Esophageal cancer facts*
*Esophageal cancer facts medically edited by: Charles P. Davis, MD, PhD
What is the esophagus?
The esophagus is a muscular tube in the chest. It's about 10 inches (25 centimeters) long.
This organ is part of the digestive tract. Food moves from the mouth through the esophagus to the stomach.
The wall of the esophagus has several layers:
Cancer Cells
Cancer begins in cells, the building blocks that make up all tissues and organs of the body, including the esophagus.
Normal cells in the esophagus and other parts of the body grow and divide to form new cells as they are needed. When normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
A tumor in the esophagus can be benign (not cancer) or malignant (cancer):
Esophageal cancer cells can spread by breaking away from an esophageal tumor. They can travel through blood vessels or lymph vessels to reach other parts of the body. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.
When esophageal cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if esophageal cancer spreads to the liver, the cancer cells in the liver are actually esophageal cancer cells. The disease is metastatic esophageal cancer, not liver cancer. For that reason, it is treated as cancer of the esophagus, not liver cancer.
Types of Esophageal Cancer
In 2013, about 18,000 Americans will be diagnosed with esophageal cancer.
The two most common types are named for how the cancer cells look under a microscope:
If you smoke, talk with an expert about quitting. It's never too late to quit. Quitting can help cancer treatments work better. It may also reduce the chance of getting another cancer.
To get help with quitting smoking...
Tests
After you learn that you have cancer of the esophagus, you may need other tests to help with making decisions about treatment.
Tumor Grade TestThe tumor tissue that was removed during your biopsy procedure can be used in lab tests. The pathologist studies tissue samples under a microscope to learn the grade of the tumor. The grade tells how different the tumor tissue is from normal esophagus tissue.
Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with other factors to suggest treatment options.
Staging Tests
Staging tests can show the stage (extent) of esophageal cancer, such as whether cancer cells have spread to other parts of the body.
When cancer of the esophagus spreads, cancer cells are often found in nearby lymph nodes. Esophageal cancer cells can spread from the esophagus to almost any other part of the body, such as the liver, lungs, or bones.
Staging tests may include...
Stages
Doctors describe the stages of esophageal cancer using the Roman numerals I, II, III, and IV. Stage I is early-stage cancer, and Stage IV is advanced cancer that has spread to other parts of the body, such as the liver.
The stage of cancer of the esophagus depends mainly on...
Stages I and II of Adenocarcinoma of the Esophagus
Stage IACancer has grown through the inner layer and invades the wall of the esophagus. The grade is 1 or 2.
Stage IBCancer has invaded the wall of the esophagus and is grade 3. Or, cancer has invaded more deeply into the muscle layer of the esophagus, and the grade is 1 or 2.
Stage IIACancer has invaded the muscle layer of the esophagus, and the grade is 3.
Stage IIBCancer has invaded the outer layer of the esophagus. Or, cancer has not invaded the outer layer, but cancer cells are also found in one or two nearby lymph nodes.
Stages I and II of Squamous Cell Cancer of the Esophagus
Stage IACancer has grown through the inner layer and invaded the wall of the esophagus. The grade is 1.
Stage IBCancer has invaded the wall of the esophagus and is grade 2 or 3. Or, cancer is found in the lower part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 1.
Stage IIACancer is found in the upper or middle part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 1. Or, cancer is found in the lower part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 2 or 3.
Stage IIBCancer is found in the upper or middle part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 2 or 3. Or, cancer has not invaded the outer layer, and cancer cells are found in one or two nearby lymph nodes.
Stages III and IV of Esophageal Cancer (Both Types)
Stage IIIAStage IIIA is one of the following:
Cancer has invaded the outer layer of the esophagus, and cancer cells are found in 3 to 6 nearby lymph nodes.
Stage IIICStage IIIC is one of the following:
The esophageal cancer has spread to other parts of the body, such as the liver, lungs, or bones.
Treatment
People with cancer of the esophagus have many treatment options. Treatment options include...
The treatment that's right for you depends mainly on the type and stage of esophageal cancer. You'll probably receive more than one type of treatment. For example, radiation therapy and chemotherapy may be given before or after surgery.
At any stage of esophageal cancer, care is available to manage health problems caused by the disease or side effects from its treatment. You can get information about coping with symptoms and side effects on NCI's website at http://www.cancer.gov/cancertopics/coping.
Also, you can get information about coping from NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). Or, chat using NCI's instant messaging service, LiveHelp (https://livehelp.cancer.gov).
Doctors Who Treat Esophageal Cancer
Your health care team may include the following specialists:
You may want to find doctors who have a lot of experience with treating esophageal cancer.
Resources are available to help you find doctors who treat this disease:
Your health care team may also include an oncology nurse, a social worker, and a registered dietitian. If your airways are affected by the cancer, you may have a respiratory therapist as part of your team. If you have trouble swallowing, you may have a speech pathologist.
For help relieving or reducing pain, you may work with a specially trained doctor, a nurse, a palliative care team, or another pain control specialist.
Your health care team can describe your treatment options, the expected results of each option, and the possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type of treatment. Side effects may not be the same for everyone, and they may even change from one treatment session to the next.
Cancer of the esophagus is hard to control with current treatments. For that reason, many doctors encourage people with this disease to consider taking part in a research study (clinical trial) of new treatment methods. Research studies are an important option for people with any stage of esophageal cancer.
Questions you may want to ask your doctor about treatment options
Second Opinion
Before starting treatment, you might want a second opinion about your diagnosis and your treatment options. You may even want to talk to several different doctors about all of the treatment options, their side effects, and the expected results.
Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some insurance companies actually require a second opinion.
If you get a second opinion, the second doctor may agree with your first doctor's diagnosis and treatment recommendation. Or, the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at all of your options.
It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some people with cancer of the esophagus need treatment right away.
Surgery
Surgery may be an option for people with early-stage cancer of the esophagus. Usually, the surgeon removes the section of the esophagus with the cancer, a small amount of normal tissue around the cancer, and nearby lymph nodes. Sometimes, part or all of the stomach is also removed.
If only a very small part of the stomach is removed, the surgeon usually reshapes the remaining part of the stomach into a tube and joins the stomach tube to the remaining part of the esophagus in the neck or chest. Or, a piece of large intestine or small intestine may be used to connect the stomach to the remaining part of the esophagus.
If the entire stomach needs to be removed, the surgeon will use a piece of intestine to join the remaining part of the esophagus to the small intestine.
During surgery, the surgeon may place a feeding tube into your small intestine. This tube helps you get enough nutrition while you heal.
You may have pain from the surgery. However, your health care team will give you medicine to help control the pain. Before surgery, you may want to discuss the plan for pain relief with your health care team. After surgery, they can adjust the plan if you need more pain relief.
Your health care team will watch for pneumonia or other infections, breathing problems, bleeding, food leaking into the chest, or other problems that may require treatment. The time it takes to heal after surgery is different for everyone. Your hospital stay may be a week or longer, and your recovery will continue after you leave the hospital.
Questions you may want to ask your doctor about surgery
Radiation Therapy
Radiation therapy is an option for people with any stage of esophageal cancer. The treatment affects cells only in the area being treated, such as the throat and chest area.
Radiation therapy may be given before, after, or instead of surgery. Chemotherapy is usually given along with radiation therapy.
Radiation therapy for esophageal cancer may be given to...
Doctors use two types of radiation therapy to treat esophageal cancer. Some people receive both types:
The side effects of radiation therapy depend mainly on the type of radiation therapy, how much radiation is given, and the part of your body that is treated.
External radiation therapy aimed at the chest may cause a sore throat, cough, or shortness of breath. You may feel a lump in your throat or burning in your chest or throat when you swallow. After several weeks of treatment, it may be painful to swallow. Your health care team can suggest ways to manage these problems. The problems usually go away when treatment ends.
External radiation therapy can harm the skin. It's common for the skin in the chest area to become red and dry and to get darker. Sometimes the skin may feel tender or itchy. Check with your doctor before using lotion or cream on your chest. After treatment is over, the skin will heal.
You're likely to become tired during external radiation therapy, especially in the later weeks of treatment. Although getting enough rest is important, most people say they feel better when they exercise every day. Try to go for a short walk, do gentle stretches, or do yoga.
Years after either type of radiation therapy, the esophagus may become narrow. If this happens, it may feel like food is getting stuck in your chest. Usually, a gastroenterologist can treat this problem.
Questions you may want to ask your doctor about radiation therapy
Chemotherapy
Most people with esophageal cancer get chemotherapy. It may be used alone or with radiation therapy.
Chemotherapy uses drugs to kill cancer cells. The drugs for cancer of the esophagus are usually given directly into a vein (intravenously) through a thin needle.
You'll probably receive chemotherapy in a clinic or at the doctor's office. People rarely need to stay in the hospital during treatment.
The side effects depend mainly on the drugs given and amount of chemotherapy that you get. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:
Other possible side effects include a skin rash, joint pain, tingling or numbness in your hands and feet, hearing problems, or swollen feet or legs.
When radiation therapy and chemotherapy are given at the same time, the side effects may be worse.
Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.
Targeted Therapy
People with esophageal cancer that has spread may receive a type of treatment called targeted therapy. This treatment can block the growth and spread of esophageal cancer cells.
Targeted therapy for cancer of the esophagus is usually given intravenously. The treatment enters the bloodstream and can affect cancer cells all over the body.
During treatment, your health care team will watch you for side effects. You may get diarrhea, belly pain, heartburn, joint pain, tingling arms and legs, or heart problems. Most side effects usually go away after treatment ends.
Questions you may want to ask your doctor about chemotherapy or targeted therapy
What is the esophagus?
The esophagus is a muscular tube in the chest. It's about 10 inches (25 centimeters) long.
This organ is part of the digestive tract. Food moves from the mouth through the esophagus to the stomach.
The wall of the esophagus has several layers:
Cancer Cells
Cancer begins in cells, the building blocks that make up all tissues and organs of the body, including the esophagus.
Normal cells in the esophagus and other parts of the body grow and divide to form new cells as they are needed. When normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
A tumor in the esophagus can be benign (not cancer) or malignant (cancer):
Esophageal cancer cells can spread by breaking away from an esophageal tumor. They can travel through blood vessels or lymph vessels to reach other parts of the body. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.
When esophageal cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if esophageal cancer spreads to the liver, the cancer cells in the liver are actually esophageal cancer cells. The disease is metastatic esophageal cancer, not liver cancer. For that reason, it is treated as cancer of the esophagus, not liver cancer.
Types of Esophageal Cancer
In 2013, about 18,000 Americans will be diagnosed with esophageal cancer.
The two most common types are named for how the cancer cells look under a microscope:
If you smoke, talk with an expert about quitting. It's never too late to quit. Quitting can help cancer treatments work better. It may also reduce the chance of getting another cancer.
To get help with quitting smoking...
Tests
After you learn that you have cancer of the esophagus, you may need other tests to help with making decisions about treatment.
Tumor Grade TestThe tumor tissue that was removed during your biopsy procedure can be used in lab tests. The pathologist studies tissue samples under a microscope to learn the grade of the tumor. The grade tells how different the tumor tissue is from normal esophagus tissue.
Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with other factors to suggest treatment options.
Staging Tests
Staging tests can show the stage (extent) of esophageal cancer, such as whether cancer cells have spread to other parts of the body.
When cancer of the esophagus spreads, cancer cells are often found in nearby lymph nodes. Esophageal cancer cells can spread from the esophagus to almost any other part of the body, such as the liver, lungs, or bones.
Staging tests may include...
Stages
Doctors describe the stages of esophageal cancer using the Roman numerals I, II, III, and IV. Stage I is early-stage cancer, and Stage IV is advanced cancer that has spread to other parts of the body, such as the liver.
The stage of cancer of the esophagus depends mainly on...
Stages I and II of Adenocarcinoma of the Esophagus
Stage IACancer has grown through the inner layer and invades the wall of the esophagus. The grade is 1 or 2.
Stage IBCancer has invaded the wall of the esophagus and is grade 3. Or, cancer has invaded more deeply into the muscle layer of the esophagus, and the grade is 1 or 2.
Stage IIACancer has invaded the muscle layer of the esophagus, and the grade is 3.
Stage IIBCancer has invaded the outer layer of the esophagus. Or, cancer has not invaded the outer layer, but cancer cells are also found in one or two nearby lymph nodes.
Stages I and II of Squamous Cell Cancer of the Esophagus
Stage IACancer has grown through the inner layer and invaded the wall of the esophagus. The grade is 1.
Stage IBCancer has invaded the wall of the esophagus and is grade 2 or 3. Or, cancer is found in the lower part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 1.
Stage IIACancer is found in the upper or middle part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 1. Or, cancer is found in the lower part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 2 or 3.
Stage IIBCancer is found in the upper or middle part of the esophagus, it has invaded the muscle layer or outer layer of the esophagus, and the grade is 2 or 3. Or, cancer has not invaded the outer layer, and cancer cells are found in one or two nearby lymph nodes.
Stages III and IV of Esophageal Cancer (Both Types)
Stage IIIAStage IIIA is one of the following:
Cancer has invaded the outer layer of the esophagus, and cancer cells are found in 3 to 6 nearby lymph nodes.
Stage IIICStage IIIC is one of the following:
The esophageal cancer has spread to other parts of the body, such as the liver, lungs, or bones.
Treatment
People with cancer of the esophagus have many treatment options. Treatment options include...
The treatment that's right for you depends mainly on the type and stage of esophageal cancer. You'll probably receive more than one type of treatment. For example, radiation therapy and chemotherapy may be given before or after surgery.
At any stage of esophageal cancer, care is available to manage health problems caused by the disease or side effects from its treatment. You can get information about coping with symptoms and side effects on NCI's website at http://www.cancer.gov/cancertopics/coping.
Also, you can get information about coping from NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). Or, chat using NCI's instant messaging service, LiveHelp (https://livehelp.cancer.gov).
Doctors Who Treat Esophageal Cancer
Your health care team may include the following specialists:
You may want to find doctors who have a lot of experience with treating esophageal cancer.
Resources are available to help you find doctors who treat this disease:
Your health care team may also include an oncology nurse, a social worker, and a registered dietitian. If your airways are affected by the cancer, you may have a respiratory therapist as part of your team. If you have trouble swallowing, you may have a speech pathologist.
For help relieving or reducing pain, you may work with a specially trained doctor, a nurse, a palliative care team, or another pain control specialist.
Your health care team can describe your treatment options, the expected results of each option, and the possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type of treatment. Side effects may not be the same for everyone, and they may even change from one treatment session to the next.
Cancer of the esophagus is hard to control with current treatments. For that reason, many doctors encourage people with this disease to consider taking part in a research study (clinical trial) of new treatment methods. Research studies are an important option for people with any stage of esophageal cancer.
Questions you may want to ask your doctor about treatment options
Second Opinion
Before starting treatment, you might want a second opinion about your diagnosis and your treatment options. You may even want to talk to several different doctors about all of the treatment options, their side effects, and the expected results.
Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some insurance companies actually require a second opinion.
If you get a second opinion, the second doctor may agree with your first doctor's diagnosis and treatment recommendation. Or, the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at all of your options.
It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some people with cancer of the esophagus need treatment right away.
Surgery
Surgery may be an option for people with early-stage cancer of the esophagus. Usually, the surgeon removes the section of the esophagus with the cancer, a small amount of normal tissue around the cancer, and nearby lymph nodes. Sometimes, part or all of the stomach is also removed.
If only a very small part of the stomach is removed, the surgeon usually reshapes the remaining part of the stomach into a tube and joins the stomach tube to the remaining part of the esophagus in the neck or chest. Or, a piece of large intestine or small intestine may be used to connect the stomach to the remaining part of the esophagus.
If the entire stomach needs to be removed, the surgeon will use a piece of intestine to join the remaining part of the esophagus to the small intestine.
During surgery, the surgeon may place a feeding tube into your small intestine. This tube helps you get enough nutrition while you heal.
You may have pain from the surgery. However, your health care team will give you medicine to help control the pain. Before surgery, you may want to discuss the plan for pain relief with your health care team. After surgery, they can adjust the plan if you need more pain relief.
Your health care team will watch for pneumonia or other infections, breathing problems, bleeding, food leaking into the chest, or other problems that may require treatment. The time it takes to heal after surgery is different for everyone. Your hospital stay may be a week or longer, and your recovery will continue after you leave the hospital.
Questions you may want to ask your doctor about surgery
Radiation Therapy
Radiation therapy is an option for people with any stage of esophageal cancer. The treatment affects cells only in the area being treated, such as the throat and chest area.
Radiation therapy may be given before, after, or instead of surgery. Chemotherapy is usually given along with radiation therapy.
Radiation therapy for esophageal cancer may be given to...
Doctors use two types of radiation therapy to treat esophageal cancer. Some people receive both types:
The side effects of radiation therapy depend mainly on the type of radiation therapy, how much radiation is given, and the part of your body that is treated.
External radiation therapy aimed at the chest may cause a sore throat, cough, or shortness of breath. You may feel a lump in your throat or burning in your chest or throat when you swallow. After several weeks of treatment, it may be painful to swallow. Your health care team can suggest ways to manage these problems. The problems usually go away when treatment ends.
External radiation therapy can harm the skin. It's common for the skin in the chest area to become red and dry and to get darker. Sometimes the skin may feel tender or itchy. Check with your doctor before using lotion or cream on your chest. After treatment is over, the skin will heal.
You're likely to become tired during external radiation therapy, especially in the later weeks of treatment. Although getting enough rest is important, most people say they feel better when they exercise every day. Try to go for a short walk, do gentle stretches, or do yoga.
Years after either type of radiation therapy, the esophagus may become narrow. If this happens, it may feel like food is getting stuck in your chest. Usually, a gastroenterologist can treat this problem.
Questions you may want to ask your doctor about radiation therapy
Chemotherapy
Most people with esophageal cancer get chemotherapy. It may be used alone or with radiation therapy.
Chemotherapy uses drugs to kill cancer cells. The drugs for cancer of the esophagus are usually given directly into a vein (intravenously) through a thin needle.
You'll probably receive chemotherapy in a clinic or at the doctor's office. People rarely need to stay in the hospital during treatment.
The side effects depend mainly on the drugs given and amount of chemotherapy that you get. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:
Other possible side effects include a skin rash, joint pain, tingling or numbness in your hands and feet, hearing problems, or swollen feet or legs.
When radiation therapy and chemotherapy are given at the same time, the side effects may be worse.
Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.
Targeted Therapy
People with esophageal cancer that has spread may receive a type of treatment called targeted therapy. This treatment can block the growth and spread of esophageal cancer cells.
Targeted therapy for cancer of the esophagus is usually given intravenously. The treatment enters the bloodstream and can affect cancer cells all over the body.
During treatment, your health care team will watch you for side effects. You may get diarrhea, belly pain, heartburn, joint pain, tingling arms and legs, or heart problems. Most side effects usually go away after treatment ends.
Questions you may want to ask your doctor about chemotherapy or targeted therapy
Source: http://www.rxlist.com
The two most common types are named for how the cancer cells look under a microscope:
If you smoke, talk with an expert about quitting. It's never too late to quit. Quitting can help cancer treatments work better. It may also reduce the chance of getting another cancer.
To get help with quitting smoking...
Source: http://www.rxlist.com
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