Esophageal squamous cell carcinoma

The esophagus plays an important role in digestion. It’s the hollow tube that food and drink travels through to reach your stomach.

The cells in the lining of the esophagus can become malignant, causing esophageal cancer.

Esophageal cancer is rare in the United States. The National Cancer Institute (NCI) estimated 17,650 new cases in 2019.

But esophageal cancer can be deadly if not caught early. According to the NCI,  the five-year survival rate for esophageal cancer in the U.S. is approximately 20%.

“Esophageal cancer is not one of the most common cancers, but it is one of the most lethal cancers,” says John Rhee, MD, a medical oncologist and hematologist at UPMC Hillman Cancer Center. “The prognosis is better when treated at an earlier stage with chemotherapy, radiation therapy, and surgery.”

Types of Esophageal Cancer

Esophageal cancer forms in the inner layer of the esophagus. It can cause the tube to become partially blocked, making it difficult for food to reach the stomach.

There are two main types of esophageal cancer that can develop in the two types of cells that line the esophagus:

  • Squamous cell carcinoma: The esophagus is lined with flat, scaly squamous cells, which are found in many organs. Cancer that forms in these cells is called squamous cell carcinoma, and it usually occurs happens in the higher portions of the esophagus, either in the neck or the upper two-thirds of the chest.
  • Adenocarcinoma: This type of esophageal cancer forms in the esophagus’ mucus-secreting glands. This type of esophageal cancer is most common in the United States and usually occurs in the lower third of the esophagus.

Squamous cell carcinoma and adenocarcinoma make up about 95 % of esophageal cancers. Rare lymphomas, melanomas, and sarcomas account for the rest.

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What Causes Esophageal Cancer?

Although the exact cause of esophageal cancer is not known, there are several risk factors, says Dr. Rhee. However, he adds that some esophageal cancer patients have zero risk factors.

Factors that can increase your risk include:

  • Age: The older you are, the higher your risk for esophageal cancer. Most cases are found in people 55 and older.
  • Gender: Men are more at risk than women.
  • Gastroesophageal reflux disease (GERD): Also known as reflux, this condition occurs when acid from the stomach gets into the lower part of the esophagus. People with GERD are more at risk of esophageal cancer.
  • Barrett’s esophagus: When reflux from stomach acid damages the lining of the esophagus, it causes squamous cells to turn to glandular tissue, which can become cancerous.
  • Tobacco and alcohol: Using tobacco and alcohol increases your risk of esophageal cancer, especially among frequent users.
  • Obesity: People who are obese are at greater risk of esophageal cancer.
  • Diet: Certain diets, such as those high in processed meat and low in fruits and vegetables, can increase the risk of developing esophageal cancer. Drinking extremely hot liquids on a regular basis also identified as a risk factor.
  • Esophagus injury: A previous injury to the esophagus can put you at risk for esophageal cancer later.

Esophageal Cancer Symptoms

Many people don’t feel symptoms in the early stages of esophageal cancer. As the disease progresses, you may experience symptoms such as:

  • Difficulty swallowing or painful swallowing.
  • Unexplained weight loss.
  • Chronic indigestion or heartburn.
  • Chest pain.
  • Coughing or hiccups.
  • Loss of appetite.
  • Bleeding in the esophagus, leading to bloody stools.
  • Vomiting.

How Is Esophageal Cancer Diagnosed?

Because symptoms often don’t occur during the early stages, esophageal cancer is rarely diagnosed until it spreads. Studies show only 1 in 8 cases is diagnosed at an early stage.

Most people aren’t routinely screened for esophageal cancer, says Dr. Rhee. “The symptoms may be nonspecific, such as heartburn or mild abdominal discomfort or unexplained weight loss. The disease may not be picked up until it’s an advanced stage.”

Dr. Rhee says if a patient is suffering from a condition such as GERD or Barrett’s esophagus, an endoscopy may reveal the disease at an earlier stage.

Doctors use several different tests to diagnose esophageal cancer:

  • Upper endoscopy: A endoscope – a small, flexible tube with a tiny video camera and light attached – is inserted through the mouth into the esophagus to examine it. If a suspicious growth is found, the doctor can collect samples to determine if it is cancerous. An upper endoscopy also can determine the size of a tumor and whether it has spread.
  • Endoscopic ultrasound: This procedure uses sound waves to produce images of the inside of the esophagus, which can help doctors look for problems. It’s often done at the same time as an upper endoscopy.
  • Barium swallow: An x-ray is taken after the patient swallows a liquid that contains barium, which makes it easier for doctors to see tumors.
  • Bronchoscopy: A scope goes down through the nose or the mouth into the lungs. The scope can check to see if the tumor has spread to your airway. This procedure is done if a tumor is present in the upper two-thirds of the esophagus.
  • Other imaging scans: Doctors can use MRI, CT, or PET scans to get images of the inside of the body and look for potential tumors.

How Is Esophageal Cancer Treated?

Treatment for esophageal cancer depends on the type, stage, and location of the disease when diagnosed.

There is a much better chance at recovery if the disease is diagnosed early. The NCI reports the five-year survival rate for esophageal cancer is 46.7% if it’s caught before the cancer spreads.

Many treatments can be used alone or in combination with others. Dr. Rhee says surgeons and medical oncologists work together on multimodal treatments that include:

  • Surgery: Is the most common treatment for esophageal cancer. A surgeon can attempt to remove a tumor if it is small and hasn’t spread. In more advanced cancers, surgeons may remove part of the esophagus and stomach in a procedure called an esophagectomy. They remaining part of the esophagus is then connected to the stomach to make sure the patient still can swallow.
  • Radiation therapy: Uses high-energy x-rays or other radiation to kill cancer cells or prevent their growth.
  • Chemotherapy: Uses drugs to kill cancer cells. Chemotherapy can be used in addition to surgery or radiation therapy. In more advanced cancers, it can help relieve pain.
  • Laser therapy: This treatment, which uses a high-intensity light laser to shrink or kill tumors inside the body, can be done with an endoscope.
  • Electrocoagulation: An electric current is used to destroy cancer cells.
  • Palliative care: Used in serious cases, palliative care differs from treatment to cure the disease. Treatment is aimed at relieving symptoms or lessening pain to improve a patient’s comfort and quality of life.

Can Esophageal Cancer Be Prevented?

You may not be able to prevent esophageal cancer, but there are ways to lower your risk  including:

  • Avoiding tobacco and alcohol: Heavy use of tobacco and alcohol products is linked to esophageal cancer. Minimizing your use of or avoiding these products entirely can help lessen your chances of getting the disease.
  • Maintaining a healthy weight: A healthy diet and regular exercise can help you avoid obesity, an esophageal cancer risk factor.
  • Treating esophageal conditions: Barrett’s esophagus and reflux are risk factors for esophageal cancer. Drugs to treat those conditions or lessen their symptoms can help lower the risk that they can develop into cancer.

Editor's Note: This article was originally published on , and was last reviewed on .

Esophagus Cancer . American Cancer Society. Esophageal Cancer: Diagnosis . American Society of Clinical Oncology. Jürgen Pohl. Gastrointestinal Medicine and Surgery, Diagnostics and Early Diagnosis of Esophageal Cancer . Volker Meves, Angelika Behrens. SEER Cancer Stat Facts: Esophageal Cancer . National Cancer Institute. Esophageal Cancer Screening . National Cancer Institute. Esophageal Cancer Treatment . National Cancer Institute. Esophageal Cancer . National Organization for Rare Disorders. Esophageal Cancer . Radiological Society of North America.

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