The esophagus is a 10-inch long, hollow, muscular tube that connects the throat to the stomach. When a person swallows, the walls of the esophagus contract to push food down into the stomach. Esophageal cancer (also called esophagus cancer) begins when cells in the lining of the esophagus grow uncontrollably and eventually form a tumor.
Cancer of the esophagus begins in the inner layer of the esophageal wall and grows outward. If it metastasizes (spreads) through the esophageal wall, it can invade lymph nodes, blood vessels in the chest, and other nearby organs. Esophageal cancer can also spread to the lungs, liver, stomach, and other parts of the body.
There are two types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma arises in squamous cells that line the esophagus. This type of cancer usually develops in the upper and middle part of the esophagus. Adenocarcinoma begins in the glandular tissue in the lower part of the esophagus at the junction between the esophagus and the stomach. Treatment is similar for both types. Very rare tumors of the esophagus (occurring in less than 1% of cases) include small cell neuroendocrine cancers, lymphomas, and sarcoma.
Statistics
In 2008, an estimated 16,470 adults (12,970 men and 3,500 women) in the United States will be diagnosed with esophageal cancer. It is estimated that 14,280 deaths (11,250 men and 3,030 women) from this disease will occur this year. Esophageal cancer is nearly four times more common among men than women and black people are twice as likely as white people to have this cancer. Esophageal cancer is the seventh most common cause of cancer death among men. The five-year relative survival rate (percentage of patients who survive at least five years after the cancer is detected, excluding those who die from other diseases) of patients with esophageal cancer is about 16%.
Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with esophageal cancer. Because the survival statistics are measured in five-year (or sometimes one-year) intervals, they may not represent advances made in the treatment or diagnosis of this cancer. These statistics also combine the survival rates of people with advanced metastatic esophageal cancer with people with cancer that is limited to the esophagus. People with cancer that has not metastasized are likely to have a higher survival rate compared with those with more advanced disease.
Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2008.
A risk factor is anything that increases a person's chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices.
The following factors may raise a person's risk of developing esophageal cancer:
Age. People between the ages of 45 and 70 are at greatest risk.
Gender. Men are nearly three times more likely than women to develop esophageal cancer.
Race. Black people are twice as likely as white people to develop esophageal cancer.
Tobacco. Using any form of tobacco, including cigarettes, cigars, pipes, chewing tobacco and snuff, raises the risk of esophageal cancer.
Alcohol. Heavy drinking over the long term increases the risk of squamous cell carcinoma of the esophagus, especially when combined with tobacco use.
Barrett's esophagus. This condition can develop in some people who have chronic gastroesophageal reflux disease (GERD) or esophagitis (inflammation of the esophagus), even when a person does not experience symptoms of chronic heartburn. Damage to the lining of the esophagus causes abnormal changes in cells. People with Barrett's esophagus are more likely to develop adenocarcinoma of the esophagus.
Diet. A diet that is low in fruits and vegetables and certain vitamins and minerals can increase a person's risk of developing esophageal cancer.
Obesity. Being severely overweight and having an excess of body fat can increase a person's risk of developing esophageal adenocarcinoma.
Lye ingestion. Lye ingestion by children is associated with an increase in squamous cell carcinoma. Lye can be found in some cleansing products, such as drain cleaners.
Achalasia. Achalasia, a condition when the lower muscular ring of the esophagus fails to relax during swallowing of food, increases the risk of squamous cell carcinoma.
People with esophageal cancer may experience the following symptoms. Sometimes, people with esophageal cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.
Difficulty swallowing, particularly when eating meat, bread, or raw vegetables (As the tumor grows, it can block the pathway to the stomach. Even liquid may be painful to swallow.)
Doctors use many tests to diagnose cancer and determine if it has metastasized. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer
Severity of symptoms
Previous test results
Routine screening tests to detect early esophageal cancer are not used in the United States. People with Barrett's esophagus may be advised to have endoscopic examinations (looking inside the esophagus through a flexible lighted tube) and biopsies (removing a small sample of tissue to examine under the microscope) on a regular basis to help detect cancer early.
In addition to a physical examination, the following tests may be used to diagnose esophageal cancer:
Barium swallow (also called an esophagram). The patient swallows a liquid containing barium and then a series of x-rays (pictures of the inside of the body) are taken. Barium coats the surface of the esophagus, making tumors or other abnormalities easier to see on the x-ray. If there is an abnormality, doctors may order an upper endoscopy and biopsy to determine if cancer is present.
Upper endoscopy (also called esophagus-gastric-duodenoscopy, or EGD). A thin, flexible tube with a light and video camera on the end is passed down the throat and into the esophagus. This test allows the doctor to see the lining of the esophagus. If an abnormality is found, a biopsy will be performed to determine if it is benign (noncancerous) or malignant (cancerous). An endoscopy can also help expand the blocked area, so that food can temporarily pass through until treatment can begin.
Endoscopic ultrasound. This procedure is often done at the same time as the upper endoscopy. During an ultrasound, sound waves provide a picture of structures inside the body. During an endoscopic ultrasound, a transducer (the machine that produces the sound waves) is inserted into the esophagus through the mouth. The ultrasound can identify if the tumor invades the wall of the esophagus, how deep the tumor is, and whether lymph nodes are involved, which may indicate advanced disease.
Bronchoscopy. Similar to an upper endoscopy, the doctor passes a thin, flexible tube with a light on the end into the mouth or nose, down through the windpipe, and into the breathing passages of the lungs. A bronchoscopy may be performed if a patient's tumor is located in the upper two-thirds of the esophagus to determine if the tumor is invading the person's airway, including the trachea and bronchial tree.
Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body.
Positron emission tomography (PET) scan. In a PET scan, radioactive sugar molecules are injected into the body. Cancer cells absorb sugar more quickly than normal cells, so they light up on the PET scan. PET scans are often used to complement information gathered from CT scan, MRI, and physical examination.
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.
One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.
TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
How large is the primary tumor and where is it located? (Tumor, T)
Has the tumor spread to the lymph nodes? (Node, N)
Has the cancer metastasized to other parts of the body? (Metastasis, M)
Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe a patient's tumor in more detail. Specific tumor stage information is listed below.
TX: The primary tumor cannot be evaluated.
T0: There is no cancer in the esophagus.
Tis: Refers to carcinoma (cancer) in situ. Cancer in situ is very early cancer, where cancer cells are found only in one small area and have not spread at all. Cancer cells are in only the top lining of the esophagus without any invasion into the lining.
T1: There is a tumor in the lamina propria and submucosa (the two inside layers of the esophagus). Cancer cells invade into the lining of the esophagus.
T2: The tumor is in the muscularis propria (the third layer of the esophagus). Cancer cells invade into but not through the muscle wall of the esophagus.
T3: The tumor is in the adventitia (the outer layer of the esophagus). Cancer cells invade through the entire muscle wall of the esophagus into surrounding tissue.
T4: The tumor has spread outside the esophagus into areas around it. Cancer cells invade into structures surrounding the esophagus, including the aorta, windpipe, and diaphragm.
Node. The "N" in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. In esophageal cancer, lymph nodes near the esophagus and in the chest are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.
NX: The lymph nodes cannot be evaluated.
N0: The cancer was not found in the lymph nodes.
N1: The cancer has spread to the lymph nodes within the chest, near the tumor.
Distant metastasis. The "M" in the TNM system indicates whether the cancer has spread to other parts of the body. In esophageal cancer, metastasis is described depending on what part of the esophagus the cancer started in: the lower thoracic esophagus (closest to the stomach), middle or midthoracic esophagus, or upper thoracic esophagus (closest to the neck).
MX: Metastasis cannot be evaluated.
M0: The disease has not metastasized.
M1: There is metastasis to another part of the body.
Tumors of the lower thoracic esophagus
M1a: The cancer has spread to the celiac nodes (the lymph nodes in the abdomen).
M1b: The cancer has spread to other parts of the body.
Tumors of the midthoracic esophagus
M1a: This term is not used.
M1b: The cancer has spread to distant lymph nodes or other parts of the body.
Tumors of the upper thoracic esophagus
M1a: The cancer has spread to the cervical nodes (the lymph nodes in the neck).
M1b: The cancer has spread to other parts of the body.
Tumor grade. The tumor may also be described by something called the grade. Grade is determined after the doctor determines how much like normal tissue the tumor appears, based on biopsy results. A microscope is used to view the cells. Normal tissue usually has different types of cells grouped together (also called differentiated tissue). Tissue that is cancerous usually is made up of cells that look more alike each other. In general, the more differentiated the tissue, the better the prognosis.
G1: The tissue looks more like normal cells (well differentiated).
G2: The cells are somewhat more abnormal (somewhat differentiated).
G3: The tumor cells look very much abnormal and barely resemble normal cells (poorly differentiated).
G4: The cancer cells look almost alike and do not look like normal cells at all (not differentiated).
Cancer stage grouping
Doctors assign the stage of the cancer by combining the T, N, and M classifications.
Stage I: This is the same as T1 cancer, which is cancer in the two inside layers of the esophagus. (T1, N0, M0)
Stage III: Cancer is in the outside layer of the esophagus or in the tissues near the esophagus. Cancer is also in the lymph nodes, either near the tumor or somewhere else in the body. (T3 or T4, N1, M0)
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.
The treatment of esophageal cancer depends on the size and location of the tumor, whether the cancer has spread, and the patient's overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. Often, specialists will recommend combining three approaches to cancer treatment-radiation therapy, chemotherapy, and surgery-for patients with tumors that have not spread beyond the esophagus and lymph nodes. The order of treatments varies, but more commonly chemotherapy and radiation therapy are being recommended before surgery (or instead of surgery in some cases). Two important studies show an advantage to using chemotherapy plus radiation therapy before surgery, rather than surgery alone.
Surgery
Surgery has traditionally been the most common treatment for esophageal cancer. A doctor may remove the esophagus in an operation called an esophagectomy and then connect the remaining healthy part of the esophagus to the stomach, so the patient can swallow normally. The stomach or part of the intestine may sometimes be used to make the connection. The doctor also removes lymph nodes around the esophagus.
If the surgeon cannot remove the entire tumor, a combination of chemotherapy (see below) and radiation therapy (see below) may be used before surgery to shrink the tumor. For people who cannot undergo surgery, the best treatment option will likely combine chemotherapy and radiation therapy.
To help patients eat and relieve symptoms caused by the cancer, surgeons can also:
Create a bypass, or new pathway, to the stomach (if a tumor blocks the esophagus but cannot be removed)
Put in a percutaneous gastrostomy or jejunostomy (also called a feeding tube), so a person can receive nutrition directly into the stomach or intestine. This may be done before chemotherapy and radiation therapy is given to ensure that the patient can eat enough food to maintain his or her weight and strength during that phase of the treatment.
Dilate (expand) the esophagus (this procedure may have to be repeated if the tumor grows)
Put a tube, called an esophageal stent, into the esophagus to keep it open
Use photodynamic therapy (lasers or light therapy; see below) to destroy cancerous tissue and relieve blockages
People who have had trouble eating and drinking may need intravenous (IV) feedings and fluids for several days before and after the operation, as well as antibiotics to prevent or treat infection. Patients learn special coughing and breathing exercises to keep their lungs clear.
Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.
Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases.
Photodynamic therapy
Photodynamic therapy is used to make swallowing easier, especially in people who cannot, or choose not, to receive surgery, radiation therapy, or chemotherapy. In photodynamic therapy, a light-sensitive substance is injected into the tumor and stays longer in cancer cells than in normal cells. A laser is directed at the tumor, destroying the cancer cells. Although photodynamic therapy may relieve swallowing problems for a brief period, it is not a curative therapy.
Advanced esophageal cancer
Cancer of the esophagus is most successfully treated when it is found in the earliest stages, before it has spread. However, since early esophageal cancer causes few symptoms, it is usually advanced at the time of the diagnosis. Recurrent disease means that the cancer has come back after it has been treated. It may come back in the esophagus or in another part of the body. In advanced or recurrent esophageal cancer, the goal of treatment is usually to prolong life, while relieving symptoms such as pain and trouble eating.
Treatment for advanced esophageal cancer usually involves chemotherapy. Radiation therapy can help relieve pain or discomfort. An esophageal stent, laser therapy, or photodynamic therapy may help keep the esophagus open.
Doctors and scientists are always looking for better ways to treat patients with esophageal cancer. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.
Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding new drugs and therapies is the only way to make progress in treating esophageal cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with esophageal cancer.
To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient's options, so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
Cancer and cancer treatment can cause a variety of side effects; some are easily controlled, and others require specialized care. Below are some of the side effects that are more common to esophageal cancer and its treatments. For more detailed information on managing these and other side effects of cancer and cancer treatment, visit the Cancer.Net Managing Side Effects section.
Diarrhea. Diarrhea is frequent, loose, or watery bowel movements. It is a common side effect of certain chemotherapy or of radiation therapy.
Difficulty swallowing (dysphagia). Dysphagia occurs when a patient has trouble getting food or liquid to pass down the throat. Some patients may gag, cough, or choke when trying to swallow, while others experience pain or feel like food is stuck in the throat. Difficulty swallowing is a relatively common side effect of some cancer treatments. Potential side effects of cancer treatment that can cause swallowing difficulties include soreness, pain, or inflammation in the throat, esophagus, or mouth (mucositis); dry mouth from radiation treatment or chemotherapy; infections of the mouth or esophagus from radiation treatment or chemotherapy; swelling or constriction of the throat or esophagus from radiation treatment or surgery; and physical changes to the mouth, jaw, throat, or esophagus as a result of surgery.
Fluid in the abdomen (ascites). Ascites is the buildup of fluid in the abdomen, in the area around the organs known as the peritoneal cavity. Ten percent (10%) of all ascites is caused by cancer and is called malignant ascites. Most cancer-related ascites appears in patients with cancers of the ovary, endometrium (lining of the uterus), breast, colon, gastrointestinal (GI) system, or pancreas. These cancers can cause fluid to build up in the body. People with ascites may experience weight gain, abdominal swelling, a sense of fullness or bloating, a sense of heaviness, indigestion, nausea and/or vomiting, changes to the navel, hemorrhoids (a condition that causes painful swelling near the anus), or ankle swelling. This problem can be treated by using diuretic pills to help the kidneys get rid of the fluid or by removing the fluid through a tube inserted temporarily through a needle into the area where the fluid has built up. Sometimes, an ultrasound technician will help to guide the needle to where the fluid is present.
Hair loss (alopecia). A potential side effect of chemotherapy is hair loss. Chemotherapy causes hair loss by damaging the hair follicles responsible for hair growth. Hair loss may occur throughout the body, including the head, face, arms, legs, underarms, and pubic area. The hair may fall out entirely, gradually, or in sections. In some cases, the hair will simply thin - sometimes unnoticeably - and may become duller and dryer. Losing one's hair can be a psychologically and emotionally challenging experience and can affect a patient's self-image and quality of life. However, the hair loss is usually temporary, and the hair often grows back.
Hypercalcemia. Hypercalcemia is an unusually high level of calcium in the blood. Hypercalcemia can be life threatening and is the most common metabolic disorder associated with cancer, occurring in 10% to 20% of patients with cancer. While most of the calcium in the body is stored in the bones, about 1% of the body's calcium circulates in the bloodstream. Calcium is important for many bodily functions, including bone formation, muscle contractions, and nerve and brain function. Patients with hypercalcemia may experience loss of appetite, nausea and/or vomiting; constipation and abdominal pain; increased thirst and frequent urination; fatigue, weakness, and muscle pain; changes in mental status, including confusion, disorientation, and difficulty thinking; and headaches. Severe hypercalcemia can be associated with kidney stones, irregular heartbeat or heart attack, and eventually loss of consciousness and coma.
Infection. An infection occurs when harmful bacteria, viruses, or fungi (such as yeast) invade the body and the immune system is not able to destroy them quickly enough. Patients with cancer are more likely to develop infections because both cancer and cancer treatments (particularly chemotherapy and radiation therapy to the bones or extensive areas of the body) can weaken the immune system. Symptoms of infection include fever (temperature of 100.5°F or higher); chills or sweating; sore throat or sores in the mouth; abdominal pain; pain or burning when urinating or frequent urination; diarrhea or sores around the anus; cough or breathlessness; redness, swelling, or pain, particularly around a cut or wound; and unusual vaginal discharge or itching.
Mouth sores (mucositis). Mucositis is an inflammation of the inside of the mouth and throat, leading to painful ulcers and mouth sores. Mucositis can be caused by chemotherapy directly, the reduced immunity brought on by chemotherapy, or radiation treatment to the head and neck area.
Nausea and vomiting. Vomiting, also called emesis or throwing up, is the act of expelling the contents of the stomach through the mouth. It is a natural way for the body to rid itself of harmful substances. Nausea is the urge to vomit. Nausea and vomiting are common in patients receiving chemotherapy for cancer and in some patients receiving radiation therapy. Many patients with cancer say they fear nausea and vomiting more than any other side effects of treatment. When it is minor and treated quickly, nausea and vomiting can be quite uncomfortable, but cause no serious problems. Persistent vomiting can cause dehydration, electrolyte imbalance, weight loss, depression, and avoidance of chemotherapy.
Pain. Depending on the stage of disease, 30% to 75% of all patients experience pain from cancer. About 85% to 95% of cancer pain can be treated successfully. Pain can make other aspects of cancer seem worse, such as fatigue (tiredness), weakness, sleep disturbance, and confusion. Pain can come from the tumor itself or may be a result of cancer treatment. Pain from a tumor can be a result of the tumor growing and spreading to the bones or other organs and putting pressure on and damaging nerves. Pain from surgery is normal and may persist for months or years. Common procedures that cause pain afterward include mastectomy (removal of the breast and, occasionally, the surrounding tissue), chest surgery, neck surgery, and amputation of a limb (stump pain). Phantom pain is perceived pain in an organ or limb that has been removed. Pain may develop after radiation therapy and go away on its own. It can also develop months or years after treatment, especially after radiation therapy to the chest, breast, or spinal cord. Certain chemotherapy can cause pain along with numbness in the fingers and toes. Usually this pain goes away when treatment is finished, but sometimes the damage can be permanent.
Weight loss. Weight loss is common among patients with cancer and is often the first sign that people with cancer notice. Up to 40% of people with cancer report unexplained weight loss at first diagnosis, and up to 80% of patients with advanced cancer experience weight loss and general wasting, called cachexia. Weight loss is more common in patients with solid tumors than in people with blood cancers. Weight loss is often associated with fatigue, weakness, loss of energy, and inability to perform everyday tasks. Often patients experiencing cachexia cannot tolerate treatments as well, and may experience normal symptoms with greater severity. Weight loss often begins when a patient stops eating (called anorexia). In addition, cancer can cause changes to the immune system or metabolism that can result in weight loss and appetite loss. Nausea and/or vomiting, constipation, mouth sores, difficulty swallowing, loss of taste, and depression may also affect a patient's appetite and cause weight loss.
After treatment for esophageal cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. If the treatment has destroyed the tumor, follow-up treatment may include evaluation with CT scans and upper endoscopy to watch for possible recurrence.
It is advised that patients who have undergone an esophagectomy (removal of the esophagus) sleep with the head of the bed elevated to avoid acid reflux, as the stomach has been surgically moved up into the chest.
People recovering from esophageal cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. For esophageal cancer survivors who smoke, quitting smoking can help recovery and reduce the risk of cancer recurrence. Learn more about Quitting Smoking.
Moderate exercise can help you rebuild your strength and energy level. Talk with your doctor about helping you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about Healthy Living After Cancer.
Research for esophageal cancer is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this current time. Always discuss all diagnostic and treatment options with your doctor.
Chemoprevention. Some evidence suggests that epigallocatechin, a compound found in green tea, may reduce the risk of esophageal squamous cell cancer. Researchers found that people who had this chemical in their urine had a statistically significant, reduced risk of esophageal and gastric (stomach) cancers. Other clinical trials are looking at the use of aspirin and antacids to prevent esophageal adenocarcinoma in people with Barrett's esophagus. Research is still ongoing, and people are encouraged to talk with their doctor before taking any medications or dietary supplements.
Combination therapy. Recent research studies have explored the addition of either chemotherapy, or a combination of chemotherapy and radiation therapy, before surgery. Some research has shown that adding these therapies to surgery improves survival compared with surgery alone. Doctors continue to evaluate both of these presurgical approaches for esophageal cancer.
Doctors are also studying combinations of different drugs, such as cisplatin (Platinol), fluorouracil (5-FU, Advicil), paclitaxel (Taxol), irinotecan (Camptosar), docetaxel (Taxotere), oxaliplatin (Eloxatin), and capecitabine (Xeloda).
New drugs and drug targets. Several promising therapies for esophageal cancer block the molecular pathways used by growing cells. In cancer, these pathways are permanently switched "on," causing uncontrolled cell growth.
A monoclonal antibody that binds and inactivates the epidermal growth factor receptor (EGFR) is being tested in clinical trials in advanced disease, and in combination with radiation therapy. EGFR is a protein that regulates cell growth and is overly active in cancer cells.
A growth factor called vascular endothelial growth factor (VEGF) is also a target for therapy. Researchers have discovered high levels of this protein in the serum of patients with late-stage or advanced esophageal cancer. Neutralizing the effects of VEGF through drugs or monoclonal antibodies is now being studied in advanced disease and in combination with radiation therapy.
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
What type of esophageal cancer do I have?
Is my cancer limited to the esophagus?
What is the stage of the disease? What does this mean?
What are my treatment options?
Is surgery required as part of therapy of my localized esophageal cancer?
How experienced is the surgeon in this type of surgery?
Are there local radiation therapy and surgery options to treat my cancer?
Can chemotherapy control my cancer?
What is the goal of each treatment?
What clinical trials are open to me?
What treatment, or combination of treatments, do you recommend? Why?
What are the possible short-term and long-term side effects of each treatment?
What is my prognosis?
What follow-up tests will I need, and how often will I need them?
What support services are available to me? to my family?
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