Esophageal Cancer: What You Need to Know Now

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Esophageal cancer is relatively rare in the U.S., but the risk goes up as we age, and cancers of the esophagus are four times more common in men than women. The esophagus connects the throat to the stomach. The upper part has a ring of muscle that opens the esophagus when we consume food or drink. The lower part, the gastroesophageal junction (GEJ), contains another ring that opens to allow food to pass to the stomach. Cancer of the esophagus grows in the inner layer and expands outward.


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How does esophageal cancer form?

The esophagus can be lined with two types of cells: squamous cells, which exist in the normal, healthy esophagus, and adenocarcinomas (cells that replace squamous cells when you have a condition called Barrett’s esophagus). Squamous cell carcinoma usually occurs near the neck or upper part of the chest. Most adenocarcinomas start in the lower esophagus.


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What causes esophageal cancer?

Scientists don’t know for sure what causes esophageal cancers, though they suspect that tobacco and alcohol use, for example, can damage the DNA in those squamous cells inside the esophagus and lead to cancer. Damage from sources of long-term irritation (reflux, Barrett’s esophagus, etc.) is also a suspected cause.


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What are the risk factors?

Are you at risk? Lifestyle factors that increase your chances of developing esophageal cancer include smoking and drinking. Other conditions that may up your chances include GERD, Barrett’s esophagus, and achalasia, a rare disorder of muscles in the lower esophagus.


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What are the symptoms?

Unfortunately, it’s hard to detect esophageal cancer early. Symptoms often don’t occur until later stages. Digestive problems can be the first sign, so a gastroenterologist may be the first line of defense. The most common symptoms are difficulty swallowing, or feeling like food is stuck in your throat; chronic heartburn or gastroesophageal reflux disease (GERD); unexplained weight loss; persistent coughing; and hoarseness.


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How do you screen for it?

If you don’t have symptoms, you likely won’t be screened for esophageal cancer. If you have the condition known as Barrett’s esophagus, however, you may have an endoscopic examination. Biopsies taken during such exams can determine if there is any cancer present.


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How is cancer of the esophagus diagnosed?

When a doctor suspects esophageal cancer, various tests can determine if cancer is the culprit behind symptoms. Imaging tests include X-rays with a barium swallow to outline the esophagus, CT scans, PET scans, and MRIs. Endoscopy tests involve a tube with a camera and light that lets a doctor look at the esophagus more closely. Biopsies and blood tests can also help.


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How is it treated?

Depending on how advanced the cancer is, it may be treated with surgery; radiation; Endoscopic mucosal resection (EMR), in which tissue is removed through an endoscope; or systemically with chemotherapy, immunotherapy, or targeted therapy. Some patients opt to try new treatments by enrolling in a clinical trial.


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Scientists don’t agree on how to classify GEJ cancers

Remember that part of the esophagus mentioned earlier, the gastroesophageal junction (GEJ)? Cancers that begin there are sometimes classified with esophageal cancers, and sometimes with stomach cancers. In the 7th edition of its "Classification of Malignant Tumours" (2009), the Union for International Cancer Control (UICC) moved GEJ cancers to the esophageal group. Not everyone agrees with the move, however.


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What about prognosis?

The chances of recovering from esophageal cancer depend on several factors, including how far it has spread, whether surgery can completely remove it, and the overall health of the patient. While the overall five-year survival rate for people with esophageal cancer is 19 percent, the survival rate shoots up to 43 percent if the cancer is confined to the esophagus.