Recognizing the Subtle Symptoms of Esophageal Cancer
- A 41-year-old father of two who experienced difficulty swallowing learned he had a strawberry-sized tumor in his chest and was later diagnosed with stage 2 esophageal cancer.
- Esophageal cancer starts when abnormal cells grow in the esophagus—the tube that carries food and drinks from your throat down to your stomach. This tube has several layers of tissue, and the cancer usually begins in the inner lining.
- Like some other cancer types, where symptoms are subtle enough to be confused with something else, esophageal cancer symptoms are also challenging to detect. However, difficulty swallowing, weight loss, or a hoarse cough are some known symptoms.
- Several treatment options exist for esophageal cancer patients, which include surgery, radiation, chemo, chemo plus radiation, laser therapy, and immunotherapy. The treatment path depends on several factors, including the severity of the disease and your overall health.
“I felt like it almost would get stuck in my throat,” Sevillano told Today.com.
Read MoreWATCH: How Esophageal Cancer Is Diagnosed
Concerned, Sevillano finally saw a doctor. While his bloodwork showed no red flags, a scan revealed something far more serious.
“Unfortunately, we got your scan back and we found a mass in the center of your chest, in your lower part of your esophagus,” his doctor told him.
The diagnosis: stage 2 esophageal cancer.
“I would have never imagined that I had any cancer, let alone esophageal cancer,” Sevillano said, reflecting on the shock of the news.
Esophageal cancer begins in the inner lining of the esophagus—the muscular tube that carries food and liquids from the throat to the stomach. As it grows, it can spread outward through the layers of tissue, making early detection critical.
Sevillano’s care team moved quickly. His treatment plan included four rounds of chemotherapy followed by surgery to remove the tumor, which was roughly the size of a strawberry. The operation involved removing ten inches of his esophagus.
“It’s rare these days that I just do surgery for a patient with esophageal cancer. They’ve often gotten other treatments,” explained Dr. Brendon Stiles, a thoracic surgeon at Montefiore Medical Center, in an interview with SurvivorNet.
WATCH: How Chemotherapy Is Given for Esophageal Cancer
After surgery, Sevillano was advised to undergo three additional rounds of chemotherapy. But the side effects were too intense, and he chose not to continue.
Chemotherapy plays a vital role in treating esophageal cancer, whether it’s adenocarcinoma (a type of esophageal cancer) or squamous cell carcinoma (a type of esophageal cancer). The specific drugs used depend on the cancer type and individual patient factors.
“Chemotherapy is typically a drug that swims through your body, killing off cancer cells wherever they are—whether they are in your esophagus, in your great toe, in your hip, or in your liver,” said Dr. Whit Burrows, thoracic surgeon at the University of Maryland Medical System.
“So, [it’s] very different from surgery, where we locally remove the cancer, or radiation therapy, when we don’t remove it, but we locally treat it.”
The goals of chemotherapy include:
- Shrinking tumor size
- Reducing the number of cancer cells in the body
- Lowering the risk of cancer spreading
- Easing current symptoms
Treatment is typically given in cycles, allowing the body time to recover between sessions. Duration and dosage vary based on the patient’s condition and response.
Six months after completing treatment, Sevillano received the news he’d been hoping for: no evidence of disease.
“I went to the beach and celebrated six months of being cancer-free,” he said.
Expert Resources on Esophageal Cancer
Esophageal Cancer: Why Early Detection Is Critical for This Often-Silent Disease
“Esophageal cancer, we know, is a tough one,” Dr. Stiles said.
“It’s one of the cancers with some of the lowest cure rates out there. But like many cancers, if we find it early, we can often treat it effectively—either with surgery, with surgery and chemotherapy, or with chemotherapy and radiation,” Dr. Stiles continued.
Esophageal cancer is notoriously difficult to detect in its early stages. Its symptoms are often subtle, easily mistaken for common digestive issues, which can delay diagnosis and treatment.
Common Symptoms to Watch For
Because early signs can mimic everyday discomforts, it’s important to take persistent symptoms seriously. Known indicators include:
- Pain or difficulty swallowing
- Unexplained weight loss
- Pain behind the breastbone
- Persistent hoarseness or cough
- Indigestion or heartburn
- A lump under the skin (often near lymph nodes)
“Symptoms include things like … they’re losing weight, they’re having some burning in their esophagus or their chest, they’re having trouble or pain with swallowing,” explained Dr. Sofya Pintova, a hematologist and oncologist at Mount Sinai Cancer Center.
“That will often lead to a medical evaluation.”
How Esophageal Cancer Is Diagnosed
Diagnosis typically begins with an endoscopy—a procedure where a gastroenterologist inserts a camera down the esophagus to examine the tissue and look for abnormalities.
“If they see an area that is suspicious for a mass, or if they see a mass, they may biopsy it,” Dr. Pintova said.
“And if the biopsy confirms cancer, the next stage is usually staging.”
Types of Esophageal Cancer
There are two primary types, each originating in different cells of the esophagus:
- Squamous Cell Carcinoma: Forms in the thin, flat cells lining the inside of the esophagus
- Adenocarcinoma: Begins in glandular cells that produce mucus and other fluids
Staging the Disease
Once diagnosed, doctors determine the cancer’s stage—ranging from 0 to 4—which helps guide treatment decisions and predict outcomes. Earlier stages are more treatable, while later stages often require more aggressive, multi-modal therapies.
How Doctors Decide the Best Treatment Path for Esophageal Cancer
Esophageal cancer treatment isn’t one-size-fits-all. It depends on the tumor’s stage, location, and its impact on the patient’s ability to eat and function. Dr. Raja Flores, a thoracic surgeon with Mount Sinai Health System, explains how physicians determine the right approach.
“As a surgeon, you’re trying to figure out what kind of patient requires surgery, chemo-radiation plus surgery, or just chemotherapy, or just chemotherapy and radiation,” Dr. Flores told SurvivorNet.
The tumor’s depth within the esophageal wall plays a major role in treatment planning. Early-stage tumors—known as T1 lesions—are confined to the surface of the esophageal mucosa.
“Basically, if you have a tumor that is considered a T1 lesion … sometimes they can remove that with an endoscope,” Dr. Flores said.
“There are some situations where T1 tumors, which are very early-stage, can be removed with surgery alone.”
As the cancer progresses to T2 or T3 stages, it penetrates deeper into the esophageal wall. These cases typically require a more aggressive approach.
WATCH: Should I Consider Minimally Invasive Surgery for Esophageal Cancer?
“When it gets a little more advanced, T2, T3, where it goes through the thickness of the wall of the esophagus, that frequently requires chemotherapy and radiation, followed by surgery,” Dr. Flores added.
In cases where the tumor causes a significant blockage—making it difficult or impossible to swallow—radiation may be the first step.
“When a patient comes in with a large obstruction, which cannot be removed with just surgery, the first move may be to send this patient to the radiation oncologist to get treatment started,” Dr. Flores explained.
“The majority of the time, you’ll get a response, things will open up, and you will be able to eat.”
Ultimately, symptoms and the presence of metastasis guide whether a patient receives chemotherapy alone or in combination with radiation.
“What determines whether you can get that combination of chemotherapy and radiation depends on your symptoms,” Dr. Flores said.
“Symptoms really dictate whether or not you’re going to get radiation there, but also, do you have distant disease? If you have a tumor in the middle of the chest but a metastasis somewhere else … if you don’t need radiation to open things up so you can swallow, usually in those cases they will just give you chemotherapy.”
Chemotherapy for Esophageal Cancer: Common Drug Combinations and Side Effects
Chemotherapy plays a central role in treating esophageal cancer, often used alongside surgery or radiation, depending on the stage and type of the disease. Most patients receive a combination of two or three drugs to maximize effectiveness.
Frequently Used Chemotherapy Drugs
The most common agents include:
- Fluorouracil (5FU) or its oral form Capecitabine (Xeloda)
- Platinum-based drugs: Cisplatin, Oxaliplatin, or Carboplatin
- Taxanes: Paclitaxel or Docetaxel
Common Drug Combinations
Doctors tailor regimens based on tumor type, location, and patient health. Some widely used combinations include:
- Cisplatin and capecitabine (CX)
- Cisplatin and fluorouracil (CF)
- Epirubicin, cisplatin, and capecitabine (ECX)
- Epirubicin, cisplatin, and fluorouracil (ECF)
- Carboplatin and paclitaxel
- Fluorouracil, oxalipatin, and docetaxel (FLOT)
These combinations are selected to attack cancer cells from multiple angles, improving the chances of shrinking tumors and preventing spread.
While chemotherapy can be life-saving, it often comes with side effects that vary in intensity. Common reactions include:
- Nausea and vomiting
- Hair loss or thinning
- Fatigue and weakness
- Peripheral neuropathy (nerve damage)
- Cardiotoxicity – irregularities causing damage to the heart rhythm or vascular function
Doctors monitor patients closely and may adjust dosages or provide supportive medications to manage these effects.
Questions to Ask Your Doctor
If you are diagnosed with esophageal cancer or are experiencing concerning symptoms compelling you to seek further examination, here are a few questions you can ask your care team.
- What type of esophageal cancer do I have?
- How will I receive chemotherapy treatments? Will I need a port?
- How often will I have chemotherapy? For how long?
- What are the risks and benefits of treatment with these drugs?
- Will my health insurance cover my treatment with this drug?
- What are the common side effects of the chemotherapy I will receive?
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