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Esophageal Cancer: Symptoms, Survival Rates & Treatment

The esophagus is a hollow tube about ten inches long that connects the oral cavity to the stomach. Once ingested, food and liquids travel through the esophagus to the stomach where the digestive process continues. The esophagus is lined with a thick protective mucous membrane and muscles that help propel the food downward.

Like everything else in our bodies, the esophagus is composed of cells. These cells grow and divide, and are regulated by genes within the cells. When an abnormal cell starts growing and dividing without control, a tumor appears in the area.

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Esophageal Cancer Causes and Risk Factors

Researchers don't know exactly what causes esophageal cancer, but they believe that certain risk factors increase the chance of developing a cancer of the esophagus. Some of those risk factors include:

age: The incidence of esophageal cancer increases with age. According to the American Cancer Society, 77 percent of people diagnosed with cancer of the esophagus are over age 55.
gender: Esophageal cancer is four times more common in men than in women.
ethnicity: Esophageal cancer is 50 percent more common among African Americans than among Caucasians.
tobacco and alcohol use: Smoking and heavy drinking increase the risk of many types of cancer, including those of the esophagus.
diet: A diet lacking in fruits and vegetables increases the risk of esophageal cancer.
obesity: Obesity is known to increase the risk of cancer.
Barrett's esophagus: Barrett's esophagus is a condition in which the lower part of the esophagus is constantly irritated due to stomach acid "backing up." Over a long period of time, the cells in the lower esophagus may change and start to resemble cells found in the lower intestinal lining. People with Barrett's esophagus are at risk of developing adenocarcinoma.
irritation of the esophagus: Whether a person has Barrett's esophagus or not, any sort of irritation to the esophagus (such as swallowing strong alkaline or very hot liquids) can increase the risk of developing esophageal cancer.
achalasia: Achalasia is a disorder of the esophagus in which the esophagus is unable to relax properly. This makes swallowing difficult and causes food to back up in the esophagus.
tylosis: Tylosis is a rare hereditary disease that causes an excessive growth of the skin on the palms of the hand and the soles of the feet. People with tylosis are at higher risk of developing squamous cell carcinoma of the esophagus.

Key Statistics on Esophageal Cancer
Statistics reveal that:

An estimated 14,250 people in the US are diagnosed with cancer of the esophagus each year.
Approximately 14,000 people die as a result of esophagus cancer each year.

Types of Esophageal Cancer

Esophageal cancer can be divided into two different types, which are determined by the affected cells:

Adenocarcinomas develop in glandular tissue. The esophagus normally does not have any glandular tissue, but certain conditions such as Barrett's esophagus can alter the existing tissue. Adenocarcinomas normally occur in the lower part of the esophagus.
Squamous cell carcinomas develop in the squamous cells lining the esophagus. Squamous cell carcinoma can develop anywhere along the esophagus.

A Leiomyoma
A leiomyoma is a common, smooth muscle tumor, often found in the uterus or a section of the gastrointestinal tract, such as the esophagus. The word "leiomyoma" comes from the roots "leio," meaning "smooth" and "myo," meaning "muscle."

Symptoms of Esophageal Cancer

Unfortunately, cancers of the esophagus show no early symptoms. While the prognosis for an early diagnosis is good, esophageal cancer that shows no symptoms is often diagnosed by accident. Symptoms for esophageal cancer normally become evident in the later stages of the cancer. If you experience any of the following symptoms, see your doctor as soon as possible:

difficulty with swallowing or painful swallowing (dysphagia)
pain or discomfort in the chest area
pain in the throat or between the shoulder blades
severe weight loss
hoarseness
coughing up blood
vomiting
frequent episodes of hiccups.

Esophageal Cancer Staging and Survival Rates

Like many other cancers, cancer of the esophagus is staged using the TNM system of the American Joint Committee on Cancer (AJCC). The TNM cancer staging system uses three important pieces of information:

tumor size and how far it has spread in the esophagus (Tis-T4)
whether the cancer has spread to the nearby lymph nodes (N0-N1)
whether the cancer has spread to other distant organs (M0-M1b).

Staging of the cancer depends on these three pieces of information. Below is a chart of the stages and sub-stages of esophageal cancer and their relative five-year survival rates.

Note: Keep in mind that cancers of the esophagus start from the inside and grow outward so, in the earliest stages, the cancer is limited to the inner layers of the esophagus and moves outwards with each progressive stage.

Stage	TNM Stages	Stage Description	5-year Relative Survival Rate
0	Tis, N0, M0	This is the earliest stage; the cancer cells are limited to the inner most layer or epithelium.	75%
I	T1, N0, M0	The cancer cells have invaded beyond the epithelium to the submucosa.	60%
IIA	T2 or 3, N0, M0	The cancer cells have spread further, invading the muscle layer of the esophagus, and possibly the adventitia—the connective tissue covering the outside of the esophagus.	40%
IIB	T1 or 2, N1, M0	The cancer cells have invaded beyond the epithelium, but have not reached the adventitia. The cancer has also spread to nearby lymph nodes.	20%
III	T3, N1, M0 T4, N0 or 1, M0	The cancer cells have invaded the adventitia and spread to nearby lymph nodes, or the cells have spread beyond the adventitia to nearby organs and may or may not have spread to nearby lymph nodes.	15%
IVA	any T, any N, M1a	The cancer has spread to distant lymph nodes.	15%
IVB	any T, any N, M1b	The cancer has spread to distant lymph nodes or other organs.	Less than 5%

(Information obtained from the American Cancer Society and the MD Anderson Cancer Center 1970-2000)

Esophageal Cancer Treatment Options

The treatment method used for esophageal cancer depends on a number of factors, including:

size and location of the tumor
stage of the cancer
overall health of the patient.

Often, the doctor or a team of specialists and the patient discuss the available treatment options and determine together which may be the best option.

Surgery: Surgery is the most common esophageal cancer treatment method. The surgeon usually performs an esophagectomy, where the tumor and some or the entire esophagus and nearby lymph nodes are removed. If part of the esophagus is removed the surgeon connects the remaining esophagus to the stomach. If the entire esophagus is removed the surgeon inserts a plastic tube or part of the patient's intestine to make the connection between the oral cavity and stomach.

Radiation Therapy: Radiation therapy uses high-energy rays to kill cancer cells. It is usually the treatment option of choice for those unable to undergo surgery due to poor health. Radiation therapy can be external (from a machine) or internal (radioactive material is placed near the cancer).

Radiation therapy is often combined with chemotherapy, and is sometimes done before surgery. Many doctors believe that radiation therapy combined with chemotherapy can be just as effective as surgery. Side effects such as fatigue, skin problems, and painful swallowing while undergoing radiation therapy are common, but generally go away once the therapy is complete.

Chemotherapy: Chemotherapy is the use of drugs to kill cancer cells. The drugs are often administered through the blood stream so they have systemic effects. Chemotherapy is most effective if the cancer has spread to distant organs.

Laser Therapy: Laser therapy uses high intensity light to destroy cancer cells.

Photodynamic Therapy: Photodynamic therapy is a type of laser therapy used to treat esophagus cancer. Nontoxic chemicals are initially injected into the body and, over the course of a few days, they accumulate in the cancer cells. A special laser is then focused on the cancerous cells; the chemical inside the cells changes into a different chemical that destroys them. This method is often used in the early stages of cancer because the light can reach only cancers found in the inner lining of the esophagus.

Prevention of Esophageal Cancer

While no surefire way to prevent cancer of the esophagus exists certain risk factors can be minimized to reduce the risk of cancer. Smoking and excessive alcohol multiply the risk of esophageal cancer up to 44 times, so avoiding these two factors decreases the risk and improves your overall health.

Maintaining a healthy diet can also help reduce the risk of esophageal cancer. A diet rich in fruits and vegetables reduces the risk of cancer and may also reduce the likelihood of obesity, another risk factor for esophageal cancer.

Resources

American Cancer Society. (updated 2005). Detailed guide: Esophagus cancer.

CancerAnswers. (2004). Esophagus cancer.

MedicineNet, Inc. (2005). Tylosis with esophageal cancer.

National Cancer Institute. (updated 2002). What you need to know about cancer of the esophagus.

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