Esophageal Cancer

What is esophageal cancer?

Cancer starts when cells change and grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby tissues. And they can spread to other parts of the body. This is called metastasis.

The esophagus is the swallowing tube. It carries food and liquid from your mouth to your stomach. It sits behind your windpipe (trachea) and in front of your spine.

The wall of the esophagus is made of layers of tissue and muscle. Esophageal cancer starts in cells that make up the inner lining layer of the esophagus. As it grows, it moves deeper into the other layers of the esophageal wall.

Who is at risk for esophageal cancer?

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change. 

The risk factors for esophageal cancer include:

• Older age
• Being a man
• Tobacco use
• Alcohol use
• Gastroesophageal reflux disease (GERD)
• Barrett esophagus, a condition in which the cells in the esophagus change because of long-term acid reflux
• Obesity
• Certain other health conditions and syndromes
• History of lung, throat, or mouth cancer
• HPV (human papillomavirus) infection

Talk with your healthcare provider about your risk factors for esophageal cancer and what you can do about them.

Can esophageal cancer be prevented?

There’s no sure way to prevent esophageal cancer. But you may be able to lower your risk for it by:

• Not using any form of tobacco
• Limiting alcohol use
• Getting to and staying at a healthy weight
• Managing reflux, if needed
• Treating Barrett esophagus, if needed

Are there screening tests for esophageal cancer?

There are no routine screening tests for esophageal cancer. Screening tests are done to check for disease in people who don’t have symptoms.

But if you have Barrett esophagus or are at high risk for esophageal cancer, talk with your healthcare provider about having an endoscopy. This test lets your provider look inside your esophagus using a thin, lighted, flexible tube that’s put in through your mouth. Patches of changed cells in the lining of the esophagus (called dysplasia) can then be found and treated before they become cancer. The test can also help find cancer early, when it’s small and easier to treat.

What are the symptoms of esophageal cancer?

Esophageal cancer often doesn’t cause symptoms until it's big and has spread. The most common signs of esophageal cancer include:

• Trouble swallowing, especially dry foods like meat, bread, or raw vegetables
• Pressure or burning in your chest
• Feeling like food is stuck in your throat
• Losing weight without trying
• Heartburn
• Indigestion
• Frequent choking
• Cough
• Hoarse voice
• Blood in stool or black, tar-like stool
• Extreme tiredness (fatigue)

Many of these may be caused by other health problems. Still, it’s important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

How is esophageal cancer diagnosed?

Your healthcare provider will ask you about your health history, symptoms, risk factors, and family history of disease. A physical exam will be done. You may also have some tests done, such as blood tests and an X-ray, barium swallow, or other imaging tests.

A biopsy is the only sure way to tell if you have esophageal cancer. Small pieces of the tumor are taken out and checked for cancer cells. Your results will come back in about a week.

After a diagnosis of esophageal cancer, you’ll need more tests. These help your healthcare providers learn more about your overall health and the cancer. They're used to find out the stage and grade of the cancer. The stage is how much cancer there is and how far it has spread (metastasized) in your body. It's one of the most important things to know when deciding how to treat the cancer.

The grade is used as part of staging. It gives you an idea of how fast the cancer will grow and spread.

Once your cancer is staged, your healthcare provider will talk with you about what it means for your treatment. Be sure to ask your healthcare provider to explain the details of your cancer to you in a way you can understand.

How is esophageal cancer treated?

Your treatment choices depend on the type of esophageal cancer you have, where it is in your esophagus, test results, and the stage of the cancer. The goal of treatment may be to cure you, control the cancer, or to help ease problems caused by cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be. Other things to think about are if the cancer can be removed with surgery, how your body will look and work after treatment, and your overall health.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy and targeted therapy are systemic treatments. You may have just one treatment or a combination of treatments. 

Esophageal cancer may be treated with:

• Surgery
• Radiation therapy
• Chemotherapy
• Targeted therapy
• Immunotherapy
• Endoscopic treatments, like laser therapy or cryotherapy

Talk with your healthcare providers about your treatment choices. Make a list of questions. Think about the benefits and possible side effects of each choice. Talk about your concerns with your healthcare provider before making a decision.

What are treatment side effects? 

Cancer treatments, like chemotherapy and radiation, can damage normal cells. This can cause side effects like hair loss, mouth sores, and vomiting.

Talk with your healthcare provider about side effects from your treatment. There are often ways to manage them. There may be things you can do and medicines you can take to help prevent or control many treatment side effects.

Coping with esophageal cancer 

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about problems and concerns you have. Work together to ease the effect of cancer and its symptoms on your daily life.

Here are tips:

• Talk with your family or friends.
• Ask your healthcare team or social worker for help.
• Speak with a counselor.
• Talk with a spiritual advisor, such as a minister or rabbi.
• Ask your healthcare team about medicines for depression or anxiety.
• Keep socially active.
• Join a cancer support group in person or online.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.
• Drink plenty of water, fruit juices, and other liquids.
• Keep physically active.
• Rest as much as needed.
• Talk with your healthcare team about ways to manage treatment side effects.
• Take your medicines as directed by your team.

When should I call my healthcare provider?

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

• New symptoms or symptoms that get worse
• Signs of an infection, such as a fever
• Side effects of treatment that affect your daily function or don’t get better with treatment

Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays.

Next steps 

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are and when they should be reported.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.