The esophagus is the muscular tube that extends from below the tongue to the stomach. At the top of the esophagus is a muscle that relaxes to let food or liquid enter. The lower part is connected to the stomach.
Esophageal cancer starts from the inner layer and grows outward. The disease is relatively uncommon in the United States and accounts for about 1 percent of all cancer diagnoses. In 2007, the American Cancer Society estimates that about 15,000 cases of esophageal cancer will be diagnosed in the United States. Because esophageal cancer is usually diagnosed at a late stage, it generally has a poor outlook for survival. The five-year survival rate for localized esophageal cancer is only 31 percent. The five-year survival rate for all cases is 15 percent. But the disease can virtually be prevented by stopping or never starting smoking and by moderating your alcohol use. Smoking and alcohol use are two of the most important risk factors for esophageal cancer.
Although the esophagus is part of the digestive system, because of its location in the chest, esophageal cancer is usually treated by a thoracic surgeon. The Cancer Center at Hackensack University Medical Center features many unique and innovative services to treat esophageal cancer:
- board-certified gastroenterologist, thoracic surgeons, medical oncolofists and radiation oncologists who are highly experienced in treating esophageal cancer
- minimally invasive laparoscopic surgical procedures and photodynamic therapy
- sophisticated diagnostic testng and imaging studies
- clinical trials to investigate new medications and treatment methods
- a full range of support services
A diagnosis of esophageal cancer is made using one or a combination of the following methods:
- barium swallow
- CT scan
- endoscopic ultrasound
- thoracoscopy or laparoscopy to view the lymph nodes in the chest and abdomen
The risk for esophageal cancer is three to four times greater in men than women because of men's greater long-term use of tobacco and alcohol, two of the most important risk factors for the disease. Age is also a factor: 80 percent of all cases are diagnosed in persons between the ages of 55 and 85. African-Americans are twice as likely to be diagnosed with esophageal cancer than Caucasians. Long-term reflux of stomach acid is also a risk factor. Reflux of stomach acid into the esophagus can change cells in the lower end of the esophagus to lead to a condition called Barrett's esophagus. These altered cells can change into cancer if they are not treated.
Other risk factors include:
- a diet low in fruits and vegetables
- certain vitamins and minerals
- accidental swallowing of lye
- achalasia (a disease where the muscles at the bottom of the esophagus do not open to release food into the stomach)
- a rare inherited disease called tylosis
- esophageal webs (abnormal pieces of tissue that extend into the esophagus)
One of the difficulties in diagnosing esophageal cancer is that symptoms do not usually appear until the disease is advanced. Symptoms include: trouble swallowing, pain in the mid-chest or a feeling of pressure or burning, weight loss, hoarseness, hiccups, pneumonia, and high calcium levels.
Surgery is usually the primary treatment for esophageal cancer. Radiation therapy, chemotherapy, and photodynamic therapy may also be combined with surgery to treat the cancer, or in the case of cancer that has advanced and is not curable, to relieve symptoms and pain.
Surgery to treat esophageal cancer is a complex operation and should be undertaken only by a thoracic surgeon who is highly experienced in the procedure. At The Cancer Center, our thoracic surgeons are skilled in all types of surgery for esophageal cancer, including the use of laparoscopic techniques that reduce pain, bleeding, scarring, hospitalization time, and recuperation. During the procedure (called a esophagectomy), the surgeon removes part of the esophagus containing the cancer with a small amount of stomach. He then connects the upper part of the esophagus to the stomach.
Radiation therapy may be combined with surgery either pre-operatively to shrink the tumor or post-operatively to kill any cancer cells that might remain after surgery. Radiation therapy can also be used as a palliative treatment for patients whose cancer cannot be cured. The radiation can relieve dysphagia (trouble swallowing) by being delivered externally (outside the body) or internally via seeds that are placed into the tumor through an endoscope.
Chemotherapy may given pre-operatively alone or combined with radiation therapy to shrink the tumor before surgery (called triple therapy). Chemotherapy may also be used as a palliative treatment for patients whose cancer cannot be cured but who suffer from pain or dysphagia (trouble swallowing).
Sometimes esophageal cancer is advanced and cannot be cured, but there are palliative procedures that can be used to treat pain, blockages, and other symptoms.
If the tumor is blocking the esophagus and causing the patient to have trouble swallowing (a condition called dysphagia), the surgeon may use a procedure called endoscopic dilatation. During this procedure, the surgeon uses a device to push through the obstruction to open the esophagus up and allow better swallowing. A metal scaffold called a stent may be placed into the esophagus to keep the area open.
Photodynamic therapy is used as a palliative treatment for advanced cancers that block the esophagus or for tumors that have recurred. Photodynamic therapy consists of an injection of a non-toxic chemical into the patient's blood. The chemical collects in the tumor for a few days. Laser light is then focused on the tumor through an endoscope. Light changes the chemical into a new chemical that can kill cancer cells. Photodynamic therapy is also used to treat Barrett's esophagus and early esophageal cancers found in Barrett's esophagus.
Radiation therapy can be used to relieve dysphagia (trouble swallowing) by being delivered externally (outside the body) or internally via seeds that are placed into the tumor through an endoscope.
Chemotherapy may be used as a palliative treatment for patients whose cancer cannot be cured but who suffer from pain or dysphagia (trouble swallowing).