Esophageal Cancer

• Painful or difficulty swallowing (dysphagia)
• Weight loss
• Pain behind the breastbone
• Hoarseness, cough and recurrent pneumonias
• Indigestion and heartburn (regurgitation or reflux)

• Smoking and alcohol use put you at risk of squamous cell carcinoma.
• Gastric reflux can increase the risk of adenocarcinoma, especially when it lasts a long time, and severe symptoms occur daily.
• Barrett’s Esophagus - A condition in which the cells lining the lower esophagus have changed to abnormal cells. Gastric reflux (heartburn) is the most common cause of Barrett’s esophagus.
• Other factors: Men are three times more likely than women to develop esophageal cancer, and white men are more at risk than Black men in all age groups. Chances increase with age.

• Physical exam and health history
• Barium swallow study- During this study, the patient drinks a liquid containing barium and undergoes a series of X-rays. The barium makes it easier to see any changes to the tissue of the esophagus.
• Esophagogastroduodenoscopy (EGD)- A thin flexible tube called an endoscope is inserted to look at the inside of the esophagus.
• Biopsy- A sample of tissue is collected to look for suspicious cells. The cells are viewed under a microscope by a pathologist.

• Avoid smoking and alcohol use
• Weight loss (maintaining a healthy weight), which also helps reduce reflux
• Eat a nutritionally sound diet including fiber, fruits and vegetables
• Treat reflux (GERD)

• Chemoprevention uses drugs, vitamins or other agents to reduce the risk of cancer. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and other drugs can reduce swelling and pain.
• Radiofrequency ablation can be used to treat patients with Barrett’s esophagus — a premalignant condition. Radio waves are employed to heat and destroy any abnormal cells that may become cancer.
• Endoscopic (through an esophageal scope) resection is also a treatment for Barrett’s esophagus

After a diagnosis, tests are performed to detect if cancer cells have spread within the esophagus or to other parts of the body. Cancer can spread through nearby tissue, through vessels in the lymph system to other parts of the body or via blood vessels. The stages of esophageal cancer are categorized from Stage 0 to Stage IV, with Stage IV indicating the cancer has spread to other parts of the body. Esophageal cancer can return, known as recurrence, even after it has been treated.

• Surgery is the most common treatment type. Part of the esophagus may be removed in an operation called an esophagectomy.
• Endoscopic resection removes the abnormal tissue and assesses the depth of tumor invasion. If the esophageal cancer is early stage without deep penetration or if the area is premalignant, surgery may not be needed, and surveillance may be all that’s required.
• Radiation therapy using high-energy X-rays and other types of radiation to kill or stop the growth of cancer cells.
• Chemotherapy using drugs to stop the growth of cancer cells.
• Chemoradiation therapy combines chemotherapy and radiation therapy to increase the effects of both.
• Laser therapy uses a laser beam to kill cancer cells.
• Electrocoagulation uses an electric current to kill cancer cells.
• Immunotherapy uses substances made naturally in the body or in a laboratory setting to boost the body’s natural defenses against cancer.
• Palliative: If advanced stage, the goals may shift toward patient comfort, including any of the above as well as endoscopic dilations of stent placement, feeding tube placement and control of pain.

Many patients have trouble eating because it is difficult to swallow- either the esophagus has narrowed because of a tumor or difficulty emerges as a side effect of treatment. In these cases, nutrients may be administered directly into a vein, or patients may require a feeding tube until they are comfortable eating on their own. Our Lady of the Lake Cancer Institute has registered dieticians available to assist patients having difficulty with nutrition.