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As the name implies, esophageal cancer is a malignant process located on the esophagus (food pipe). There are several different subtypes of esophageal tumors but they all usually lead to dysphagia – difficulty swallowing, pain, and other symptoms.

The histological type could be only diagnosed with biopsy. 
 
Less common than lung cancer, but no less serious, esophageal cancer starts in the inner layer of the esophagus. The esophagus is the 10-inch long tube that connects the patient’s throat and stomach. The outlook for people with esophageal cancer is poor, but in the past few years survival rates have improved, mostly because close monitoring of Barrett's esophagus – one serious, pre-malignant complication of acid reflux.

Incidence and Prevalence

Experts from the National Cancer Institute (NCI) are saying that esophageal cancer is the third most common cancer of the digestive tract and the seventh leading cause of cancer-related deaths worldwide. Statistical data tells us that the incidence of this disease is highest in men over the age of 50 but, it has also been proven that it varies considerably according to geographic location.
 
It is more common in northern China, northern Iran, and southern republics of the former Soviet Union, and is less common in Japan, Great Britain, Europe and Canada. In the United States incidence is highest in urban areas, and overall incidence is about 5 in 100,000.
 

Signs and Symptoms

A serious diagnostic problem of the fact that it's extremely unusual to have experience symptoms of esophageal cancer in the early stages of the disease. When the cancer is more advanced, it may be too late for any kind of treatment, but only then some of the following signs could be present:
 
Difficulty swallowing (dysphagia): This is probably the most common symptom of esophageal cancer, appearing only when the tumor has grown large enough to narrow the patient’s esophagus to about half its normal width. At this stage, the patient will probably not be able to swallow, chewing more slowly and carefully, or switching to softer foods.
 
Severe weight loss: As eating becomes more difficult, the patient may not be able to consume enough calories to maintain weight. Not only that; cancer in general can cause weight loss and muscle wasting because it changes the way the body metabolizes nutrients. That’s why a great majority of patients looks skinny and unhealthy in the late stages of disease.
 
Pain: Also a common symptom, pain can be located on different places, sometimes in the patient’s throat, sometimes in mid-chest or between shoulder blades. Although not common, patients might feel pain when they swallow, or discomfort or burning behind the breastbone.
 
Cough: Hoarseness, a chronic cough, and sometimes coughing up blood is also a common symptom. This symptom a usually doesn't appear until the cancer is quite advanced.

Types of esophageal cancer

As said before, there are several different types of esophageal cancer. It can occur almost anywhere along the length of the esophagus and that’s how it is classified – according to the types of cells in which it originates. Most common forms are:
 
Squamous cell or epidermoid carcinoma:This is the most common esophageal cancer in African-Americans and the most prevalent esophageal cancer worldwide. Experts are saying that this form of cancer develops in the flat squamous cells that line the esophagus
 
Adenocarcinoma: This form of cancer arises in the glandular tissue in the lower part of the esophagus nearest the stomach. It is is more common in Caucasians, and is the fastest increasing cancer in the United States.
 
Other forms of cancer: Beside squamous cell and adenocarcinoma, there are also certain other, rare forms of the disease. These include sarcoma, lymphoma, small cell carcinoma, and spindle cell carcinoma.  

Risk factors for developing esophageal cancer

Several researches have shown that the greatest risk factors for esophageal cancer are:
  •  Heavy drinking
  •  Smoking
  • Chronic acid reflux or Barrett's esophagus
Other factors that may increase chances of developing esophageal cancer include:
 
Age: The risk of developing esophageal cancer increases as a person grows older; most people with the disease are between 45 and 70.  
Gender: Men are far more likely to develop esophageal cancer than women are.
Race: As mentioned before, squamous esophageal cancer affects African-Americans most often, whereas esophageal adenocarcinoma is more prevalent in the Caucasian and Asian-American populations.
Diet: A diet low in fruits and vegetables, as well as the overweight condition, increases the risk of esophageal cancer.
Radiation therapy: Research has confirmed that women with breast cancer who have had radiation treatments are at an increased risk of developing esophageal cancer.  

Overview of risk factors

Increased risk
  • Age (most patients are over 60)
  • Gender (it is more common in men)
  • Heavy alcohol and tobacco use 
  • Swallowing lye or other caustic substances.
  • Particular dietary substances
  • Plummer-Vinson syndrome
  • Tylosis and Howel-Evans syndrome 
  • Radiation therapy for other conditions in the mediastinum
  • Celiac disease and primary biliary cirrhosis
  • Gastroesophageal reflux disease (GERD) 
  • Certain eating habits
Decreased risk
  • Risk appears to be less in patients using aspirin or related drugs (NSAID)
  • Helicobacter pylori may carry a protective effect
  • Diets high in cruciferous (cabbage, broccoli, cauliflower) and green and yellow vegetables and fruits   
  • Various kinds of berries, particularly raspberries and black raspberries, have protective properties against cancer of the esophagus  

Possible complications

The most common complication of esophageal cancer is difficulty swallowing. 
 
Other complications of esophageal cancer include:
 
Severe, unintended weight loss: About 50% of esophageal cancer patients experience severe weight loss and weakness.
 
Metastasis: The most serious complication of esophageal cancer is metastasis. Since esophageal tumors are rarely discovered in the early stages, they often spread to nearby lymph nodes or to other parts of body.
 
Tracheoesophageal fistula: This occurs when a tumor creates a hole between your esophagus and windpipe, leading to coughing and gagging when you swallow.

Treatment

Surgery: An operation is possible if the disease is localized, which is the case in only 20-30% of patients. The operation is called the esophagectomy and it involves removal of a segment of the esophagus. This shortens the distance between the throat and the stomach, so some other segment of the digestive tract is typically placed in the chest cavity and interposed.  
 
Laser therapy: The use of high-intensity light to destroy tumor cells is typically chosen if the cancer cannot be removed by surgery. The relief of a blockage can help reduce dysphagia and pain.  
 
Chemotherapy: Also a very good and effective treatment option, it depends on the tumor type. It tends to be cisplatin-based every three weeks with fluorouracil (5-FU) either continuously or every three weeks. Chemotherapy may be used at different times – after surgery, before surgery (neoadjuvant), or if surgery is not possible; in this case, cisplatin and 5-FU are used.  
 
Radiotherapy: Radiotherapy has been in use for many years, and has shown to be a highly effective cancer treatment option, although not without side effects. This form of therapy can be given before, during or after chemotherapy or surgery, and sometimes on its own to control symptoms. In patients with a localized disease but contraindications to surgery, one special form of radiotherapy called the "radical radiotherapy" may be used with curative intent, instead of an operation.

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