Definition
Esophageal cancer is a malignant tumor of the esophagus. The risk of cancer of the esophagus is increased by long-term irritation of the esophagus, such as from smoking, heavy alcohol intake, and Barrett esophagitis. Very small tumors in the esophagus usually do not cause symptoms. As a tumor grows, the most common symptom is difficulty in swallowing. There may be a feeling of fullness, pressure, or burning as food passes down the esophagus. Cancer of the esophagus can also cause indigestion, heartburn, vomiting, and frequent choking on food. Because of these problems, weight loss is common. Esophageal cancer can be diagnosed through a barium X-ray study of the esophagus and endoscopy and biopsy of the tumor. Treatment includes chemotherapy and sometimes surgery.
Desciption
Esophageal cancer usually originates in the inner layers of the lining of the esophagus and grows outward. In time, the tumor can obstruct the passage of food and liquid, making swallowing painful and difficult. Since most patients are not diagnosed until the late stages of the disease, esophageal cancer is associated with poor quality of life and low survival rates.
Squamous cell carcinoma is the most common type of esophageal cancer, accounting for 95% of all esophageal cancers worldwide. The esophagus is normally lined with thin, flat squamous cells that resemble tiny roof shingles. Squamous cell carcinoma can develop at any point along the esophagus but is most common in the middle portion.
Adenocarcinoma has surpassed squamous cell carcinoma as the most common type of esophageal cancer in the United States. Adenocarcinoma originates in glandular tissue not normally present in the lining of the esophagus. Before adenocarcinoma can develop, glandular cells must replace a section of squamous cells. This occurs in Barrett's esophagus, a pre-cancerous condition in which chronic acid reflux from the stomach stimulates a transformation in cell type in the lower portion of the esophagus.
A very small fraction of esophageal cancers are melanomas, sarcomas, or lymphomas.
There is great variability in the incidence of esophageal cancer with regard to geography, ethnicity, and gender. The overall incidence is increasing. About 13,000 new cases of esophageal cancer are diagnosed in the United States each year. During the same 12-month period, 12,000 people die of this disease. It strikes between five and ten North Americans per 100,000. In some areas of China the cancer is endemic.
Squamous cell carcinoma usually occurs in the sixth or seventh decade of life, with a greater incidence in African-Americans than in others. Adenocarcinoma develops earlier and is much more common in white patients. In general, esophageal cancer occurs more frequently in men than in women.
There has been an alarming increase in the incidence of esophageal cancer in the United States. This has affected all segments of the population, but has most specifically affected white males 50-70 years of age. A multidisciplinary approach to the diagnosis and treatment of esophageal cancer is crucial for proper staging and therapy. The Cleveland Clinic’s team approach employs members of the department of Gastroenterology, Thoracic Surgery, Medical Oncology, Radiation Oncology, and Anatomic Pathology.
When a patient is newly diagnosed with esophageal cancer, determining precisely the stage, or extent of the tumor is crucial. Patients with esophageal cancer that is limited to the wall of the esophagus are frequently best treated with a surgical approach. Those patients with cancer that has spread through the wall are often best treated with a combination of chemotherapy, and radiation therapy, followed by surgery. This stage directed therapy has resulted in significant improvements in patient survival.
Proper staging of esophageal cancer utilizes multiple techniques, including CT scanning, PET scanning, and endoscopic ultrasound.
Patents with esophageal cancer may frequently have difficulty swallowing because of tumor obstruction of their esophagus. Relief of the swallowing difficulties may be accomplished with laser therapy, argon plasma coagulation, photodynamic therapy or the placement of an expandable metal stent. These treatments are all offered as a part of our multidisciplinary approach.