Esophageal Cancer

Esophageal cancer forms inside the esophagus, a hollow, muscular tube that carries food and drink from your throat to your stomach. Both adults and children can develop esophageal cancer. Around 22,000 adults are diagnosed with esophageal cancer in the U.S. each year.

Types & Stages

The two most common types of esophageal cancer are:

• Squamous cell carcinoma. This type of cancer starts in the lining of the esophagus. These tumors often form in the upper part of the esophagus, closer to the throat.
• Adenocarcinoma. This type of cancer starts in glands of the esophagus that make mucus. These tumors are typically found in the lower part of the esophagus, closer to the stomach.

If you are diagnosed with esophageal cancer, your doctor will run tests to find out what stage it is. The stage means how big the tumor or tumors are and whether they have spread outside of the esophagus. Knowing the stage will help your doctor figure out the best treatment for you.

Signs & Symptoms

When esophageal cancer is in the early stages, it doesn’t usually cause symptoms.

When esophageal cancer gets more advanced, it can cause symptoms like:

• difficulty swallowing
• pain, burning or a feeling of pressure in the chest
• chronic cough
• vomiting or coughing up blood

Causes & Risk Factors

Esophageal cancer is more common among men. Men are nearly four times more likely to develop this type of cancer than women.

Other risk factors for esophageal cancer include:

• Smoking. If you smoke a lot, your risk of getting esophageal cancer is higher than someone who doesn’t smoke.
• Alcohol use. If you drink a lot of alcohol, your risk of getting esophageal cancer is higher than someone who doesn’t drink.
• Chronic acid reflux, also called GERD (gastroesophageal reflux disease). When stomach acid constantly flows up into the esophagus, it can irritate the lining of the esophagus.
• HPV infection. An HPV (human papillomavirus) infection that doesn’t go away can sometimes turn cells cancerous. HPV can infect the mouth, throat and genitals.

Screening

There is no routine screening test for esophageal cancer.

Diagnosis

At Stony Brook Cancer Center, our doctors use a combination of tests to diagnose esophageal cancer, such as:

• Imaging tests, like ultrasound and CT, to look at the esophagus. They may also use an imaging test known as a barium swallow. For this test, you will drink a liquid that contains a metal called barium. Then, a radiologist will take X-rays of your esophagus. Barium helps your esophagus show up better on the X-ray.
• Biopsy, to look at a sample of esophageal cells under the microscope.

Treatment

What esophageal cancer treatment you will get depends on many factors, including the size of your tumors and whether the cancer has spread outside of the esophagus.

Treatment for esophageal cancer often involves a combination of approaches. Your treatment may include:

• Surgery to remove part of the esophagus where the cancer is growing.
• Radiation therapy. At Stony Brook Medicine, most of our radiation treatments are given with x-rays and electron beams generated by machines called linear accelerators.
• Targeted therapy, which is therapy that is targeted to the genetic or molecular changes in your tumors.
• Immunotherapy, a type of therapy that helps your immune system find and attack your tumors.

If you have difficulty swallowing because a tumor is blocking your esophagus, you may get the following treatments to make it easier to swallow:

• Stent surgery. This involves surgery to place a mesh tube that will help keep your esophagus open.
• Laser therapy. For this type of therapy, your doctor will insert a long, flexible tube with a laser on the end (an endoscope) into your esophagus. They will aim the laser beam at your tumor to shrink it.
• Photodynamic therapy. For this type of therapy, you will get an injection of a cancer-killing drug that only turns on when it is exposed to a specific kind of laser light. Your doctor will then insert a long, flexible tube with a light on the end (an endoscope) into your esophagus to turn the drug on only near your tumor.

At Stony Brook Medicine, our Palliative Care Service is available to everyone, no matter the stage of your cancer. This specialized team helps patients and their families cope with the physical, emotional, and spiritual distress of cancer. They can provide relief from symptoms of esophageal cancer and/or its treatment, such as pain, difficulty eating and fatigue.