Good Health Segment Esophageal Cancer

Esophageal cancer is the fastest growing cancer today. Each year approximately 13,500 Americans are diagnosed with esophageal cancer, which result in nearly 12,500 deaths. Most patients are diagnosed in their 50s or 60s, with approximately four times as many men diagnosed than women. Cancers of the esophagus tend to be more common in Caucasian males and it is thought that the majority develop from Barrett's esophagus.

What is the esophagus?

The esophagus is a muscular tube that connects the mouth to the stomach. The wall of the esophagus is composed of a series of muscles that are responsible for peristalsis, or the muscular motion that eases the delivery of food into the stomach. The esophagus is lined with two layers of tissue known as the mucosa and submucosa, which are where most cancers of the esophagus develop.

What is esophageal cancer?

Esophageal cancer occurs when cells in the lining of the esophagus grow uncontrollably and form tumors that can invade normal tissues and spread to other parts of the body.

Am I at risk for esophageal cancer?

Esophageal cancer occurs in approximately 13,500 Americans per year, causing about 12,500 deaths. Most patients are diagnosed in their 50s or 60s, with approximately four times as many men diagnosed than women. Cancers of the esophagus tend to be more common in Caucasian males and it is thought that the majority develop from Barrett's esophagus.

How can I prevent esophageal cancer?

There is not a clear link between family history of esophageal cancer and an individual’s risk of developing esophageal cancer. Smoking is by far the strongest risk factor associated with the development of squamous cell cancer of the esophagus, with alcohol likely playing a supporting role. Obesity may also increase the risk of developing esophageal cancer, so maintaining a healthy diet, getting regular exercise, decreasing caffeine and alcohol intake, along with smoking cessation are the best methods of decreasing your risk.

What is Barrett's Esophagus?

Barrett’s esophagus is a condition in which the muscular tube that carries food and saliva from the mouth to the stomach changes so that some of its lining is replaced by a type of tissue similar to what is normally found in the intestines. This process is called intestinal metaplasia. Barrett's esophagus is estimated to affect about 700,000 adults in the United States.

The exact cause or causes of Barrett's esophagus are not known. However, there are factors that can increase the chances for developing it. The most common is GERD. GERD is a condition where the lining of the esophagus becomes damaged as a result of stomach acid "refluxing" back into the esophagus. Other risk factors include obesity, age, and gender.

What are the major symptoms of Esophageal Cancer?

Over 90% of people with esophageal cancer present with problems swallowing, often leading to a significant amount of weight loss prior to the actual diagnosis. Equal often complain of a sensation that food "gets stuck" somewhere in the chest, where the growing of the cancer precludes the passage of food. Problems usually start with food, though eventually even liquids could "get stuck" if the cancer progresses and continues to grow into the hollow tube that the esophagus is.

How is esophageal cancer diagnosed and staged?

Diagnosis

The first step is to establish the diagnosis of esophageal cancer. Initial tests sometimes include a barium swallow, where the patient swallows barium to permit visualization of the contours of the esophagus on x-rays. Generally, the esophagus is smooth, and if there is a defect in the smooth contour of the esophagus, this may suggest a cancer.

An endoscopy is commonly done when people first present with symptoms. Using endoscopy, the area of concern can be viewed directly with a fiber-optic camera where the obstruction can be seen. Endoscopy also allows a biopsy to be performed. Once a biopsy is performed, the pathologist will determine if there is esophageal cancer, and whether it is adenocarcinoma or squamous cell carcinoma.

The highest standard of care also includes performing an ultrasound during the endoscopy, called an endoscopic ultrasound examination (EUS). This allows for the prediction of how much of the esophageal wall is involved by tumor with over 90% accuracy and the presence of any lymph nodes that may be involved.

Other, more routine tests done before treatment may include a blood screening, to insure that overall blood counts are within normal limits, and that a patient's liver, kidneys, and overall health are normal.

Staging

Staging describes how much cancer has grown within the esophagus as well as whether it has spread. Staging systems used in esophageal cancer are designed to describe the extent of disease within the esophagus, in the surrounding lymph nodes, and distantly. Though complicated, staging systems help determine the extent of the cancer.

What are treatments for esophageal cancer?

The preferred treatment is dependent on two main factors: the extent of the cancer and the general health state of the person. For patients who have very early stage disease where it has not spread to lymph nodes or deep into the esophagus, surgery alone may be appropriate.

For patients with more advanced stage disease there are a number of different ways to treat esophageal cancer including surgery, radiation, and chemotherapy. However, in people who can tolerate it, combined modality treatment with surgery, radiation and chemotherapy is often preferred.