Esophageal Cancer: Symptoms, Causes & Treatment

Janis

By Janis | Updated January 1, 2024

Esophageal cancer is a serious condition that begins in the lining of the esophagus, the muscular tube that connects the back of the throat to the stomach. The esophagus enables the passage of fluid and food from the throat to the stomach for digestion. 

It is the 10th most common cancer in the world, with various symptoms that may not be noticeable until it has progressed, making early detection and prevention essential. 

To diagnose esophageal cancer, several tests and procedures may be used, including endoscopy and barium swallow study. Understanding the risk factors, staging, and treatment options can help improve outcomes and manage potential complications.

Symptoms

Esophageal cancer often doesn’t present symptoms in its early stages; however, as it progresses, several signs become noticeable. 

Trouble Swallowing

One of the most common symptoms is difficulty swallowing or dysphagia

Initially, a person might find it challenging to swallow solid foods, and later, even liquids might become difficult to ingest.

Chest Pain

Another prevalent indication is chest pain. The pain may vary in intensity and duration, and be especially noticeable when swallowing. It may be accompanied by other symptoms like heartburn.

Esophageal cancer can also cause discomfort, pressure, or burning sensations in the chest area – sometimes mistaken for heartburn – that might worsen when swallowing food. 

Long-Term Cough

Additionally, a chronic cough may develop due to the irritation of the esophagus, further exacerbating chest pain.

A chronic cough can be a notable symptom of esophageal cancer, particularly if it persists for several weeks and is unresponsive to standard treatments.

Changes in Voice Tone

Hoarseness in the voice is another symptom that may occur, caused by the tumor pressing on nerves responsible for voice control. 

This can be particularly concerning if it is ongoing and unexplainable by typical factors like colds or allergies.

Throwing Up

Individuals with esophageal cancer might also experience vomiting, which can be distressing and lead to unintentional weight loss. The feeling of being unable to swallow food or drink properly can negatively impact their appetite and overall health.

Keep in mind that these symptoms by themselves do not definitively indicate esophageal cancer, as other conditions could cause them as well. 

Causes and Risk Factors

Several additional factors may increase an individual’s risk of developing esophageal cancer. These include lifestyle choices and certain medical conditions that can contribute to the formation of cancer cells in the esophagus.

Unhealthy Lifestyle

One major risk factor for esophageal cancer is tobacco use, including both smoking and smokeless tobacco products. 

Excessive alcohol usage has also been connected to an increased risk for this type of cancer.

Individuals who consume large quantities of alcohol and use tobacco products are at an even higher risk as these substances are known to work synergistically to promote the development of cancer cells in the esophagus.

Diet

Diet can influence the risk of esophageal cancer. A diet that’s deficient in fruits and vegetables and high in processed meats and red meat might heighten the risk. 

Consuming insufficient levels of certain nutrients, such as vitamins A, C, and E, can also contribute to the development of this cancer.

Existing Health Issues

Gastroesophageal reflux disease (GERD) is another medical condition that can contribute to the development of esophageal cancer. 

GERD causes stomach acid to flow back into the esophagus, damaging the lining and potentially leading to a condition called Barrett’s esophagus. 

Barrett’s esophagus is a modification in the cells lining the lower esophagus that may heighten the risk of adenocarcinoma, a type of esophageal cancer.

Additionally, individuals infected with human papillomavirus (HPV) may be at a slightly increased risk for the development of esophageal cancer, though more research is needed to confirm this link.

Toxic Substance Exposure

In some cases, exposure to certain chemicals or lye (a strong alkaline substance) can increase the risk of esophageal cancer as well. 

Prolonged exposure to these substances can irritate and damage the lining of the esophagus. 

Regional Location

Another aspect to consider is the geographical factor. Esophageal cancer is more prevalent in Asia, which suggests that it is essential to pay particular attention to preventive measures in this region. 

Research has shown that certain dietary and lifestyle habits prevalent in Asian countries contribute to an increased risk of the disease.

Age

In the United States, esophageal cancer is more common among those aged 45 years and older. 

Proper diagnosis and monitoring of the condition can help improve patient outcomes, and it is essential that individuals experiencing symptoms or who have risk factors consult with a healthcare professional for proper evaluation and management.

Diagnosis

Diagnosing esophageal cancer typically involves a series of tests and procedures to confirm the presence of the disease. 

Endoscopy and Biopsy

One standard method is an endoscopy, also known as an upper GI endoscopy or EGD (esophagogastroduodenoscopy), which allows the doctor to view the inner lining of the esophagus using a thin, flexible tube called an endoscope. 

If any suspicious tissue is detected, a sample can be collected via biopsy and examined under a microscope to identify cancerous cells.

Barium Swallow

Barium swallow or esophagram is another useful diagnostic tool that involves the patient swallowing a liquid containing barium, a substance that coats the lining of the esophagus, making it more visible on X-rays. 

This test helps detect any abnormal narrowing (strictures), diverticula (enlargements), or areas with cancerous growth.

Bronchoscopy

A bronchoscopy may be performed if there is concern that cancer has spread to the trachea or bronchi. 

In this procedure, another type of endoscope called a bronchoscope is used to visualize the respiratory structures and assess any abnormalities.

Other Imaging Tests

Advanced imaging techniques, such as computed tomography (CT) scans and positron emission tomography (PET) scans, may be employed to determine the extent of cancer and if it has spread to nearby lymph nodes or other organs. 

CT scans produce detailed cross-sectional images of the body, while PET scans detect cellular changes related to cancer using radioactive tracers.

Endoscopic ultrasound (EUS) is a specialized procedure that combines endoscopy with ultrasound technology to evaluate the esophageal wall and surrounding lymph nodes for cancer involvement. 

An ultrasound probe attached to the endoscope emits sound waves to create images of internal organs and tissues.

DNA Testing

In some cases, the presence of certain genetic mutations can affect the choice of treatment or predict the likelihood of esophageal cancer recurrence. In such scenarios, DNA testing of the tumor tissue may be beneficial. 

However, individuals with a high risk, such as those with long-term acid reflux or achalasia, should discuss risk factors and screening options with their doctor.

Types of Esophageal Cancer

There are two primary kinds of esophageal cancer: adenocarcinoma and squamous cell carcinoma. Both of these cancers differ in their origins, affected areas in the esophagus, and the types of cells involved.

Adenocarcinoma

Adenocarcinoma, the most common form of esophageal cancer in the United States, starts in the glandular cells that create mucus to assist in the seamless transit of food down the esophagus. 

This kind of cancer generally impacts the lower part of the esophagus close to the stomach. Several factors, such as obesity, gastroesophageal reflux disease (GERD), and Barrett’s esophagus, increase the risk of developing adenocarcinoma.

Squamous Cell Carcinoma

On the other hand, squamous cell carcinoma initiates in the squamous cells that line the inner esophagus. It can occur anywhere along the length of the esophagus, but it is commonly detected in the middle and upper parts

Squamous cell carcinoma is typically associated with smoking and excessive alcohol consumption.

Staging

Staging is a critical process in understanding esophageal cancer, as it helps determine the extent of the cancer and the appropriate course of treatment. 

Esophageal cancer staging involves assessing how the cancer has spread within the esophagus and to nearby tissues, lymph nodes, and other organs.

There are various stages for esophageal cancer, with each stage denoting the extent of the cancer’s progression. In general, lower stages have better treatment outcomes, while higher stages may require more aggressive therapeutic approaches.

Stage 0: 

Also referred to as carcinoma in situ, this stage involves cancer cells only in the inner lining of the esophagus without invading deeper layers or nearby structures. Treatment at this stage is usually successful.


Stage I: 

At this stage, the cancer has expanded into the underlying layers of the esophagus but has not spread to lymph nodes or distant sites. 

Treatment options may include surgery, radiation, or minimally invasive procedures.

Stage II: 

Cancer has either invaded the deeper layers of the esophagus and nearby lymph nodes or grown through the esophageal wall without lymph node involvement. 

Treatment at this stage usually involves a combination of surgery, chemotherapy, and radiation therapy.

Stage III: 

This stage indicates that the cancer has spread to nearby tissues or organs and involves greater involvement of nearby lymph nodes. 

Treatment may include a combination of surgery, radiation, and chemotherapy, with a focus on relieving symptoms and maintaining quality of life.

Stage IV: 

This stage denotes that the cancer has metastasized to distant organs, such as the lungs, liver, or bones. 

Treatment for stage IV esophageal cancer primarily focuses on symptom management and improving the patient’s quality of life, as the prognosis at this stage is generally poor.

Early detection is vital in increasing chances of successful treatment; however, many esophageal cancers are not diagnosed until they have spread to nearby lymph nodes or other parts of the body, which can decrease survival rates.

Treatment

Treatment options for esophageal cancer typically depend on various factors, including the stage of cancer, overall health, and patient preferences. Common approaches include surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, and palliative care techniques.

Surgery

Surgery is often recommended for early-stage esophageal cancer. 

A possible surgical procedure is esophagectomy, where a part of the esophagus is removed, and the remaining part is reconnected to the stomach.

Chemotherapy

Chemotherapy is another option that uses drugs to kill cancer cells, and it can be used before surgery to shrink tumors or after surgery to eliminate any residual cancer cells. 

Chemotherapy can also be combined with radiation therapy in a treatment approach known as chemoradiation.

Radiation Therapy

Radiation therapy employs high-energy beams to destroy cancer cells. 

This therapy can be delivered externally or internally with brachytherapy, where radioactive seeds are placed close to the tumor.

Targeted therapy

Targeted therapy involves the use of medications designed to attack specific vulnerabilities in cancer cells. 

Unlike traditional chemotherapy, which affects all rapidly dividing cells, targeted therapy aims to minimize damage to healthy tissues, potentially reducing side effects.

Immunotherapy

Immunotherapy harnesses the patient’s immune system to combat cancer. It has shown promise in cases that are resistant to traditional chemotherapy, offering another treatment avenue for advanced stages.

Immune checkpoint inhibitors are a type of immunotherapy that can be utilized for advanced esophageal cancer.

Comfort Care Methods

For malignant blockages, stent placement can be performed to keep the esophagus open and help the patient swallow food more easily. 

Other palliative care techniques, such as electrocoagulation or cryotherapy, can also be employed to control symptoms by destroying tumor cells or stopping bleeding.

Photodynamic therapy (PDT) merges a light-sensitive drug with a laser in order to destroy cancer cells. This treatment might be an option for small, localized tumors in the early stages.

Lastly, adjuvant therapy refers to additional treatments used in conjunction with the main therapy and is often utilized to increase the chances of successful outcomes.

It’s crucial to discuss the available treatment options with your healthcare team, to consider the benefits, risks, and side effects, and to develop a tailored plan best suited to your individual needs and preferences.

Complications

Esophageal cancer can lead to various complications, impacting an individual’s health and daily life. 

Blood Loss

One of the primary concerns in esophageal cancer is bleeding. 

As the tumor grows, it may erode the blood vessels in the esophagus, causing bleeding, which may manifest as vomiting blood or passing black, tarry stools.

Problems with Food Digestion

Another common complication is an obstruction in the esophagus, making it difficult for the patient to swallow food and drink. 

This can result in malnutrition and dehydration, further exacerbating the patient’s condition.

Tiredness

Fatigue is a prevalent concern, often experienced as both a symptom of esophageal cancer and a side effect of cancer therapy. 

Fatigue may negatively impact a patient’s day-to-day life and overall well-being.

Sexual and Reproductive Health

Esophageal cancer and its treatment may also affect a patient’s sexual health and functioning. 

Issues may arise due to reduced hormone production, physical discomfort, or psychological stress.

Prevention

Maintaining a healthy lifestyle is crucial in preventing esophageal cancer. While it is not possible to prevent all cases, taking certain measures can significantly reduce your risk.

Avoid Tobacco and Alcohol

It is crucial to avoid tobacco and alcohol consumption, as these are major risk factors for esophageal cancer. 

Both substances are known carcinogens that irritate the esophageal lining and can lead to cellular changes. Limiting alcohol to moderate levels and quitting tobacco use are highly recommended preventive measures. 

Embrace Healthy Habits

A balanced diet plays a significant role in cancer prevention. Consuming a variety of fruits and vegetables, as well as whole grains, is essential for maintaining a healthy body weight. 

Obesity has been linked to a higher risk of esophageal cancer, particularly in Western countries. 

Therefore, weight loss and maintaining a healthy weight can lower the risk for both men and women.

Schedule Routine Check-ups

Regular check-ups are also helpful for early detection of esophageal cancer, especially if you have a family history or other risk factors.

Talk to your doctor about the appropriate screening tests and the frequency of check-ups for your age and risk levels.

Frequently Asked Questions

What are the early warning signs of esophageal cancer?

Esophageal cancer may not show any signs or symptoms or be detected until it has reached an advanced stage. 

However, some early warning signs may include difficulty swallowing, chest pain, unexplained weight loss, and changes in the sound of your voice. It’s essential to consult a doctor if you experience any of these symptoms for an extended period.

How is esophageal cancer diagnosed?

The diagnosis of esophageal cancer involves multiple steps, from preliminary screenings to more invasive procedures. Early detection is crucial for better treatment outcomes.

Typically, the diagnostic process begins with a medical history and physical exam, followed by specialized tests like endoscopy and imaging studies. Each method provides valuable information for a definitive diagnosis.

What factors contribute to the development of esophageal cancer?

Several factors can heighten the risk of developing esophageal cancer, such as tobacco usage, excessive consumption of alcohol, obesity, and gastroesophageal reflux disease (GERD). 

Certain genetic predispositions and age may also play a role in the development of this cancer.

What treatments are available for esophageal cancer?

Treatment options for esophageal cancer can differ based on the stage and location of the tumor. Some of the standard treatment options include surgery, radiation therapy, chemotherapy, and targeted therapy. 

In some cases, a combination of these treatments may be utilized for the best possible outcome. Your healthcare provider will determine the most appropriate treatment plan based on your specific case.

How can esophageal cancer be prevented?

While it may not be possible to prevent esophageal cancer, lifestyle changes can be introduced to help reduce the risk. 

These include quitting tobacco use, reducing alcohol consumption, maintaining a healthy weight, and managing GERD symptoms with appropriate medications and diet modifications.

What is the role of staging in esophageal cancer prognosis?

Staging pertains to the process of determining the reach and spread of cancer throughout the body. Accurate staging is crucial to determine the most effective treatment plan and predict the potential outcome for a patient. 

The prognosis for esophageal cancer varies depending on the stage, with early-stage cancers having a better chance of successful treatment and positive outcomes.