- The Esophagus
- Understanding the Cancer Process
- Risk Factors
- Recognizing Symptoms
- Diagnosing Esophageal Cancer
- Staging the Disease
- Orthodox Treatment
- Side Effects of Orthodox Treatment
The esophagus is a hollow tube that carries food and liquids
from the throat to the stomach. When a person swallows, the
muscular walls of the esophagus contract to push food down
into the stomach. Glands in the lining of the esophagus produce
mucus, which keeps the passageway moist and makes swallowing
easier. The esophagus is located just behind the trachea (windpipe).
In an adult, the esophagus is about 10 inches long.
Understanding the Cancer Process
Cancer is a disease that affects cells, the body's basic
unit of life. To understand any type of cancer, it is helpful
to know about normal cells and what happens when they become
The body is made up of many types of cells. Normally, cells
grow, divide, and produce more cells when they are needed.
This process keeps the body healthy and functioning properly.
Sometimes, however, cells keep dividing when new cells are
not needed. The mass of extra cells forms a growth or tumor.
Tumors can be benign or malignant.
Cancer that begins in the esophagus (also called esophageal
cancer) is divided into two major types, squamous cell carcinoma
and adenocarcinoma, depending on the type of cells that are
malignant. Squamous cell carcinomas arise in squamous cells
that line the esophagus. These cancers usually occur in the
upper and middle part of the esophagus. Adenocarcinomas usually
develop in the glandular tissue in the lower part of the esophagus.
The treatment is similar for both types of esophageal cancer.
- Benign tumors are not cancer. They usually can be removed
and, in most cases, they do not come back. Cells in benign
tumors do not spread to other parts of the body. Most important,
benign tumors are rarely a threat to life.
- Malignant tumors are cancer. Cells in malignant tumors
are abnormal and divide without control or order. These
cancer cells can invade and destroy the tissue around them.
Cancer cells can also break away from a malignant tumor
and enter the bloodstream or lymphatic system (the tissues
and organs that produce, store, and carry white blood cells
that fight infection and other diseases). This process,
called metastasis, is how cancer spreads from the original
(primary) tumor to form new (secondary) tumors in other
parts of the body.
If the cancer spreads outside the esophagus, it often goes
to the lymph nodes first. (Lymph nodes are small, bean-shaped
structures that are part of the body's immune system.) Esophageal
cancer can also spread to almost any other part of the body,
including the liver, lungs, brain, and bones.
The exact causes of cancer of the esophagus are not known.
However, studies show that any of the following factors can
increase the risk of developing esophageal cancer:
Having any of these risk factors increases the likelihood
that a person will develop esophageal cancer. Still, most
people with one or even several of these factors do not get
the disease. And most people who do get esophageal cancer
have none of the known risk factors.
- Age. Esophageal cancer is more likely to occur as people
get older; most people who develop esophageal cancer are
over age 60.
- Sex. Cancer of the esophagus is more common in men than
- Tobacco Use. Smoking cigarettes or using smokeless tobacco
is one of the major risk factors for esophageal cancer.
- Alcohol Use. Chronic and/or heavy use of alcohol is another
major risk factor for esophageal cancer. People who use
both alcohol and tobacco have an especially high risk of
esophageal cancer. Scientists believe that these substances
increase each other's harmful effects.
- Barrett's Esophagus. Long-term irritation can increase
the risk of esophageal cancer. Tissues at the bottom of
the esophagus can become irritated if stomach acid frequently
"backs up" into the esophagus's problem called
gastric reflux. Over time, cells in the irritated part of
the esophagus may change and begin to resemble the cells
that line the stomach. This condition, known as Barrett's
esophagus, is a premalignant condition that may develop
into adenocarcinoma of the esophagus.
- Other Types of Irritation. Other causes of significant
irritation or damage to the lining of the esophagus, such
as swallowing lye or other caustic substances, can increase
the risk of developing esophageal cancer.
- Medical History. Patients who have had other head and
neck cancers have an increased chance of developing a second
cancer in the head and neck area, including esophageal cancer.
Identifying factors that increase a person's chances of developing
esophageal cancer is the first step toward preventing the
disease. We already know that the best ways to prevent this
type of cancer are to quit (or never start) smoking cigarettes
or using smokeless tobacco and to drink alcohol only in moderation.
Researchers continue to study the causes of esophageal cancer
and to search for other ways to prevent it. For example, they
are exploring the possibility that increasing one intake of
fruits and vegetables, especially raw ones, may reduce the
risk of this disease.
Researchers are also studying ways to reduce the risk of esophageal
cancer for people with Barrett's esophagus.
Early esophageal cancer usually does not cause symptoms.
However, as the cancer grows, symptoms may include:
These symptoms may be caused by esophageal cancer or by other
conditions. It is important to check with a doctor.
- Difficult or painful swallowing
- Severe weight loss
- Pain in the throat or back, behind the breastbone or between
the shoulder blades
- Hoarseness or chronic cough
- Coughing up blood
Diagnosing Esophageal Cancer
To help find the cause of symptoms, the doctor evaluates
a person's medical history and performs a physical exam. The
doctor usually orders a chest x-ray and other diagnostic tests.
These tests may include the following:
- A barium swallow (also called an esophagram) is a series
of x-rays of the esophagus. The patient drinks a liquid
containing barium, which coats the inside of the esophagus.
The barium makes any changes in the shape of the esophagus
show up on the x-rays.
- Esophagoscopy (also called endoscopy) is an examination
of the inside of the esophagus using a thin lighted tube
called an endoscope. An anesthetic (substance that causes
loss of feeling or awareness) is usually used during this
procedure. If an abnormal area is found, the doctor can
collect cells and tissue through the endoscope for examination
under a microscope. This is called a biopsy. A biopsy can
show cancer, tissue changes that may lead to cancer, or