Esophageal Cancer

Esophageal cancer forms in tissues lining the esophagus (the muscular tube through which food passes from the throat to the stomach). Two types are:

Squamous cell carcinoma — cancer that begins in flat cells lining the esophagus
Adenocarcinoma — cancer that begins in cells that make and release mucus and other fluids

The UC Davis esophageal cancer program utilizes a full team of professionals and revolutionary techniques to treat patients and relieve them of their symptoms.

cell If you have a symptom that suggests esophageal cancer, your doctor must find out whether it's due to cancer or to some other cause. The doctor gives you a physical exam and asks about your personal and family health history. You may have blood tests. You also may have:

Barium swallow: After you drink a barium solution, you have x-rays taken of your esophagus and stomach. The barium solution makes your esophagus show up more clearly on the x-rays. This test is also called an upper GI series.

Endoscopy: The doctor uses a thin, lighted tube (endoscope) to look down your esophagus. The doctor first numbs your throat with an anesthetic spray, and you may also receive medicine to help you relax. The tube is passed through your mouth or nose to the esophagus. The doctor may also call this procedure upper endoscopy, EGD, or esophagoscopy.

Biopsy: Usually, cancer begins in the inner layer of the esophagus. The doctor uses an endoscope to remove tissue from the esophagus. A pathologist checks the tissue under a microscope for cancer cells. A biopsy is the only sure way to know if cancer cells are present.

Echoendoscope and CT scan: If biopsy results show cancer, an echoendoscope is used to evaluate the stage of the disease locally. During the procedure, a small flexible scope with an ultrasound device is inserted into the upper or lower digestive tract to obtain high-quality ultrasound images of organs using sound waves. The pictures help determine the degree of invasion into the wall of the GI tract, into adjacent organs as well as to see if the tumor has spread to local lymph nodes. A CT scan is ordered, either before or after the echoendoscope, to determine if the cancer has spread to distant sites of the body (metastasized).

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center

Early esophageal cancer may not cause symptoms. As the cancer grows, the most common symptoms are:

Food gets stuck in the esophagus, and food may come back up
Pain when swallowing
Pain in the chest or back
Weight loss
Heartburn
A hoarse voice or cough that doesn't go away within 2 weeks

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center

Risk factors for squamous cell carcinoma of the esophagus include:

tobacco use
alcoholism
malnutrition
infection with human papillomavirus

Risk factors associated with esophageal adenocarcinoma are less defined, although adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids) is strongly associated with gastroesophageal reflux disease (GERD). Long-standing GERD predisposes to Barrett esophagus, the condition in which the color and composition of the cells lining the lower esophagus change. Obesity also is a key risk factor for esophageal adenocarcinoma.

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center

Primary treatment modalities include surgery alone, combined modality therapy (i.e., chemotherapy plus surgery, or chemotherapy and radiation therapy plus surgery) or in some cases chemotherapy with radiation therapy alone.

UC Davis specialists offer a variety of endoscopic techniques for the treatment of pre-cancerous abnormalities, as well as early-stage cancers and the relief of symptoms of esophageal cancers.

Recent advances in endoscopic treatments have been shown to be effective and safe. Endoscopic mucosal resection (EMR) is currently used to remove small, stage 1 tumors, in which the cancer is limited to the mucosal lining, and combined with other endoscopic procedures, it is becoming the recommended treatment of choice for early stage esophageal cancers.

More about surgical interventions for esophageal cancer

Sources: National Cancer Institute and UC Davis Comprehensive Cancer Center