Esophageal Cancer

The UofL Brown Cancer Center’s dedicated esophageal cancer team treats a large number of patients with newly diagnosed cancer each year.

Overview

 UofL Brown Cancer Center’s dedicated esophageal cancer team treats a large number of patients with newly diagnosed cancer each year. Studies have shown a link between the number of patients treated and successful outcomes, and we have one of the most active programs in the region. You are followed by a team of highly specialized physicians and support specialists – all with extensive experience in esophageal cancer care.

We are especially proud of our minimally invasive surgery capabilities, including an endoscopic mucosal resection and esophagectomy. Minimally invasive procedures often are able to preserve the function of the esophagus and stomach and avoid the need for radical surgery. This allows you to retain higher levels of function and quality of life.

We're often able to provide hope for advanced esophageal cancer that might not be available elsewhere, including therapies that deliver maximum effectiveness with the least impact on your body.

As one of the region’s largest cancer research centers, our Multidisciplinary Lung Cancer Clinic is leading investigation into new methods of esophageal cancer diagnosis and treatment. You benefit from the most advanced research, conducted by some of the nation's top scientists.

Understanding a disease is the first step toward finding the right care. Get the facts about esophageal cancer, including the different types, how it starts and who’s at risk.

According to the American Cancer Society, more than 16,000 Americans are diagnosed with esophageal cancer each year. It affects men much more often than women. Middle-aged men who are overweight with a history of acid reflux (heartburn) seem to be at the highest risk. Because the disease often has no symptoms in the early stages, it is usually detected at a more advanced stage that is more challenging to treat.

The esophagus is a foot-long tube that carries food and liquids from the mouth to the stomach. Its lining has several layers. Esophageal cancer begins in the cells of the inside lining. It then grows into the channel of the esophagus and the esophageal wall.

A sphincter, a special muscle that relaxes to let food in or out, is on each end of the esophagus. The one at the top lets food or liquid into the esophagus. The one on the bottom lets food enter the stomach.

This sphincter also prevents stomach contents from going back into the esophagus. If stomach juices with acid and bile come into the esophagus, it causes indigestion or heartburn. Reflux and gastroesophageal reflux disease (GERD) are the medical names for heartburn.

If you have reflux for a long time, the cells at the end of the esophagus change to become more like the cells in the intestinal lining. This is called Barrett’s esophagus, and it is a pre-malignant condition which can become esophageal cancer, and needs to be watched closely.

Esophageal cancer types

The types of esophageal cancer are named after the cells where they begin.

Adenocarcinoma is the most common type of esophageal cancer in western societies, especially in white males. It starts in gland cells in the tissue, most often in the lower part of the esophagus near the stomach. The major risk factors include reflux and Barrett’s esophagus.

Squamous cell carcinoma begins in the tissue that lines the esophagus, particularly in the middle and upper parts. In the United States, this type of esophageal cancer is on the decline. Risk factors include smoking and drinking alcohol. This is the most common type of esophageal cancer worldwide. In other countries, including Iran, northern China, India and southern Africa, this type of esophageal cancer is much more common than in the United States.

Risk Factors

The best thing you can do to prevent esophageal cancer is to not smoke or drink too much alcohol. 

Anything that increases your chance of getting esophageal cancer is a risk factor. Long-term heartburn or reflux is a factor in half of esophageal cancers. Other risk factors include:

 

  • Long-term history of smoking: Half of squamous cell esophageal cancers involve smoking. Smoking also increases the risk of adenocarcinoma.
  • Drinking too much alcohol, especially if you smoke.
  • Barrett's esophagus, a condition in which chronic acid reflux causes changes in the cells lining the lower esophagus.
  • Age: Most cases of esophageal cancer are in people over 55.
  • Gender: Men are three times more likely than women to develop esophageal cancer.
  • Achalasia, a disease in which the sphincter, or muscle, at the bottom of the esophagus fails to open and move food into the stomach.
  • Tylosis, a rare, inherited disorder that causes excess skin to grow on the soles of the feet and palms. It has a near 100 percent chance of developing into esophageal cancer.
  • Esophageal webs: These flaps of tissue protrude into the esophagus, making swallowing difficult.
  • Lye ingestion or being around dry-cleaning chemicals.
  • Diet and weight: Risk is higher if you are overweight, tend to overeat or do not eat a healthy diet.
  • History of other squamous cell cancers related to tobacco use

Not everyone with risk factors gets esophageal cancer. However, if you have risk factors, you should discuss them with your doctor.

Most cancers have the same symptoms as other, less serious conditions. Still, it’s important to know the signs.

Esophageal cancer often does not have symptoms in the early stages. If you have symptoms, they may include:

  • Indigestion and heartburn
  • Difficult or painful swallowing (dysphagia)
  • Pain, pressure or burning in the throat or chest
  • Weight loss, less appetite
  • Black tar-like stools
  • Anemia
  • Vomiting
  • Hoarseness
  • Persistent hiccups
  • Chronic cough
  • Pneumonia
  • High levels of calcium in the blood

These symptoms do not always mean you have esophageal cancer. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.

Blood tests, imaging exams and even surgical procedures are used to check for cancer.

Experts at UofL Brown Cancer Center use the most advanced technology and techniques to pinpoint esophageal cancer. Precise diagnosis often improves your chances for successful treatment. Since esophageal cancer often does not have symptoms in early stages, it may be found during procedures or tests for other conditions.

Diagnostic tests

If you have symptoms that may signal esophageal cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family medical history.

One or more of the following tests may be used to find out if you have esophageal cancer and if it has spread. These tests also may be used to find out if treatment is working.

Imaging tests, which may include:

  • X-rays
  • CT or CAT (computed axial tomography) scans
  • MRI (magnetic resonance imaging) scans
  • PET (positron emission tomography) scans

Biopsy

One of the following methods may be used to biopsy tissue to find out if you have esophageal cancer: 

  • Esophagoscopy: An endoscope is inserted through the mouth or nose into the esophagus. The doctor looks at the esophagus and removes small pieces of tissue.
  • Endoscopic ultrasound (EUS) or endosonography: An endoscope is inserted through an opening in the body, usually the mouth or rectum. At the end of the tube are a light, a tiny camera and a device that sends out ultrasound (high-energy sound) waves to make images of internal organs.
  • Video endoscopy: An endoscope with a special fiber-optic camera is inserted through the mouth, allowing the doctor to view the esophagus and biopsy the suspicious area.
  • Bronchoscopy: Using a tool called a bronchoscope, which is similar to the endoscope, the doctor looks at the trachea (windpipe) and the tubes that go into the lungs.
  • Laryngoscopy: With a tool called a laryngoscope, which is similar to the endoscope, the doctor examines the larynx (voice box).
  • Thoracoscopy: A small incision is made between two ribs, and an instrument called a thoracoscope is inserted through it into the chest. The thoracoscope is similar to the endoscope. It lets the doctor view and biopsy the lymph nodes inside the abdomen and chest.

Common cancer treatments include chemotherapy, radiation treatment and surgery. Doctors select the treatment for esophageal cancer based on your diagnosis and disease stage.

Studies have shown that people have better outcomes in cancer programs that treat a high level of patients. We have one of the most active esophageal cancer programs in the region.

We offer many innovative treatments for esophageal cancer, including minimally invasive surgeries, targeted therapies and endoscopic surgery for early stage disease. In addition, our status as a major research site allows us to offer a full range of clinical trials for esophageal cancer.

If you are diagnosed with esophageal cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the type and stage of the cancer and your general health. Your treatment for esophageal cancer will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Surgery

This is the most common treatment for esophageal cancer that has not spread to the lymph nodes or other organs. The procedure most often performed is an esophagectomy, and there are several methods to perform it. Your doctor will recommend the best technique for you based on the location of the tumor and if it has spread. At UofL Brown Cancer Center we often perform this surgery minimally invasively through keyhole incisions, reducing our patient’s pain and complications while speeding their recovery. Currently, we are the only center in Kentucky with this capability. 

Generally, the surgery includes removal of:

  • All or part of the esophagus
  • Part of the stomach
  • Lymph nodes that are close to the esophagus

The remaining stomach is pulled up into the chest or neck and connected to the remaining esophagus. You may need a feeding tube (a small tube that is inserted into the nose or mouth and into the stomach) until you are able to eat.

Side effects of the surgery may include:

  • Leaking at the site where the stomach and esophagus are joined. This may mean the stomach empties slowly, causing nausea and vomiting.
  • Trouble swallowing: An upper endoscopy to stretch passages may help
  • Heartburn
  • Digestive problems: You may be able to eat only small amounts of food at a time

To treat more-advanced stages of esophageal cancer, surgery is often combined with chemotherapy and/or radiation therapy.

Radiation Therapy

New radiation therapy techniques and remarkable skill allow doctors at UofL Brown Cancer Center to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

UofL Brown Cancer Center provides the most advanced radiation treatments for esophageal cancer, including:

3D-conformal radiation therapy: Several radiation beams are given in the exact shape of the tumor

Intensity-modulated radiotherapy (IMRT): Treatment is tailored to the specific shape of the tumor

Chemotherapy

UofL Brown Cancer Center offers the most up-to-date and advanced chemotherapy options for esophageal cancer.

Endoscopic mucosal resection (EMR)

This minimally invasive technique may be used if the cancer is small and only on the surface of the esophagus.

A needle is placed in the esophageal wall, and then saline (saltwater) is injected to make a bubble under the growth. Using suction, the lesion is removed.

Esophageal stents

Small, expandable metal or plastic tubes are placed over the tumor with the aid of an endoscope. Once placed, the stent can expand and open up the blocked part of the esophagus, allowing food and liquids to pass through easier.

Electrocoagulation

Electricity is used to burn off the tumor.

Targeted therapies

These innovative drugs stop the growth of esophageal cancer cells by interfering with certain proteins and receptors or blood vessels that allow the tumor to grow.

Our doctors at UofL Brown Cancer Center are proudly part of UofL Physicians and the UofL School of Medicine.

We believe knowledge comes from questioning the status quo, discovering more about disease and using that knowledge to improve the health of our community. Our physicians are the teachers and researchers at the UofL School of Medicine, involved in the research and development of new treatments and cures for cancer. This means you receive the most advanced and appropriate treatment, even for complex or rare conditions.

To learn more about the physicians who make the academic difference in esophageal cancer treatment, visit the UofL Physicians web site here.