« University Specialty Surgery Associates « Thoracic Conditions

Esophageal Diseases: GERD, Esophageal Cancer

Esophageal cancer occurs in the esophagus (the muscular tube that connects the throat (pharynx) to the stomach). Esophageal Cancer usually starts in the cells that line the inside of the esophagus. It is uncommon in the United States, but when it does occur, it is more common in men than women and more common in the lower part of the esophagus. However, it can occur in both and women and anywhere along the esophagus.

Signs and Symptoms

  • Difficulty swallowing (dysphagia)
  • Weight loss without trying
  • Chest pain, pressure or burning
  • Worsening indigestion or heartburn
  • Coughing or hoarseness

Early esophageal cancer typically has no signs or symptoms.

Types of Esophageal Cancer

  • Adenocarcinoma – begins in the cells of mucus-secreting glands. It occurs most often in the lower portion of the esophagus. This is the most common form of esophageal cancer in the United States. It primarily affects white men.
  • Squamous cell carcinoma – are flat, thin cells that line the surface of the esophagus. It occurs most often in the middle of the esophagus. This is the most prevalent esophageal cancer worldwide.
  • Other rare types – Rate forms of esophageal cancer include choriocarcinoma, lymphoma, melanoma, sarcoma and small cell cancer.

Factors

It is thought that constant irritation of your esophagus may contribute to the DNA changes that cause esophageal cancer. Factors that increase your risk of esophageal cancer are:

  • Drinking alcohol
  • Having bile reflux
  • Having difficulty swallowing because of an esophageal sphincter that won’t relax (achalasia)
  • Drinking very hot liquids
  • Not eating enough fruits and vegetables
  • GERD (having gastroesophageal reflux disease)
  • Obesity
  • Barrett’s esophagus (precancerous changes in the cells of the esophagus)
  • Having radiation treatment to the chest or upper abdomen
  • Smoking

Complications

As esophageal cancer advances complications rise, such as:

  • Obstruction of the esophagus – Cancer growth may make it difficult or impossible to swallow food or liquid
  • Pain – As this cancer advances it becomes painful
  • Bleeding – As the cancer advances bleeding can occur. It is usually gradual; however, it can be sudden and severe.

Testing

  • Physician exam and history – An exam to look for lumps and anything else usual. A history of your health habits and past illnesses and treatments.
  • Chest x-ray
  • Barium swallow – A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach and x-rays are taken. This is called the upper GI series.
  • Esophagoscopy – An esophagoscpe is inserted through the mouth or nose and down the throat into the esophagus. Tissue samples may be removed at this time – these tissue samples will be viewed under a microscope. This is called an upper endoscopy.
  • Biopsy – This will be done during the esophagoscopy (mentioned above).

Treatments

  • Nutritional plan will be set up – patients have special nutritional needs during treatment for esophageal cancer.
  • There are six types of standard treatment:
    • Surgery
    • Radiation therapy
    • Chemotherapy
    • Chemoradiation therapy
    • Laser therapy
    • Electrocoagulation