to 6 cases per 100,000 population.

Certain factors intervene in the development of this type of cancer which can be modified. Esophageal cancer has two different main types, Adenocarcinoma, and Esophageal squamous cell carcinoma. Adenocarcinoma is the most common type of cancer in white people. At the same time, squamous cell carcinoma is most common in Afro-American people.

Throughout the world, esophageal cancer is the seventh most common cancer and the sixth most common cause of cancer deaths. It is a type of cancer more common in third world countries rather than first world countries. It accounts for 1% of all the types of cancer diagnosed in the United States on average. There are certain areas of the world with a very high risk of developing this disease that receives the name of esophageal cancer belt. This includes northern Iran, southern Russia, and Northern China, and there are over 800 cases per 100,000 population.  

What are risk factors for esophageal cancer?

Certain habits may induce changes to the normal cells of the esophagus, turning them into cancerous cells. These habits that count as risk factors can be changed, but on the other hand, other ones cannot. Among these ones are risk factors like age or familiar history. Some of these factors may increase the risk of esophageal adenocarcinoma and others squamous cell carcinoma. The risk factors for this disease are the following:

  • Age: Being over 55 years old increases the risk of developing esophageal cancer.
  • Gender: Men are more likely to develop this disease.
  • Tobacco: Tobacco use is a major risk factor for developing esophageal cancer. The more a person uses it and the longer, the higher the risk. People who smoke a pack of cigarettes or more a day have twice the risk of having esophageal adenocarcinoma. It is important to notice that the risk does not go away if the person stops smoking.
  • Alcohol: Alcohol intake also increases the risk of developing esophageal cancer. The more alcohol a person drinks, the higher the risk. It increases the risk of developing squamous cell carcinoma more than adenocarcinoma.
  • Gastroesophageal Reflux Disease (GERD): In some people, the stomach acids can escape from the stomach up into the lower esophagus. These people have a slightly higher risk of developing esophageal carcinoma. 
  • Barrett Esophagus: Acid reflux from the stomach into the lower esophagus may damage the esophagus if it goes on for a long time. This causes the normal squamous cells of the esophagus to be replaced with glandular cells, which can become cancer cells over time.
  • Achalasia: A condition in which the lower esophagus does not relax properly. Food and liquid have trouble passing to the stomach and collect in the lower esophagus. 
  • Diet
  • Obesity
  • Drinking hot liquids

What are the stages of esophageal cancer?

After diagnosing esophageal cancer, doctors will try to figure out if it has spread and how much; this process receives the name of staging. It is a process that helps to determine how serious the cancer is and the best way to treat it. 

The most common staging system for esophageal cancer is the American Joint Committee on Cancer (AJCC) TNM System. This system uses three different key pieces. 

  • Tumor (T): It evaluates the extent or size of the tumor. Doctors evaluate how far cancer has grown into the esophagus wall or if it has reached nearby structures.
  • Lymph Nodes (N): This set of information evaluates if cancer has spread to nearby lymph nodes.
  • Metastasis (M): This is the last key piece of information. It evaluates if cancer has spread to distant lymph nodes or distant organs. 

The TNM system also has numbers that go with the corresponding letter. The higher the number is it means the cancer is more advanced. There are simplified versions of the TNM system that stage Esophageal cancer from 0 to IV. This means that esophageal cancer has 5 different stages, all of them with differences between them. The staging will also vary depending on the type of cancer, adenocarcinoma, or squamous cell carcinoma. To make the subject understandable, the stages will be general for both of the conditions. The stages are the following:

Stage 0 

It is a stage that receives the name of high-grade dysplasia. This means that there are huge amounts of abnormal cells in the inner lining of the esophagus. These cells are at risk of transforming into cancer cells.

Stage I

This stage usually means that cancer has spread only to the thick muscle wall of the esophagus. It is also very common that people with Stage I do not have compromise in nearby lymph nodes. However, this will depend on the type of esophageal cancer.

Stage II

In stage II, cancer may have spread to the outermost layer of the esophagus, the adventitia. It also means that cancer has reached 1 or 2 nearby lymph nodes. However, at this point, cancer has not spread to other organs.

Stage III

In stage III, esophageal cancer might have spread from the adventitia layer to nearby structures or tissue. It also means that it might have spread to up to 6 nearby lymph nodes. Among the nearby structures are the pleura, the pericardium, or the diaphragm.

Stage IV

This is the last stage of esophageal cancer. If a patient reaches this stage, it means that this cancer is advanced or in metastasis. Cancer may have spread to other body structures or organs like the lungs or the liver. It also means that it may have spread to 7 or more lymph nodes.

What are the symptoms of esophageal cancer?

The symptoms of esophageal cancer are very characteristic. Therefore, they allow the doctors to perform a diagnosis of the disease as soon as these symptoms appear. However, at early stages, this condition does not generate any type of symptoms. This makes it difficult to diagnose at the early stages. Still, when it happens, it is usually by accident because of tests related to other medical problems. Among the symptoms are the following:

  • Trouble swallowing (Dysphagia)
  • Chest pain
  • Weight loss
  • Pressure or burning in the chest
  • Hoarseness
  • Chronic cough
  • Vomiting
  • Bone pain (In case of cancer has spread to the bones)
  • Bleeding into the esophagus. This may turn the stool black as the blood becomes digested. Also, this bleeding may lead to anemia in the future, making the person feel tired.

However, having any of these symptoms does not mean that the person has cancer. These patients should look for medical attention to find the cause of these symptoms. In fact, many of these symptoms are very likely to be caused by other conditions.

How is esophageal cancer diagnosed?

Usually, when a patient comes to the doctor, they will refer pain or an uncomfortable symptom. That is why the first tool for making a diagnosis of this disease is a proper history of the patient. The doctor will ask for the patient’s habits and the familiar history to determine if the patient can have cancer. The doctor will also perform a complete physical examination to rule out other possibilities. If the impression after the complete history and physical examination is not conclusive, the doctor will ask for further tests. Among the tests are the following:

Imaging Tests

  • Barium Swallow Test: For this study, the patient will swallow a liquid that contains barium to later perform an X-Ray. The barium will allow the doctor to see your esophagus and determine if there is any abnormality. However, this is a test that cannot determine how far cancer may have spread outside of the esophagus.
  • Computed Tomography (CT) Scan: This is a test that uses X-Rays to make detailed cross-sectional images of your body. This test can help to determine if cancer has spread to nearby organs or lymph nodes. In some cases, doctors may ask the patient to take oral contrast to help outline the esophagus and the intestines.
  • Magnetic Resonance Imaging (MRI) Scan: It is a study that also shows images of soft tissues within the body. It shows possible cancer spread to the brain or the spinal cord due to its nature of using magnetic waves instead of X-Rays.
  • Positron Emission Tomography (PET) Scan: PET scans can be a very valuable resource as they use a slightly radioactive form of sugar. This sugar is collected mainly by cancerous cells and tumor cells. Therefore, it is a useful study to determine esophageal cancer and its spread within the body.

Endoscopy

  • Upper endoscopy: This is an important test for diagnosing esophageal cancer. The patient is asleep, and the doctor introduces a flexible and narrow tube with a camera. This allows the doctor to see if there is any abnormality in the esophagus.
  • Endoscopic Ultrasound: It is usually done at the same time as the upper endoscopy. It allows the doctor to determine the size of esophageal cancer and its possible extension to nearby areas.
  • Bronchoscopy
  • Thoracoscopy and laparoscopy

Lab tests of Biopsy Samples

Suppose the doctor, while performing an endoscopy, finds anything abnormal that may correlate to cancer. In that case, he or she may take a sample of this tissue. This sample receives the name of the biopsy.

Furthermore, this sample will undergo a series of tests to determine if it has cancerous genes or proteins. The following are HER2, PD-L1, MMR, and MSI. Testing for these genes and proteins can be very valuable and may help to determine if it is cancer or not.  

What is the treatment for esophageal cancer?

The treatment for esophageal cancer will depend on many factors, like the extent of cancer, the type of cells, and the patient’s overall health. The following are the different types of cancer treatment available. 

Surgery

  • Endoscopic mucosal resection: If the tumors are small and have not spread, doctors may recommend removing them. This can be done through endoscopy, and it also removes a margin of healthy surrounding tissue.
  • Transhiatal esophagectomy: Your thoracic surgeon may recommend this type of surgery if the tumor is slightly bigger and invasion of lymph nodes. The surgeon will remove a portion of the esophagus, nearby lymph nodes, and a small portion of the upper stomach after removing the esophageal tumor.
  • Esophagogastrectomy: During this procedure, the surgeon will remove a part of the esophagus, nearby lymph nodes, and a large part of the stomach. 

Treatment for Complications

  • Relieving esophageal obstruction: Doctors may introduce a stent to hold the esophagus open. There are other options like chemotherapy, laser therapy, and photodynamic therapy.
  • Providing nutrition: Doctors may also recommend a feeding tube if the patient has trouble swallowing or if they have esophagus surgery nearby.

Chemotherapy

It is a drug treatment that uses certain types of chemicals to kill cancerous cells. This type of treatment is most commonly used before or after surgery in patients with esophageal cancer. If the cancer is advanced, it may be used to relieve symptoms caused by cancer.

Radiation Therapy

This type of therapy uses high-energy beams to kill cancer cells. In most cases, the radiation comes from a machine outside of the body. Doctors also use it alongside chemotherapy before surgery to manage signs and symptoms of esophageal cancer.

Targeted Therapy

The targeted drug therapy focuses on specific weaknesses present within cancer cells. When these treatments block the weaknesses, the cancerous cells die. This type of treatment is common in patients with advanced cancers who do not respond to other therapies.

Do you have Esophageal Cancer symptoms?

This tool is an Esophageal Cancer Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for the disease. Therefore, the tool will tell anybody who uses it the likelihood of having esophageal cancer. Using the tool is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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