Cancer Institute A national cancer institute
designated cancer center

Information about Esophageal Cancer

What is esophageal cancer?

Esophageal cancer is cancer that develops in the esophagus, the muscular tube that connects the throat to the stomach. The esophagus, located just behind the trachea, is about 10 to 13 inches in length and allows food to enter the stomach for digestion. The wall of the esophagus is made up of several layers and cancers generally start from the inner layer and grow out.

The American Cancer Society (ACS) estimates that 13,900 Americans will be newly diagnosed with esophageal cancer during 2003. About 13,000 people will die from this disease each year. Other facts about esophageal cancer include the following:

What causes esophageal cancer?

No one knows exactly what causes esophageal cancer. At the top of the esophagus is a muscle, called the sphincter, that releases to let food or liquid go through. The lower part of the esophagus is connected to the stomach. Another muscle is located at this connection that opens to allow the food to enter the stomach. This muscle also works to keep food and juices from the stomach from backing into the esophagus. When these juices do back up, reflux, commonly known as heartburn, occurs.

Long-term reflux can change the cells in the lower end of the esophagus. This condition is known as Barrett's esophagus. If these cells are not treated, they are at much higher risk of developing into cancer cells.

What are the different types of esophageal cancer?

There are two main types of esophageal cancer. Squamous cell carcinoma, which accounts for about half of all esophageal cancers, grows in the cells that form the top layer of the lining of the esophagus, known as squamous cells. This type of cancer can grow anywhere along the esophagus.

The other type of esophageal cancer, known as adenocarcinoma, develops in the glandular tissue in the lower part of the esophagus, near the opening of the stomach.

Treatment for both types of esophageal cancer is similar.

What are the symptoms of esophageal cancer?

Often, an early stage of esophageal cancer has no symptoms. Symptoms do not appear until the disease is more advanced. The following are the most common symptoms of esophageal cancer. However, each individual may experience symptoms differently. Symptoms may include:

The symptoms of esophageal cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

There is no routine screening examination for esophageal cancer, however, persons with Barrett's esophagus should be examined often since they are at greater risk for developing the disease.

What is a Risk Factor?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.

Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors.

But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

What are the risk factors for esophageal cancer?

The following factors can put an individual at greater risk for developing esophageal cancer:

How is esophageal cancer diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for esophageal cancer may include the following:

  • chest x-ray - a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • upper GI (gastrointestinal) series (Also called barium swallow.) - a diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.
  • esophagogastroduodenoscopy (Also called EGD or upper endoscopy.) - a procedure that allows the physician to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the physician to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).
Illustration demonstrating upper endoscopy, part 1
click image to enlarge
Illustration demonstrating upper endoscopy, part 2
click image to enlarge
Illustration demonstrating upper endoscopy, part 3
click image to enlarge
  • computed tomography scan (CT or CAT scan) - diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • endoscopic ultrasound - this imaging technique uses sound waves to create a computer image of the inside of the esophagus and stomach. The endoscope is guided into the mouth and throat, then into the esophagus and the stomach. As in standard endoscopy, this allows the physician to view the inside of this area of the body, as well as insert instruments to remove a sample of tissue (biopsy).
  • thoracoscopy and laparoscopy - these methods allow the physician to examine the lymph nodes inside the chest or abdomen with a hollow, lighted tube, and remove these nodes for further testing.

What are the stages of esophageal cancer?

When esophageal cancer is diagnosed, tests will be performed to determine how much cancer is present, and if the cancer has spread from the colon to other parts of the body. This is called staging, and is an important step toward planning a treatment program. The National Cancer Institute defines the following stages for esophageal cancer:

Stage I The cancer is detected only in the top layers of cells lining the esophagus.
Stage II The cancer involves deeper layers of the lining of the esophagus or it has spread to nearby lymph nodes. However, the cancer has not spread to other parts of the body.
Stage III The cancer has spread into the wall of the esophagus or has spread to tissues or lymph nodes near the esophagus. However, it has not spread to other parts of the body.
Stage IV The cancer has spread to other parts of the body, such as the liver or lungs.

Treatment for esophageal cancer:

Specific treatment for esophageal cancer will be determined by your physician based on:

Different types of treatment may be used to control esophageal cancer and to reduce symptoms. Treatment may include:

Sometimes, several of these treatments may be combined for treating esophageal cancer.

Stanford Medicine Resources:

Footer Links: