Esophageal Cancer: Disease Overview

Esophageal cancer is a difficult diagnosis to receive. You’re likely dealing with a lot of questions, uncertainty, and emotions as you consider treatment options. This guide aims to break down those options, and provide some guidance when it comes to living with esophageal cancer.

The disease causes cancer cells to form in the tissues of the esophagus, a hollow, muscular tube that food and liquid move through when traveling from the throat to the stomach. The wall of the esophagus is made of up several layers of tissue; cancer begins on the inside lining and spreads to the outer layers of the esophagus as it grows.

It can be very difficult to treat because in many cases, the disease is diagnosed at a later stage.

“Esophageal cancer, we know is a tough one,” Dr. Brendon Stiles, a thoracic surgeon at Montefiore Medical Center, told SurvivorNet. “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.”

Symptoms

Unfortunately, symptoms of esophageal cancer 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. Brendon Stiles explains the signs and symptoms of esophageal cancer. 

Diagnosing esophageal cancer

Several tests may be used when diagnosing a patient with esophageal cancer. These include:

• Physical exam/health history – An exam of the body to check for general signs of health as well as signs that may indicate disease
• Chest X-ray – An X-ray of the organs and bones in the chest
• Upper endoscopy – A test that allows doctors to examine the walls of the esophagus using a small camera that is attached to a thin tube and passed down the patient’s throat

Other tests may be used as well to help get an accurate diagnosis. The upper endoscopy is particularly important because it helps your doctor to clearly see if there are any abnormalities in the wall of your esophagus.

Dr. Whit Burrows, a thoracic surgeon with the University of Maryland Medical System, explains what happens during an endoscopy. 

Usually if a suspected esophageal cancer is found during an imaging test or an endoscopy, it will be biopsied, which means your doctor will remove a small piece of tissue using a cutting instrument that is passed though the scope. That will then be tested.

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.”

Treatment Options

The treatment route you and your medical team decide on after an esophageal cancer diagnosis will depend on several factors, including the severity of the disease and your overall health. Often, the treatment approach will involve several different types of therapy, Dr. Stiles explained.

Dr. Brendon Stiles provides an overview of treatment options for esophageal cancer. 

“It’s rare these days that I just do surgery for a patient with esophageal cancer. They’ve often gotten other treatments,” Dr. Stiles said. “Remarkably, with very early stage disease, stage one, a patient can often have their tumor resected endoscopically, through a scope down their esophagus without the need to invasive surgery. That’s a very selected group of very early, invasive cancer — but increasingly, as we do more endoscopies, we’re able to find those patients.”

Currently, there are several treatment options available for people with esophageal cancer. These include:

• Surgery
• Radiation
• Chemotherapy
• Chemo-radiation
• Laser therapy
• Electroagulation (using heat from an electric current to destroy abnormal tissue)
• Immunotherapy (training the immune system to recognize and attack cancer cells)

There are also clinical trials underway to look at targeted therapies for esophageal cancer.

Staying Healthy During Treatment

Because of where esophageal cancer develops, patients often have trouble swallowing, or can’t swallow at all, which leads to issues eating and drinking, and ultimately, getting enough nutrition. The rate of malnutrition in esophageal cancer patients is as high as 78.9%, and weight loss often continues throughout treatment.

There are some things that patients can do both before and during the treatment process to supplement that nutrition, including temporarily using feeding tubes.

Dr. Raja Flores explains how esophageal cancer patients who become malnourished can supplement their nutrition intake. 

“Before you can really treat [patients], many of them look emaciated where they’re not getting enough nutrition,” Dr. Raja Flores, a thoracic surgeon with Mount Sinai Health System, told SurvivorNet. “So, what we like to do is fatten them up a little bit, maybe put a tube in their intestine, give them food that way, start treating with some chemotherapy and radiation, and give them time to try and open up [to reduce the issues eating/swallowing].”

Living With Esophageal Cancer

Getting the news that you have cancer, especially a disease that is known for being difficult to treat like esophageal cancer, can be a very traumatic experience. When it comes to treating cancer, making sure the patient feels healthy mentally is part of the process as well—and that may look different from patient to patient.

Esophageal cancer is more commonly diagnosed in men, who stereotypically have a more difficult time asking for help when they are struggling mentally.

Dr. Raja Flores explains why taking care of patients’ mental health is so important as well. 

“The esophageal cancer population is a unique population,” Dr. Raja Flores, a thoracic surgeon with Mount Sinai Health System, told SurvivorNet. “Many of the people who develop esophageal cancer are men who are taking care of their families, who are proud, who are strong, who are self-reliant. So when they get faced with this diagnosis and this real vulnerability, they get depressed in a way that can make them crawl up in bed and not want to get out—and that’s when the family comes into play.”

Dr. Flores stressed the importance of having a good support system in place. Having close friends or family members there to rally for you when you feel the lowest can make a huge difference in how a patient handles treatment.

There are also plenty of resources available for people living with cancer who feel like they’re struggling mentally, from traditional therapy to support groups to integrative medicine that may include treatment approaches like acupuncture or meditation. Check out SurvivorNet’s resources on mental health for cancer survivors.