Esophageal Cancer Services at UPMC in South Central Pa.

Esophageal cancer is cancer of the esophagus, or the pipe that carries food between the throat and the stomach.

As of 2012, esophageal cancer is the eighth-most common cancer globally with 456,000 new cases diagnosed during the year and about 400,000 deaths, up from 345,000 deaths only 20 years ago. Esophageal cancer is around three times more common in men than in women.

There are two main types of esophageal cancer:

• Squamous cell cancer, which is more common in developing countries, occurs in the inner lining of the esophagus.
• Adenocarcinoma, which is more common in developed countries such as the United States, occurs in the middle and lower third of the esophagus. Patients who have a condition known as Barrett's esophagus, which causes cells to transform into another type of tissue, are at greater risk for developing esophageal adenocarcinoma.

Symptoms

Symptoms of esophageal cancer vary from person to person. Patients may experience mild to severe symptoms—or sometimes no symptoms at all. Symptoms may include:

• Trouble swallowing
• Food coming back up hours after eating
• Weight loss
• Pain when swallowing
• Hoarse voice
• Enlarged lymph nodes (glands) around the collarbone
• Dry, hacking cough
• Coughing up or vomiting blood

Esophageal cancer can sometimes be difficult to detect. If you experience any of these symptoms, you should contact your doctor right away. Esophageal cancer can be more successfully treated if it is diagnosed in its early stages, before it spreads to other areas of the body.

Risk Factors

There are several lifestyle habits and health conditions that increase your risk of developing esophageal cancer, including:

• Smoking or using tobacco products
• Drinking alcohol
• Drinking very hot drinks
• Poor diet
• Obesity
• Acid reflux
• Barrett’s esophagitis, which is a serious complication of acid reflux

Diagnosis And Staging

Accurate diagnosis is essential to successful treatment of esophageal cancer. The physicians at the UPMC Hillman Cancer Center may use one or more of the following tests to determine if you have cancer, if your cancer has spread or if your treatment is working:

• CT/PET scan. Your doctor may order a CT scan of the chest or a PET scan to determine if cancer cells are present and if they have spread.
• Swallowing study/upper GI (also known as an Upper Gastrointestinal Swallow). Your doctor may order this test to identify problems in your esophagus.
• Endoscopy. Your doctor may perform an endoscopy of the esophagus using a fiber optic camera to look directly at the esophagus and take biopsies at the same time. An endoscopic ultrasound, which uses sound waves to provide more information about the presence of cancer in nearby tissues, may also be used.

If you are diagnosed with esophageal cancer, staging is a very important factor in determining treatment. Your doctor will evaluate the type of esophageal cancer, the extent, and whether or not it has spread. Then, your doctor will assign an appropriate stage to help guide your treatment.

Treatment

When it comes to treating esophageal cancer, it is important that you and your doctor discuss all of your treatment options—along with possible side effects—before making a decision. Treatment options may include:

Surgery. Your doctor may recommend an esophagectomy, which is the removal of a segment of the esophagus, to treat esophageal cancer. A minimally invasive procedure called an endoscopic resection may also be recommended to treat early-stage, localized esophageal cancer. Early-stage esophageal cancer may be treated with surgery alone; later-stage esophageal cancer may also require chemotherapy and/or radiation.

Chemotherapy. Chemotherapy may be recommended to kill cancer cells. You may receive chemotherapy treatments through a vein in your arm or a pill. Chemotherapy is often used in combination with radiation and/or surgery.

Radiation. Radiation uses beams of energy to stop the growth of cancer cells. Radiation may be used in combination with chemotherapy and/surgery.

Laser therapy. If the cancer cannot be removed with surgery, laser therapy may be used to deliver high-intensity light to kill tumor cells. Removing a blockage in the esophagus can help reduce pain and difficulty swallowing.

Palliative Care. If your cancer is extensive or if you are not fit enough to undergo surgery, your physician may recommend palliative care to maximize your quality of life. If you and your doctor decide that palliative care is right for you, a team of UPMC physicians, nurses, and other health care workers will help you and your family navigate the issues that arise once a cancer diagnosis is made. Your doctor may recommend a procedure called palliative esophageal stenting, which may help you to swallow and allow you to tolerate a soft diet. For patients who cannot swallow at all, a feeding tube can be used to provide direct access to the stomach.