Cancer is a word that can strike fear into the bravest of hearts. Cancer refers to a condition involving healthy cells multiplying out of control; their behaviors can also change, and they may spread and destroy other healthy cells. Unfortunately, the human body is made entirely of cells – this means that quite a number of parts of the body can be subject to cancerous growths. The esophagus is one of them.
The esophagus is the tube leading from your mouth, through your neck, to your stomach. It’s the channel that brings the chewed-up steak from your mouth into your stomach for digestion. This hollow tube is made of muscles, mucous membranes, and connective tissue.
Cancer of the esophagus tends to arise from the innermost layers of tissue. There are two common types of esophageal cancer, which are named after the types of cells that turn cancerous.
- Adenocarcinoma: When the glandular cells of the esophagus become malignant (cancerous), this is termed an adenocarcinoma. Glandular cells are responsible for producing mucus, an important fluid for lubricating the esophagus as well as a defense mechanism. Adenocarcinomas are most commonly found in the lower esophagus toward the entrance of the stomach.
- Squamous cell carcinoma: Squamous cells are the thin, flat cells that line the esophagus. Squamous cell carcinoma is also known as epidermoid carcinoma, and tends to begin in the upper to middle sections of the esophagus.
Risk Factors for Esophageal Cancer
Cancer of the esophagus ranks around 10th of the most common cancers in the USA, with over 20,500 estimated new cases in 2022. In the same year, it was responsible for around 16,400 deaths. This represents a comparatively poor survival rate, despite advancements in cancer treatment.
Although it is possible to develop esophageal cancer out of the blue in an otherwise perfectly healthy human, several risk factors have been identified:
- Ethnicity. Compared to Hispanic races, Caucasians have a two-times increased risk of esophageal adenocarcinoma. When comparing to African Americans, Caucasians are three to four times more likely to develop adenocarcinoma esophageal cancer. However, the majority of esophageal cancer cases in African Americans tend to be squamous cell carcinomas, compared to less than half of esophageal cancer cases in Caucasians.
- Gender. Studies suggest esophageal adenocarcinomas are a whopping 38-times more likely to develop in males over females. Squamous cell carcinomas of the esophagus are also significantly more prevalent in males than females.
- Barrett’s esophagus. Barrett’s esophagus is a condition involving normal cells of the esophageal lining transforming into a different type of cell. It is known to be a significant risk factor for esophageal adenocarcinoma. However, it’s contribution as a risk factor is a little more complicated, as there are risk factors associated with having Barrett’s itself. These include male gender, gastrointestinal reflux disease, and smoking, which are all also independent risk factors for esophageal cancer.
- Gastrointestinal reflux disease (GERD). GERD is a condition involving symptoms such as heartburn and acid reflux. This constant regurgitation of your acidic stomach contents can induce the cellular changes seen in Barrett’s esophagus and esophageal adenocarcinoma. GERD is associated with a 5-fold increased risk of adenocarcinoma. Around 10% of people with GERD will develop Barrett’s esophagus.
- Smoking. Tobacco smoking is linked to both Barrett’s esophagus and esophageal cancer, both adenocarcinoma and squamous cell carcinoma types. Even quitting smoking still carries an increased risk 10 years later when compared to someone who had never puffed a cigarette in their life.
- Diet. Though a certain diet isn’t directly related to modifying your risk for esophageal cancer, there is research indicating it can help to reduce the risk of Barrett’s esophagus, which can indirectly reduce your likelihood of cancer. Foods and nutrients linked with a lower risk of Barrett’s include omega-3, polyunsaturated fats, fiber from fruits and vegetables, vitamin C, beta-carotene, and vitamin E. In other words, less meat and fast food.
- Body weight. Obesity is a risk factor for a number of things – sleep apnea, GERD, bad knees, not fitting into your clothes, and esophageal cancer. Having a body mass index (BMI) of 26 or higher has been linked with a higher risk of adenocarcinoma; this risk increases even further at higher BMIs.
- Genetics. Certain genes have been identified as associated with esophageal cancers, including those that regulate cell cycles and cell signaling.
What are the Symptoms of Esophageal Cancer?
One of the reasons esophageal cancer is so fatal is that it is often not detected until the more advanced stages. And the reason for this is that early cancer often develops with no noticeable signs or symptoms.
Knowing that you have Barrett’s esophagus should put you on higher alert for anything that seems out of the ordinary with you and your esophagus. You may ask your doctor about what screening services are available if you know you have this risk factor for esophageal cancer.
Typical signs and symptoms of esophageal cancer include:
- A hoarse voice
- The feeling of pressure, pain, or burning in your chest
- Deteriorating indigestion or heartburn
- Pain or difficulty swallowing
- A lump under the skin of your throat
- Unexplained weight loss
Treatment of Esophageal Cancer
The diagnosis of esophageal cancer involves a number of tests, including chest x-rays, inserting a scope into the esophagus to have a good look-see (esophagoscopy), and a biopsy to examine the suspicious cells under a microscope for signs of malignancy.
It’s also important to determine whether the cancerous cells are still confined to the esophagus or have traveled afar to other parts of the body, a process known as metastasis. The most common sites of metastasis for esophageal cancer are the lymph nodes, lung, liver, bones, adrenal glands, and brain. To hunt down metastatic cancer cells, your cancer team will need to perform other various tests and procedures, including MRI, thorascopy (surgically inserting a scope into the chest area), or ultrasound.
Identifying the characteristics of the esophageal tumor and whether it has spread is crucial for planning cancer treatment. There are seven accepted standard treatments for esophageal cancer:
- Surgery is the most common treatment. An esophagectomy involves removing the affected section of the esophagus. The remaining healthy esophagus is reconnected to the stomach, possibly with a plastic tube or by grafting part of your intestine.
- Radiation therapy can be used to destroy the offending cancerous cells or prevent them from multiplying further. Radiation therapy may be external, using a machine to emit cancer-killing rays, or internal, by inserting a radioactive substance directly into or nearby the tumor.
- Chemotherapy involves the use of drugs to destroy the cancer cells or prevent their growth. It can be administered either through tablets or injection.
- Chemoradiation is a combination of chemotherapy and radiation therapy, because teamwork makes the dream work.
- Laser therapy uses a medical laser device to zap off cancer cells.
- Electrocoagulation involves destroying cancerous cells with an electric current.
- Immunotherapy is a type of biologic therapy, which is designed to support the body’s own immune system in fighting the cancer. Immunotherapy drugs can enhance, redirect, or restore the body’s natural defensive response to cancer.
As esophageal cancer is a particularly aggressive cancer, it’s important not to delay if you are experiencing any of the symptoms that may indicate its development. Your esophagus (and life) will thank you for it!