|
Esophageal cancer is a disease in which malignant (cancer) cells form in the
tissues of the esophagus.
The esophagus
is the hollow, muscular tube that moves food and liquid from the throat to the stomach.
The wall of the esophagus is made up of several layers of tissue,
including mucous membrane, muscle, and connective tissue. Esophageal cancer
starts at the inside lining of the esophagus and spreads outward through the
other layers as it grows.
The two most common forms of esophageal cancer are named for the type of cells
that become malignant
(cancerous):
- Squamous
cell carcinoma: Cancer that forms in squamous
cells, the thin, flat cells lining the esophagus. This cancer is most
often found in the upper and middle part of the esophagus, but can occur
anywhere along the esophagus. This is also called epidermoid
carcinoma.
- Adenocarcinoma:
Cancer that begins in glandular
(secretory) cells. Glandular cells in the lining of the esophagus produce
and release fluids such as mucus.
Adenocarcinomas usually form in the lower part of the esophagus, near the
stomach.
Smoking, heavy alcohol use, and Barrett's esophagus can affect the risk of
developing esophageal cancer.
Risk
factors include the following:
- Tobacco use.
- Heavy alcohol use.
- Barrett's
esophagus: A condition in which the cells lining the lower part of the
esophagus have changed or been replaced with abnormal cells that could lead
to cancer of the esophagus. Gastric reflux (the backing up of stomach
contents into the lower section of the esophagus) may irritate the esophagus
and, over time, cause Barrett's esophagus.
- Older age.
- Being male.
- Being African-American.
The most common signs of esophageal cancer are painful or difficult
swallowing and weight loss.
These and other symptoms may be caused by esophageal cancer or by other
conditions. A doctor should be consulted if any of the following problems occur:
- Painful or difficult swallowing.
- Weight loss.
- Pain behind the breastbone.
- Hoarseness and cough.
- Indigestion and heartburn.
Tests that examine the esophagus are used to detect (find) and diagnose
esophageal cancer.
The following tests and procedures may be used:
- Chest x-ray:
Brief exposure of the chest to radiation
to produce an image of the chest and its internal structures.
- Barium
swallow: X-rays of the esophagus are taken after the patient drinks a
solution that contains barium.
The barium coats the esophagus and outlines it on the x-ray. This procedure
is also called an esophagram.
- Esophagoscopy:
The inside of the esophagus is viewed with an esophagoscope (a thin, lighted
tube). The esophagoscope is passed through the mouth and down the throat
into the esophagus. Before the test, a local anesthetic
(a medication that causes temporary loss of feeling) is applied to the
throat so no pain is felt. This test is usually done in a doctor's office.
- Biopsy:
Cells, tissues, or fluid are removed and viewed under a microscope to see if
cancer cells are present. The biopsy is usually done during an esophagoscopy.
Sometimes a biopsy shows changes in the esophagus that are not cancer but
may lead to cancer.
Certain factors affect treatment options and prognosis (chance of
recovery).
The treatment options and prognosis
(chance of recovery) depend on the stage
of the cancer (whether it affects part of the esophagus, involves the whole
esophagus, or has spread to other places in the body), the size of the tumor,
and the patient's general health.
When esophageal cancer is found very early, there is a better chance of
recovery. Esophageal cancer is often in an advanced stage when it is diagnosed.
At later stages, esophageal cancer can be treated but rarely can be cured.
Taking part in one of the clinical
trials being done to improve treatment should be considered.
Stages of Esophageal Cancer
After esophageal cancer has been diagnosed, tests are done to find out if
cancer cells have spread within the esophagus or to other parts of the body.
The process used to find out if cancer cells
have spread within the esophagus
or to other parts of the body is called staging.
The information gathered from the staging process determines the stage
of the disease. It is important to know the stage in order to plan the best
treatment. The following tests and procedures may be used in the staging
process:
- Bronchoscopy:
A procedure in which a thin, lighted tube is inserted through the nose or
mouth into the trachea
(windpipe) and bronchi
(air passages that lead to the lungs). This allows the inside of the
trachea, bronchi, and lungs to be examined.
- Chest x-ray:
Brief exposure of the chest to radiation
to produce an image of the chest and its internal structures.
- Laryngoscopy:
A procedure in which the doctor examines the larynx
(voice box) with a mirror or with a laryngoscope
(a thin, lighted tube).
- CT
scan (CAT scan): A CT scan creates a series of detailed pictures of
areas inside the body, taken from different angles. The pictures are created
by a computer linked to an x-ray machine. This test is also called computed
tomography, computerized tomography, or computerized axial tomography.
- EUS (endoscopic
ultrasound): An endoscope
(a thin, lighted tube used to look at tissues
inside the body) is used to bounce high-energy sound waves off internal
tissues and organs and change the echoes into pictures called sonograms.
This is also called endosonography.
- Thoracoscopy:
An endoscope is inserted through an incision
in the chest wall to examine the inside of the chest.
- Laparoscopy:
A laparoscope (a thin, lighted tube) is inserted through an incision in the
abdominal wall to view the organs and remove tissue samples.
- PET
scan (positron emission tomography scan): A PET scan creates a picture
showing the location of tumor
cells in the body. A substance called radionuclide glucose (sugar) is
injected into the patient through a vein and the PET scanner rotates around
the patient to create the picture. Malignant
tumor cells show up brighter in the picture because they are more active and
take up more glucose than normal cells. The use of PET for staging esophageal
cancer is being studied in clinical
trials.
The following stages are used for esophageal cancer:
Stage 0 (Carcinoma in Situ)
In stage 0 (carcinoma
in situ), cancer is found only in the innermost layer of cells lining the
esophagus.
Stage I
In stage
I, cancer has spread beyond the innermost layer of cells to the next layer
of tissue in the wall of the esophagus.
Stage II
Stage
II esophageal cancer may be divided into stage IIA and stage IIB, depending
on where the cancer has spread.
-
Stage IIA: Cancer has spread to the layer of esophageal muscle or to the
outer wall of the esophagus.
-
Stage IIB: Cancer may have spread to any of the first three layers of the
esophagus and to nearby lymph
nodes. Lymph nodes are small, bean-shaped structures that are found
throughout the body. They filter substances in a fluid called lymph
and help fight infection and disease.
Stage III
In stage
III, cancer has spread to the outer wall of the esophagus and may have
spread to tissues or lymph nodes near the esophagus.
Stage IV
In stage
IV, cancer has spread from the esophagus to other parts of the body and may
also have spread to nearby lymph nodes. Stage IV esophageal cancer may be
divided into stage IVA and stage IVB, depending on where the cancer has spread.
Recurrent Esophageal Cancer
Recurrent esophageal cancer
is cancer that has recurred (come back) after it has been treated. The cancer
may come back in the esophagus
or in other parts of the body.
Treatment Option Overview
There are different types of treatment for patients with esophageal
cancer.
Different types of treatment are available for patients with esophageal cancer.
Some treatments are standard (the currently used treatment), and some are being
tested in clinical
trials. Before starting treatment, patients may want to think about taking
part in a clinical trial. A treatment clinical trial is a research study meant
to help improve current treatments or obtain information on new treatments for
patients with cancer. When clinical trials show that a new treatment is better
than the standard
treatment, the new treatment may become the standard treatment.
Five types of standard treatment are used:
Surgery
Surgery
is the most common treatment for cancer of the esophagus.
Part of the esophagus may be removed in an operation called an esophagectomy.
The doctor will connect the remaining healthy part of the esophagus to the stomach
so the patient can still swallow. A plastic tube or part of the intestine
may be used to make the connection. Lymph
nodes near the esophagus may also be removed and viewed under a microscope
to see if they contain cancer. If the esophagus is partly blocked by the tumor,
an expandable metal stent
(tube) may be placed inside the esophagus to help keep it open.
Radiation therapy
Radiation
therapy is the use of x-rays
or other types of radiation
to kill cancer cells
and shrink tumors. Radiation therapy may use external
radiation (using a machine outside the body) or internal
radiation. Internal radiation involves putting radioisotopes
(materials that produce radiation) through thin plastic tubes into the area
where cancer cells are found.
A plastic tube may be inserted into the esophagus to keep it open during
radiation therapy. This is called intraluminal intubation and dilation.
Chemotherapy
Chemotherapy
is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or
it may be put into the body by inserting a needle into a vein or muscle. Either
type of chemotherapy is called systemic
treatment because the drugs enter the bloodstream, travel through the body,
and can kill cancer cells throughout the body.
Laser therapy
Laser
therapy is the use of a powerful beam of light to kill cancer cells.
Electrocoagulation
Electrocoagulation is the use of an electric current to kill cancer cells.
Patients have special nutritional needs during treatment for esophageal
cancer.
Many people with esophageal cancer find it hard to eat because they have
difficulty swallowing. The esophagus may be narrowed by the tumor or as a side
effect of treatment. Some patients may receive nutrients directly into a vein.
Others may need a feeding tube (a flexible plastic tube that is passed through
the nose or mouth into the stomach) until they are able to eat on their own.
Treatment Options By Stage
Stage 0 Esophageal Cancer (Carcinoma in Situ)
Treatment of stage 0 esophageal cancer
(carcinoma
in situ) is usually surgery.
Stage I Esophageal Cancer
Treatment of stage
I esophageal cancer may include the following:
- Surgery.
- Clinical
trials of chemotherapy
plus radiation
therapy, with or without surgery.
- Clinical trials of new therapies used before or after surgery.
Stage II Esophageal Cancer
Treatment of stage
II esophageal cancer may include the following:
- Surgery.
- Clinical trials of chemotherapy plus radiation therapy, with
or without surgery.
- Clinical trials of new therapies used before or after surgery.
Stage III Esophageal Cancer
Treatment of stage
III esophageal cancer may include the following:
- Surgery.
- Clinical trials of chemotherapy plus radiation therapy, with
or without surgery.
- Clinical trials of new therapies used before or after surgery.
Stage IV Esophageal Cancer
Treatment of stage
IV esophageal cancer may include the following:
- External
or internal
radiation therapy as palliative
therapy to relieve symptoms
and improve quality
of life.
- Laser
surgery or electrocoagulation as palliative therapy to relieve symptoms
and improve quality of life.
- Chemotherapy.
- Clinical trials of chemotherapy.
Treatment Options for Recurrent Esophageal Cancer
Treatment of recurrent esophageal cancer
may include the following:
- Use of any standard
treatments as palliative
therapy to relieve symptoms
and improve quality
of life.
- Clinical
trials of new therapies used before or after surgery.
Clinical trials are taking place in many parts of the country. Information
about ongoing clinical trials is available from the NCI
Cancer.gov Web site. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care team.
Source: National Institutes of Health; National Cancer Institute
|
