Cancer of the Esophagus

Cancer of the Esophagus Introduction

The  esophagus is a muscular tube measuring 20-25 cm (8-10 in) long and 2-3 cm (0.75-1.25 in) wide that serves as a conduit for moving food and drink from the mouth to the stomach. Two major types of esophageal cancers exist, as follows:

• Squamous cell carcinoma arises from the epithelial cells that line the esophagus.
  
  
• Adenocarcinoma arises from the esophageal glands or within a segment of Barrett esophagus.
  
  
• Most tumors occur in the lower esophagus.
  
  
  • Forty percent occur in the lowest third.
    
    
  • Forty-five percent occur in the middle third.
    
    
  • Fifteen percent occur in the upper third.

Risk Factors

Both types of esophageal cancer more commonly affect men older than 60 years, but risk factors for adenocarcinoma are different from those of squamous cell carcinoma.

• Adenocarcinoma of the esophagus is most commonly seen within a segment of Barrett esophagus, chronic peptic sores in the lower esophagus. This is an acquired condition characterized by precancerous cells that replace the normal cellular lining of the lowest portion of the esophagus. The condition occurs as a complication of chronic reflux of gastric contents (GERD) into the lower esophagus.
  
  
• Squamous cell carcinoma occurs more commonly in people who heavily use tobacco and alcohol or who have previously swallowed some caustic substance, for example lye. The disease is also more common in people who have been diagnosed with squamous cell cancer of the head and neck.
  
  
• Men are up to 5 times more likely than women to be diagnosed with esophageal cancer.
  
  
  • Among men, African Americans have the highest rate, more than 2.7 times greater than the rate for non-Hispanic white men.
    
    
  • Incidence rates generally increase with age in all racial and ethnic groups.
  
  
• Cancer of the esophagus is a common cancer in developing countries of the world, where most tumors are squamous cell cancers.
  
  
• Important risk factors in developing countries include the following:
  
  
  • Nutritional deficiencies related to lack of fresh fruit and vegetables
    
    
  • Drinking hot beverages
    
    
  • A range of chewing and smoking habits
    
    
  
  
• In the developed world, adenocarcinoma is becoming almost as common as squamous cell cancer.

Cancer of the Esophagus Symptoms

• Symptoms of esophageal cancer usually do not show up until the disease has reached an advanced stage.
  
  
• The most common symptom is difficulty swallowing (dysphagia).
  
  
  • Initially, swallowing solids is difficult.
    
    
  • Over time, even swallowing liquids becomes difficult.
  
  
• The following symptoms may accompany cancer of the esophagus. Any of these symptoms are indications of advanced disease and should be considered as a sign to get medical attention.
  
  
  • Weight loss
    
    
  • Central chest pain
    
    
  • Pain upon swallowing
    
    
  • Vomiting
    
    
  • Chronic cough
    
    
  • Symptoms of gastrointestinal bleeding
    
    
    • Black stools
      
      
    • Vomiting blood or material that looks like coffee grounds