The esophagus is the tube that carries food from the mouth to the stomach. Esophageal cancer develops when cancer cells grow in this tube. It's a fairly rare type of cancer in the United States, but it's slowly becoming more common. Lifestyle can play an important role in this cancer, so learning more about how it happens could help you take steps to lower your risk.
What are the types of esophageal cancer?
The major types of esophageal cancer are:
- Squamous cell cancer, which starts in the cells that line the esophagus (squamous cells). This type can occur anywhere along the length of the esophagus.
- Adenocarcinoma, a cancer of glandular tissue in the lower part of the esophagus just above the stomach. This type of cancer is on the rise in the United States, especially among white men.
In rare cases, esophageal cancer may take other forms.
What causes esophageal cancer?
Experts are not sure what causes the cell changes that lead to esophageal cancer. They think they may occur because of long-term irritation of the esophagus.
Things that can put you at risk for esophageal cancer include:
- Tobacco use of any kind. Over half of squamous cell cancers are linked to tobacco use.
- Heavy or long-term alcohol use. People who both smoke and drink have a much higher risk.
- Gastroesophageal reflux disease (GERD). Long-term acid reflux irritates the esophagus. It can also cause squamous cells in the lower part of the esophagus to turn into glandular cells. This is called Barrett's esophagus and it increases the risk of adenocarcinoma.
- A diet low in fruits, vegetables, and certain vitamins and minerals.
- Obesity, which makes a person more likely to have GERD.
The risk of esophageal cancer is increased in people who have certain rare medical problems, especially tylosis. This is an inherited disorder that causes thick skin on the soles of the feet and the palms.
The rate of esophageal cancer is also higher in:
- Older adults. Most people who get this cancer are older than 60.
- Men. Men get esophageal cancer three to four times more often than women.
What are the symptoms?
Esophageal cancer usually doesn't cause symptoms until it's advanced and harder to cure. When symptoms occur, they often include:
- Trouble swallowing (dysphagia)
- Unplanned weight loss
- Hoarseness or hiccups
- Pain in the chest
How is it diagnosed?
The tests done most often are:
- Barium swallow. For this test, a series of x-rays are taken after you swallow a thick liquid that coats the esophagus.
- Upper endoscopy. While you are sedated, a slim, lighted tube with a tiny camera on the end is passed down the esophagus. This test lets the doctor see inside the esophagus and also take tissue samples (biopsies) to find out if cancer is present.
Other tests may be done to find the extent (or stage) of cancer. They include CT scan, bronchoscopy, PET scan, and ultrasound. Surgical tests may also be needed to check for the spread of cancer. These tests include laparoscopy or video-assisted thoracoscopy.
How is it treated?
Treatment is based on the type of cancer, its location, and stage. If the cancer is caught at an early stage, treatment will aim to get rid of the cancer. If the cancer is found at an advanced stage, treatment may focus on controlling the cancer and reducing symptoms.
The main treatments for esophageal cancer are:
- Surgery. Surgery may be done to remove the affected part of the esophagus (esophagectomy) or lower part of the esophagus and the upper part of the stomach (esophagogastrectomy).
- Chemotherapy. This is the use of medicines to kill cancer cells. It may be given along with radiation to help shrink the cancer, or alone to reduce symptoms.
- Radiation. This may be used to help shrink a tumor or to kill remaining cancer cells after surgery.
Can esophageal cancer be prevented?
Some things that put you at risk for esophageal cancer are beyond your control, such as your age and sex. But there are changes you can make to lower your risk of getting this cancer:
- Don't use tobacco.
- Avoid or limit alcohol use.
- Eat plenty of fresh fruits and raw vegetables, especially such vegetables as broccoli, cabbage, and cauliflower.
- Get treatment for heartburn. Your doctor can suggest medicines and lifestyle changes to reduce acid reflux.
- Stay at a healthy weight. Being overweight makes you more likely to develop GERD.
If you are at high risk for esophageal cancer, ask your doctor if you should have testing. People who have Barrett's esophagus or tylosis may need to have endoscopy every 3 months to every 5 years. The frequency of endoscopy depends on the presence of precancerous changes (dysplasia) and the severity of dysplasia.
Created on 03/18/2008
Updated on 08/29/2011
- American Gastroenterological Association. American Gastroenterological Association medical position statement on the management of Barrett's esophagus.
- Kleinberg LR, Forastiere AA, Heitmiller RF. Cancer of the esophagus. In: Abeloff: Clinical Oncology, 3rd edition. Philadelphia, PA: Elsevier; 2004. Accessed January 7, 2008.
- National Cancer Institute. Esophageal cancer.
- Ginsberg GG, Fleischer DE. Tumors of the esophagus. In: Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 8th ed. Philadelphia, PA: Saunders Elsevier; 2006.