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Cancer InDepth: Esophageal Cancer
Esophageal cancer is a malignant growth of tissues that line the inner surface of the esophagus.
The esophagus is the tube that connects your throat with your stomach. It runs the length of your chest, between your lungs, behind your heart, and in close proximity to your back bone. The esophagus is a complex, four-layered muscular organ. It propels food into your stomach with a series of rhythmic contractions called peristalsis. The depth of cancer invasion is important in determining the stage, prognosis, and appropriate treatment.
There are two main types of esophageal cancer:
Squamous cell carcinoma—This type of cancer begins in the squamous cells, the top layer of the lining of the esophagus. Squamous cell carcinoma can occur anywhere in the esophagus. The incidence has been decreasing, accounting for less than half of all esophageal cancers in the United States.
Adenocarcinoma—This type of cancer arises from Barrett’s esophagus. Barrett’s esophagus occurs when the squamous cells in the lower esophagus are exposed to acid from the stomach due to acid reflux. The acid causes the cells to change from squamous cells, which are flat, to cells shaped like columns. These column-shaped cells are the hallmark of Barrett’s esophagus and can eventually become an adenocarcinoma.
The incidence of adenocarcinoma, particularly in the United States, has been rising for many years.
Who Is Affected
Esophageal cancer is 3-4 times more common in men than in women. It is also more common in countries outside the United States.
Squamous cell carcinoma—More common in African-Americans, in people aged 60 years and older, and outside the US.
Adenocarcinoma—More common in Caucasians, people aged 50 years and older, and in the US.
Causes and Complications
There are many risk factors for esophageal cancer that appear to be causative. Many are ingested agents that do damage directly to the esophagus, like excess alcohol, nitrates, toxins in pickled vegetables, and very hot beverages. Other irritants that increase the risk of esophageal cancer are radiation, tobacco, smoked opiates, and gastroesophageal reflux disease (GERD).
Ionizing radiation, as experienced by survivors of the atomic bomb, has been associated with a higher rate of esophageal cancer. Obesity is also associated with a higher risk. Additionally, the condition may run in families. Plummer-Vinson syndrome (a rare disorder characterized by anemia due to a low iron level and low levels of certain nutrients) has been associated with a higher risk for esophageal cancer in women residing in Sweden. Celiac disease, a disorder characterized by malabsorption, has also been linked to this form of cancer.
Esophageal cancer restricts and ultimately prevents swallowing, leading to weight loss, malnutrition, and starvation. Food and liquids not swallowed can be diverted into the lungs, causing choking, aspiration, and pneumonia. Inability to swallow liquids can lead to death by dehydration. Occasionally the cancer erodes into the breathing tubes creating a tracheo-esophageal fistula, through which food passes directly into the lungs.
Metastases from esophageal cancer can lodge anywhere in the body, most frequently ending up in the liver, lungs, brain, and bones. About 80% of patients with this disease die within five years of diagnosis.
Esophageal cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated June 2, 2013. Accessed August 2, 2013.
Esophageal cancer. National Cancer Institute website. Available at: http://www.nci.nih.gov/cancerinfo/wyntk/esophagus. Accessed August 2, 2013.
Esophagus cancer. American Cancer Society website. Available at http://www.cancer..... Accessed August 2, 2013.
Last reviewed August 2013 by Mohei Abouzied, MD; Michael Woods, MD
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