Experts predict that roughly 17,000 new cases of esophageal cancer will be diagnosed in the U.S. and 2,000 cases in Canada this year, according to the American Cancer Society and the Canadian Digestive Health Foundation.
Anatomy of the esophagus
The esophagus is a hollow tube that connects the mouth to the stomach and the remainder of the digestive system. It lies just behind the trachea and in front of the spine. Food that is chewed and swallowed will travel down this muscular tube, which averages 10 to 13 inches long in most adults, until it reaches the stomach to start the digestion process.
Called the upper esophageal sphincter, this is a muscle that relaxes to open and allow food to enter. At the bottom of the esophagus is the area that connects the esophagus to the stomach, known as the gastroesophageal, or GE, junction. Part of the lower esophagus is the lower esophageal sphincter, which regulates the flow of food into the stomach and prevents stomach acid from entering the esophagus.
Inside of the esophagus are different layers. The first layer is the mucosa, which has different layers of its own. The innermost layer of the esophagus is the epithelium, which is made up of flat, thin cells called squamous cells. This layer is where most cancers of the esophagus begin, according to the ACS. The other layers of the esophagus are the submucosa, muscularis propria and the adventitia. These layers are largely made up of connective tissue, muscles, nerves, and blood vessels.
In many cases, the cancer will begin in the inner-most layer of the esophagus (mucosa) and work its way outward. However, the cancer can occur anywhere.
Risk factors for esophageal cancer
There are no definitive causes of esophageal caner, but doctors surmise that chronic irritation of the esophagus may contribute to the mutation of DNA, which leads to the presence of abnormal cancer cells.
Behaviors and factors that may cause this irritation include:
• Alcohol consumption
• Smoking
• An esophageal sphincter that won’t relax
• Gastroesophageal reflux disease (GERD)
• Frequent consumption of very hot liquids
• Obesity
• Consuming foods preserved in lye
• Barrett’s Esophagus, a condition where the lining of the esophagus is damaged from acid reflux
• Gender and age: men over the age of 70 are at greater risk
Symptoms
The Mayo Clinic says that very early stages of esophageal cancer may cause no symptoms. However, as the disease progresses and tumors form, there may be some symptoms. One of the more common is a feeling of a lump or blockage in the throat that disrupts the ability to swallow. Sufferers may choke on food or feel that it gets stuck going down.
Chest pain or burning similar to GERD heartburn also may occur. Coughing or hoarseness can be symptoms as well. Over time, individuals may lose weight without trying due to their impaired ability to eat.
Screening for esophageal cancer is not frequent because of the rarity of the condition and a lack of evidence of an identifiable risk group. Therefore, it is often up to patients to ask for screening from their doctors.
Treatment
Doctors can do a series of tests to diagnose the cancer. These may include an endoscopy to see inside of the esophagus, different imaging scans to take pictures of the esophagus and checking the function of other organs to see if cancer is present.
Depending on the severity of the cancer, an oncologist may recommend the following treatments.
• Surgery to remove a tumor.
• Surgery to remove a portion of the esophagus and reconnect it to the stomach by pulling the stomach up or using a piece of the colon.
• Surgery to remove a portion of the stomach, esophagus and surrounding lymph nodes.
• Insertion of a stent to hold open the esophagus and relieve esophageal obstruction.
• Insertion of a feeding tube that bypasses the throat.
• Chemotherapy and radiation treatment used separately or together.
Again, the type of treatment will be based on a doctor’s recommendation.
Survival rates for esophageal cancer continue to improve through the years as doctors have better methods of diagnosis and treatment at their disposals. However, statistics do indicate that the majority of esophageal cancer patients will die within five years of diagnosis. Getting diagnosed early and reducing behaviors that can lead to the cancer are a person’s best precautions.