Esophageal cancer is a cancer that forms in tissues lining the esophagus. The esophagus is a muscular tube through which food passes from the mouth to the stomach. Its inner surface is lined by flat cells, called squamous cells. 

There are two types of esophageal cancer:

• Squamous: This cancer has been tied to smoking and excessive drinking
• Adenocarcinoma: Seems to be more closely related to heartburn, and possibly other things like hazardous chemicals and inhalants. In the past, most cancers arose from squamous cells. It is now believed that about half of all esophageal cancers arise from adenocarcinomas cells.

What Causes Esophageal Cancer?

In most cases the cause of esophageal cancer is unclear but certain factors are known to play a part. These include longstanding acid reflux, alcohol and tobacco. Barrett’s esophagus can lead to adenocarcinoma of the esophagus. The disorder is more frequent in old age.

Risk Associated with Esophageal Cancer?

In about 5% of individuals with inflammation in the esophagus from acid reflux or gastroesophageal reflux disorder (GERD), the cells at the lower end of the esophagus are replaced by glandular cells resembling those of the stomach and small intestine. This change is referred to as Barrett’s esophagus. This disorders is believed to increase the risk of developing esophageal cancer.

Unfortunately, because of its aggressive nature, the outlook for patients with esophageal cancer is not good and fewer than 5% of patients survive more than five years. It is estimated that 1,600 – 1,800 Canadians will be diagnosed with esophageal cancer in 2009. Three out of every four esophageal cancer patients are male.

Trouble with swallowing or sticking of solid food is usually the first symptom and with time this becomes more persistent and severe. Eventually it becomes difficult to even swallow liquids. Trouble with swallowing should always be investigated. Some pain behind the breastbone and weight loss can occur.

The first investigation for swallowing problems may be a barium X-ray (upper GI series) and this is generally followed by endoscopy. This safe test involves the insertion of a slim, flexible tube with a TV camera at one end into the esophagus. It allows the doctor to see the cause of narrowing and to biopsy (take tissue samples for examination under a microscope) any abnormalities of endoscopic therapy include laser or electrical burning of the cancer. Photodynamic therapy uses chemicals and light to destroy the abnormal cells on the surface lining, but is used most commonly in Barrett’s esophagus.

Testing for esphageal cancer

The following procedures are used to test for esophageal cancer:

• Barium x-rays: Also called upper and lower GI series, x-rays use barium sulfate, a metallic chemical that x-rays cannot pass through, to take an image of the area under examination.
• Endoscopy: This safe test involves the insertion of a slim, flexible tube with a TV camera at one end into the esophagus. It allows the doctor to see the cause of narrowing and to biopsy (take tissue samples for examination under a microscope) any abnormalities.

Treating Esophageal Cancer

Unfortunately, most cancers are too advanced to be cured. Several types of treatment are used for esophageal cancer. Usually, the only curative treatment is surgical removal of the esophagus.

Other forms of treatment include chemotherapy, radiotherapy and endoscopic therapy. Chemotherapy and radiotherapy together appear better than either in isolation.Endoscopic treatment is palliative and is intended to relieve the swallowing difficulty. The most commonly used approach is the insertion of a flexible wire sleeve, called a stent, through the narrowed esophagus in order to maintain an open channel.Other forms of endoscopic therapy include laser or electrical burning of the cancer. Photodynamic therapy uses chemicals and light to destroy the abnormal cells on the surface lining, but is used most commonly in Barrett’s esophagus.

• An estimated 2,300 individuals were diagnosed with esophageal cancer in Canada in 2017, with 2,200 dying from it. (Canadian Cancer Society’s Advisory Committee on Cancer Statistics 2017)
• The 5-year survival of esophageal cancer is 14%, meaning that the majority of esophageal cancer patients will die within five years of diagnosis. (Canadian Cancer Statistics Advisory Committee 2017)
• From 2003 to 2011, it is estimated that the mean net costs of esophageal cancer care per 30 patient-days were $1,016 in the initial phase, $669 in the continuing care phase, and $8,678 in the terminal phase, based on Ontario data. (Thein HH et al. 2018)

_Citations:

1. _{Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian Cancer Statistics 2017. Toronto, ON: Canadian Cancer Society; 2017. https://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2017-EN.pdf?la=en [accessed 3 September 2018]}
2. _{Thein HH et al. Estimates and predictors of health care costs of esophageal adenocarcinoma: A population-based cohort study. BMC Cancer. 2018 Jun 27;18(1):694.}

I’m having trouble swallowing. Do I have esophageal cancer?

There could be several reasons why you are having trouble swallowing. This could be an indication of serious illness. Trouble swallowing should always be investigated by your physician.

I’ve been told that I have Barrett’s Esophagus. Does this mean I will develop esophageal cancer?

Sometimes the cells at the lower end of the esophagus are replaced by glandular cells resembling those of the stomach and small intestine. This change is referred to as Barrett’s esophagus. This disorder is believed to increase the risk of developing esophageal cancer. It can be controlled with medications. You need to carefully monitor the status of the cells in your esophagus to minimize the likelihood of developing cancer.