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Esophageal Cancer

By Ashlyn Seeley Everett, M.D., radiation oncologist at Alliance Cancer Care

Esophageal cancer is relatively rare, making up about 1% of cases of cancer in the United States.  There are about 19,000 new cases diagnosed every year.  However, esophageal cancer also accounts for 15,000 deaths annually, with relatively poor survival rates at five years.  Esophageal cancer is more prevalent in men than women, with a lifetime risk of about 1 in 125 for men and 1 in 417 for women.  You can read more about esophageal cancer here.

What is esophageal cancer?

The esophagus is the muscular tube that passes food from the mouth to the stomach.  It often starts in the inner lining of the esophagus and spreads through the wall of the esophagus. There are two types of cancers of the esophagus, adenocarcinoma and squamous cell carcinoma.  Adenocarcinomas of the esophagus are often associated with obesity and Barrett’s esophagus, a condition of the lining of the esophagus being damaged by acid reflux.  This causes abnormal transformation of the cells in the lower esophagus to better tolerate the harsh acid, but also puts patients at higher risk of cancer.  Esophageal adenocarcinoma is typically found in the lower esophagus near the stomach, also called the gastro-esophageal junction or GE junction.  Squamous cell carcinoma in the esophagus is associated with heavy alcohol use and tobacco smoking.  These chemicals are known to cause damage to cells in the body, and increase the risk of esophageal cancer, also.

What are the symptoms of esophageal cancer?

Esophageal cancer may cause symptoms of difficulty swallowing, food getting stuck, hoarseness, weight loss, low appetite, or feeling full before completing a meal.

What testing is done to diagnose esophageal cancer?

If esophageal cancer is suspected, your doctor will likely refer you to a gastroenterologist, a doctor who would perform an esophago-gastro-duodenoscopy (EGD).  This is a test done under anesthesia, where a camera is inserted through the mouth and passed into the esophagus and stomach to look for abnormalities.  If a cancer is suspected, a biopsy, or sample of the abnormal area, is obtained for testing. If the biopsy confirms cancer, it will also specify which type. Then, your doctor may order additional testing.  Typically a CT and/or PET-CT is obtained for the evaluation of the cancer, and if it has spread to any lymph nodes or other parts of the body. This will allow your doctor to determine the stage of the esophageal cancer and then recommend treatment.

What are treatment options for esophageal cancer?

Treatment for esophageal cancer typically involves tri-modality therapy, including surgery, radiation therapy, and chemotherapy.  Some very early cancers may be treated with surgery alone.  Most tumors are treated upfront with a combination of radiation and chemotherapy, followed by surgery.  If there is an active tumor found at the time of surgery, you may also be recommended to have immunotherapy.

What are the side effects of treatment?

Chemotherapy and radiation therapy both cause side effects during treatment.  Chemotherapy may cause fatigue, nausea, and low blood counts, which recover after treatment ends. Radiation therapy may cause fatigue, nausea, difficulty swallowing, food sticking, heartburn, and low appetite, which may lead to weight loss.  Effects on patients’ nutrition are some of the most difficult to overcome during treatment.  Some patients require a s​tent to be placed into the esophagus to open the narrowing caused by the tumor so food and liquids can pass.  This is usually done before starting treatment.  Other times, a temporary feeding tube is placed, which allows food, medications, and water to go into the stomach or bowel without having to swallow.  To learn more about nutrition during and after esophageal treatment, visit The American Cancer Society’s nutrition website here.

What kind of recovery is involved after treatment?

After chemotherapy and radiation treatment, typically your doctors will give you about 6-8 weeks to recover before surgery.  You may have new CT scans done during this time.  You will meet with a specialized surgeon who will perform your surgery.  Your surgeon will likely have you stay overnight in the hospital several days after surgery to recover and ensure that you are safe to return home.  It often takes many weeks after surgery before you can eat “normal meals” again since your body will need time to recover.

What happens after treatment and surgery?

After surgery, your medical oncologist may recommend you receive immunotherapy. Immunotherapy is an infusion in the vein that “wakes up” your immune system to fight the cancer. In patients with active tumors found at the time of surgery, immunotherapy helped patients live longer without cancer.  After surgery, you will have periodic scans and possible repeat EGD to confirm there is no evidence of cancer.

What can you do to move forward into survivorship and maximize a good quality of life?

You should keep all scheduled appointments for follow-up visits and scans as directed by your physicians.  Talk with your physician and healthcare team during appointments letting them know how you have been feeling and report anything that seems different or is concerning to you.  You may want to keep a journal between visits so that you can remember important information you want to share or questions you may want to ask.  As you can tolerate it, increase your physical activity level and strive to be as active as you can.  Eat a healthy, well-balanced diet and strive to reach a normal body weight.  Avoid or limit intake of alcohol and don’t smoke.

What happens if the tumor spreads?

If the tumor spreads beyond the esophagus or lymph nodes, the cancer is considered metastatic. By definition, this is Stage IV cancer.  This likely means that the cancer is not curable, but remains very treatable.  Chemotherapy is the main treatment for cancers that have spread, since it goes into the bloodstream and travels through the body.  Radiation therapy may be used in circumstances where a tumor is causing pain or other symptoms.

Where can I find more information?

If you were diagnosed with esophageal cancer and would like to discuss treatment with one of our expert physicians, please contact our office at 256-319-5400 to schedule a consultation.