Understanding Esophageal Cancer
- Esophageal cancer is a disease that causes cancer cells to form in the tissues of the esophagus, a hollow, muscular tube that food and liquid move through.
- Several lifestyle factors, like smoking or heavy alcohol use, can increase a person’s risk of developing esophageal cancer.
- The disease can be tough to treat because it is often diagnosed late.
- It’s important to be aware of symptoms that may indicate esophageal cancer, such as pain/difficulty swallowing, weight loss, and pain behind the breastbone.
Several lifestyle factors, like smoking or heavy alcohol use, can increase a person’s risk of developing esophageal cancer. About 20,640 new cases of esophageal cancer are diagnosed in the U.S. every year, according to American Cancer Society estimates, and it is more common among men.
Read MoreEsophageal cancer symptoms
Unfortunately, symptoms can be a bit vague, so those experiencing them may not think cancer right away. Still, it’s important to be aware of signs of this disease, which include:
- Pain/difficulty swallowing
- Weight loss
- Pain behind the breastbone
- Hoarseness/cough
- Indigestion/heartburn
- A lump under the skin
“Try to get diagnosed early,” Dr. Stiles said. “For esophageal cancer, that means getting screened, getting endoscopies if you have any symptoms. The problem with esophageal cancer is it can mimic a lot of other things. You lose a little weight, have a little trouble swallowing, have a little heartburn—those are tough symptoms to pin down sometimes and often leads to patients with esophageal cancer presenting with later disease.”
Dr. Sofya Pintova, who practices hematology and oncology at Mount Sinai Cancer Center, also stressed the importance of getting checked up when these symptoms, which may not immediately indicate cancer, arise.
“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 — and that will often lead to a medical evaluation,” Dr. Pintova explained.
“It includes an endoscopy, which is when a gastroenterologist puts a camera down the esophagus in the stomach and if they see an area that is suspicious for a mass, or if they see a mass, they may biopsy it. And if the biopsy confirms cancer, the next stage is usually staging,” she added.
Dr. Sofya Pintova explains how esophageal cancer is diagnosed.
Staging esophageal cancer
The two most common types of esophageal cancer are:
- Squamous cell carcinoma (which forms in the thin, flat cells lining the inside of the esophagus)
- Adenocarcinoma (cancer begins in the glandular cells, or the cells in the lining of the esophagus that produce and release fluids like mucus)
After you receive an esophageal cancer diagnosis, your doctor will need to determine the type, as well as the stage. Both types of esophageal cancer are broken up into five stages (0, 1, 2, 3, and 4).
“Once you do get diagnosed, ask what’s the stage,” Dr. Stiles said. “Patients should never be afraid to push doctors and say, ‘What is my stage? What are the treatment options at my stage? Do I have less invasive treatment options? Do I need multi-modality therapy?’ That means therapy with more than just surgery or more than just radiation with chemotherapy.”
Dr. Stiles stressed that patients with esophageal cancer must be advocates for their own disease and speak up about treatment concerns, and what other treatment options or routes may be available in their situation.
What is metastatic esophageal cancer?
Getting a diagnosis of metastatic esophageal cancer means that the cancer has spread to distant parts of the body.
“This is the esophageal cancer that started in the esophagus and spread to other organs,” Dr. Pintova said. “In general, that type of stage is not curable — but it is treatable.
“The goal of treatment is to help people live longer and better, of course balancing that very carefully with the potential side effects of the treatment,” she added.
In this stage, Dr. Pintova explained that a “systemic” treatment is often given — which may include chemotherapy, immunotherapy, targeted therapies, or combination approaches.
“An oncologist has to analyze the cancer in a lot of detail. It’s no longer enough to know that it’s esophageal cancer. We really get into the nitty gritty in understanding the different proteins the cancer expresses, the genetics in the cancer itself, and then choose the best type of treatment,” she said.
Questions to Ask Your Doctor
- What can I expect from an endoscopy?
- What tests are needed to determine the best form of treatment?
- Do I need multi-modality therapy (more than one form of therapy)?
- What are my treatment options and potential side effects of each?
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