Esophageal Cancer
Esophageal cancer is a deadly malignancy with very low survival, even with treatment. In the United States, esophageal cancers represent the fifth most common gastrointestinal cancer, with an estimated 16,940 cases per year, and are the sixth most common cancer worldwide. Most esophageal cancers can be classified as one of two types: adenocarcinoma or squamous cell carcinoma.
A third type of esophageal cancer, called small cell carcinoma, is very rare. These different types of cancer begin in different kinds of cells in the esophagus. They develop in unique ways and call for approaches to treatment that are unique to each person.
TYPES OF ESOPHAGEAL CANCER
Adenocarcinoma is the most common form of esophageal cancer in the United States, making up more than half of all new cases. It starts out in glandular cells, which are not normally present in the lining of the esophagus. These cells can grow there due to a condition called Barrett's esophagus, which increases a person’s chance of developing esophageal cancer. Adenocarcinoma occurs mainly at the lower end of the esophagus and the upper part of the stomach. Adenocarcinoma of the esophagus occurs most often in middle-aged, overweight white men. Since the 1970s, the incidence of this disease has grown faster than almost any other cancer in the United States. Research indicates this may be due to an increase in the number of people with gastroesophageal reflux disease (GERD), a condition in which contents from the stomach, such as acid and bile, move up into the esophagus repeatedly, causing chronic inflammation.
Recent studies have shown that treating acid reflux reduces the risk of esophageal cancer. The second most common form of esophageal cancer is squamous cell carcinoma. It begins when squamous cells (thin, flat cells lining the inside of the esophagus) begin to grow uncontrollably. Squamous cell carcinoma of the esophagus is strongly linked with smoking and drinking too much alcohol.
HOW IS ESOPHAGEAL CANCER DIAGNOSED?
A patient complaining of the above symptoms is typically first seen by a gastroenterologist, a doctor specializing in treating digestive system conditions. The gastroenterologist may perform an endoscopy, a procedure in which a camera is used to look down the esophagus. If a mass is seen, a biopsy is typically performed, in which a tissue sample is extracted from the suspicious mass and analyzed under a microscope to determine whether it is cancerous.
If the cells are malignant (cancerous), the patient usually has imaging tests such as a computerized tomography (CT) scan of the chest and abdomen and/or a positron emission tomography (PET) scan of the full body to see whether the cancer has spread.
An endoscopic ultrasound may also be recommended to determine how deep the tumor sits in the esophageal wall and thus determine the stage of the cancer. (Cancer is typically given a stage, from 0 to IV, depending on how advanced the cancer is and whether it has spread.)
HOW CAN WE HELP?
The treatment of esophageal cancer requires a multidisciplinary. We work closely with the medical oncologists, radiation oncologists, gastroenterologists, pulmonologists, and your PCP to coordinate your care.