What Is Esophageal Cancer?
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Medically reviewed by Archana Sharma, DO, FAAP
Esophageal cancer is a type of cancer that begins in the lining of the esophagus, the muscular tube that connects the throat to the stomach. Cancer cells can form anywhere in the esophagus, and usually start in the innermost layer and then spread out.
Esophageal cancer is more common in men than in women. Known risk factors include tobacco use, a history of acid reflux, and older age. Esophageal cancer makes up about 1% of all cancers in the United States.
Symptoms of esophageal cancer usually do not present until the later stages and often include trouble swallowing, chest pain, and unintentional weight loss. Esophageal cancer is treatable; treatment options include surgery, chemotherapy, radiation therapy, and immunotherapy.
Types
There are two main types of esophageal cancer: adenocarcinoma and squamous cell carcinoma. The two types tend to form in different areas of the esophagus.
Adenocarcinoma
An adenocarcinoma is a type of cancer that begins in the gland cells that produce mucus. Adenocarcinoma is usually found in the lower third of the esophagus. Certain conditions such as Barrett’s esophagus raise the risk of developing adenocarcinoma. Barrett's esophagus occurs when the lower part of the esophagus is damaged, often due to repeated exposure to stomach acid (such as when you have acid reflux).
Adenocarcinoma may also begin in the gastroesophageal (GE) junction, the area where the esophagus meets the stomach.
Squamous Cell Carcinoma
Squamous cell carcinoma begins in the squamous cells. These cells make up the innermost layer of the esophagus. Squamous cell carcinoma can develop anywhere along the esophagus but is most common in the neck area and the upper chest. Squamous cell carcinoma makes up less than 30% of esophageal cancer cases in the United States.
Squamous Cell Carcinoma Occurs Elsewhere
Squamous cells are located in tissue all around the body, including the surface of the skin and the lining of many organs. Therefore, squamous cell carcinoma can occur in other areas. It is commonly associated with skin cancer.
Esophageal Cancer Symptoms
Symptoms of esophageal cancer usually affect your ability to eat and swallow food. Esophageal cancer does not usually cause symptoms in the early stages. Once cancer cells have spread throughout the esophagus, the following symptoms are possible:
Trouble swallowing: The most common cause of esophageal cancer is trouble swallowing (dysphagia). You may notice that food tends to “get stuck” in your throat. This symptom tends to get worse as cancer spreads.
Vomiting: You may experience vomiting when food gets stuck in the esophagus. This can lead to an inability to eat and, therefore, requires immediate medical attention.
Chest pain: Many people with esophageal cancer experience chest pain or burning. This is often mistaken for heartburn (acid reflux).
Weight loss: Esophageal cancer causes trouble eating and decreased appetite. Because of this, it is common to lose weight without trying.
Chronic cough: Esophageal cancer may cause a chronic cough and hoarseness.
Bleeding: When there is bleeding in the esophagus, your stool may appear black. Over time, this can lead to anemia, a shortage of red blood cells.
Fatigue: A common symptom of anemia is fatigue or tiredness during the day.
What Causes Esophageal Cancer?
The exact cause of esophageal cancer is unknown, but researchers have determined many of the risk factors. Esophageal cancer develops when there are DNA changes in the cells. Certain risk factors may cause DNA damage that leads to the genetic changes that cause cancer.
Inherited Gene Mutations
A small percentage of esophageal cancer cases are caused by inherited gene mutations. These are mutations that run in families and are passed down by your parents in your DNA. The following genetic conditions are linked to esophageal cancer:
Tylosis: Mutations in the RHBDF2 gene
Bloom syndrome: Mutations in the BLM gene
Fanconi anemia: Mutations in FANC genes
Barrett’s esophagus: Exact genes affected are unknown
Talk with your healthcare provider about genetic testing and genetic counseling to know if any of these conditions may run in your family.
Acquired Gene Mutations
In addition to inherited gene mutations, acquired gene mutations can also affect your risk of esophageal cancer. Acquired mutations develop on their own during your lifetime and are not passed down from parent to child. These acquired mutations are often related to known risk factors.
Risk Factors
There are several known risk factors for esophageal cancer. Fortunately, some of these factors can be changed to lower your risk. Risk factors for esophageal cancer include:
Age: Over 85% of esophageal cancer cases are found in people older than age 55.
Sex: Men are much more likely to be diagnosed with esophageal cancer than women.
Tobacco use: The more a person uses tobacco products, the higher the risk of esophageal cancer. Smoking at least one pack per day doubles the risk of esophageal cancer.
Reflux: People with gastroesophageal reflux disease (GERD) have stomach acid that moves up the esophagus. This often leads to heartburn and pain. GERD raises the risk of adenocarcinoma.
Barrett’s esophagus: Barrett’s esophagus is a condition that occurs when the lower esophagus is exposed to stomach acid over a long period of time. This causes the squamous cells to be replaced with gland cells and increases the risk of developing adenocarcinoma of the esophagus.
Cancer history: A history of throat, mouth, or lung cancer is linked to a higher risk of esophageal cancer. This may be because smoking increases the risk of all of these types of cancer.
Obesity: People with obesity are at an increased risk of adenocarcinoma. This group is also at higher risk of experiencing GERD.
Diet: Eating a large amount of highly-processed meats may raise the risk of esophageal cancer.
Physical activity: A lack of physical activity is associated with an increased risk of esophageal cancer.
Achlasia: Achlasia is a condition that occurs when the muscle at the bottom of the esophagus is unable to relax. This means that food and liquids have a harder time passing into the stomach, which stretches out the esophagus and irritates the cells.
Tylosis: Tylosis is a rare condition that causes growths in the esophagus and raises the risk of squamous cell carcinoma.
Lye exposure: Lye is a powerful chemical that is found in certain household cleaners. Accidentally drinking lye damages the esophagus and raises the risk of cancer.
Human papillomavirus (HPV): A history of HPV increases the risk of several cancers including throat, anal, cervical, and esophageal.
Related: Nearly Half of Cancer Deaths Worldwide Linked to Preventable Factors, Study Shows
Diagnosis
There are several tests used to diagnose esophageal cancer. Most cases of esophageal cancer are found because a person notices symptoms and sees their healthcare provider.
When you see your healthcare provider, they will start by performing a thorough history and physical. Your provider will ask about your symptoms, how long they have lasted, and if they have been worsening. They will also perform a physical exam looking for any signs of cancer. They may refer you to an oncologist, or a medical doctor who specializes in cancer.
The next step in diagnosing esophageal cancer is performing imaging tests, including:
Barium swallow test: Shows any abnormal areas of the esophagus
Computed tomography (CT) scan: Determines if esophageal cancer has spread to nearby organs
Magnetic resonance imaging (MRI): Detects if cancer cells have spread to the brain or spinal cord
Positron emission tomography (PET) scan: Detects cancer cells in the esophagus
An endoscopy is a type of test that uses a flexible tube with a tiny camera to visualize the esophagus and take biopsies if needed. The types used to diagnose esophageal cancer may include:
Upper endoscopy: Determines if there are any abnormal areas of the esophagus
Endoscopic ultrasound: Determines the size and extent of esophageal cancer
Bronchoscopy: Detects if cancer cells have spread to the trachea and bronchi (breathing tubes)
Biopsy: Tests samples of tissue from the esophagus for cancer cells
Blood tests used to diagnose esophageal cancer may include:
Complete blood count (CBC): Detects low red blood cells, which could mean that there is bleeding from the esophagus
Liver enzymes: Determines if cancer cells have spread to the liver
If you are at high risk for esophageal cancer, such as having a history of Barrett’s esophagus, your healthcare provider may recommend regular upper endoscopies to screen for esophageal cancer.
Treatments for Esophageal Cancer
There are several treatment options for esophageal cancer. The right treatment plan for you will depend on your type of esophageal cancer, how advanced it is, and your overall health.
Common treatments for esophageal cancer include:
Surgery: Removing part of the esophagus (esophagectomy) is the most common treatment for esophageal cancer.
Radiation therapy: Radiation therapy uses high-energy X-rays to destroy cancer cells in the esophagus.
Chemotherapy: Chemotherapy uses powerful drugs to destroy cancer cells. It may be used in combination with radiation therapy.
Esophageal opening: Laser therapy or electrocoagulation may be used to destroy a tumor (a mass of cancerous cells) in the esophagus and keep the esophagus open and clear.
Immunotherapy: Immunotherapy is used to boost the body’s immune response to better fight cancer cells.
Targeted therapy: Targeted therapy uses drugs and other substances to mark cancer cells so that they are easier to identify and destroy.
Prevention
Esophageal cancer cannot always be prevented. However, it is possible to lower your risk by avoiding certain risk factors.
Smoking and not exercising regularly are common risk factors for esophageal cancer. Avoiding these factors will lower your risk of developing esophageal cancer. Talk to your healthcare provider if you need support quitting smoking.
Research studies show that taking nonsteroidal anti-inflammatory drugs (NSAIDs) may lower the risk of esophageal cancer. However, regularly taking NSAIDs has been linked with heart disease, stroke, and bleeding problems. Talk with your healthcare provider before starting a new NSAID regimen.
Related: Is Ibuprofen Bad for Your Heart?
Comorbid Conditions
Comorbid conditions are health problems that may be more likely to occur when you have esophageal cancer. A 2019 study found that common comorbid conditions of esophageal cancer are heart disease, high blood pressure (hypertension), lung (pulmonary) disease, and diabetes.
This does not mean that esophageal causes these conditions. It means that people with esophageal cancer are more likely to experience these other conditions as well. This may be due to the fact that having obesity raises the risk of esophageal cancer and its common comorbidities.
Living With Esophageal Cancer
The goal of esophageal cancer treatment is to reach remission. It is important to note that esophageal cancer usually does not cause symptoms in the early stages. This means that it is usually diagnosed in later stages when it is more difficult to treat. The 5-year survival rate of esophageal cancer is 60%.
Many people with esophageal cancer are able to reach remission and live healthy lives. Once you finish treatment for esophageal cancer, you will continue to follow up with your healthcare team regularly. It’s important to let your oncologist know as soon as you develop any new symptoms or concerns. They may recommend a regular schedule of imaging studies to screen for any recurrence of cancer cells.
It can be challenging to live with some of the symptoms of esophageal cancer. Having difficulty swallowing can significantly impact your quality of life and ability to eat. Consider working with a dietitian to learn techniques to make your food easier to swallow. If you are experiencing throat or chest pain, talk with your healthcare provider about pain control options.
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