Esophageal Cancer

Esophageal Cancer at a Glance

• The incidence of esophageal cancer has risen in recent decades.
• Several risk factors include age 65 or older, being male, smoking, heavy drinking, low fiber diet, acid reflux disorder, obesity.
• The most common symptoms are food getting stuck in the esophagus, food that comes back up, pain when swallowing, pain in the chest or back, weight loss, heartburn, hoarse voice or cough that persists.

Esophageal cancer is a form of cancer that forms in tissues lining the esophagus. The incidence of esophageal cancer has risen in recent decades, coinciding with a shift in histologic type and primary tumor location. Adenocarcinoma of the esophagus is now more prevalent than squamous cell carcinoma in the United States and Western Europe, with most tumors located in the distal esophagus.

Estimated new cases and deaths from esophageal cancer in the United States in 2010 are 16,640 and 14,500 respectively.

The Esophagus

The esophagus is in the chest. It's about 10 inches long. This organ is part of the digestive tract. Food moves from the mouth through the esophagus to the stomach. The esophagus is a muscular tube. The wall of the esophagus has several layers:

• Inner layer or lining (mucosa): The lining of the esophagus is moist so that food can pass to the stomach.
• Submucosa: The glands in this layer make mucus. Mucus keeps the esophagus moist.
• Muscle layer: The muscles push the food down to the stomach.
• Outer layer: The outer layer covers the esophagus.

About Esophageal Cancer

Normally cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place. Sometimes, this process goes wrong. New cells form when the body does not need them, and old or damaged cells do not die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor. Growths in the wall of the esophagus can be benign or malignant. The smooth inner wall may have an abnormal rough area, an area of tiny bumps, or a tumor. Benign growths are not as harmful as malignant growths.

Esophageal cancer begins in cells in the inner layer of the esophagus. Over time, the cancer may invade more deeply into the esophagus and nearby tissues.

Cancer cells can spread by breaking away from the original tumor. They may enter blood vessels or lymph vessels, which branch into all the tissues of the body. The cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. The spread of cancer cells is called metastasis.

Types of Esophageal Cancer

There are two main types of esophageal cancer.

• Adenocarcinoma of the esophagus: This type is usually found in the lower part of the esophagus, near the stomach. In the United States, adenocarcinoma is the most common type of esophageal cancer. It's been increasing since the 1970s.
• Squamous cell carcinoma of the esophagus: This type is usually found in the upper part of the esophagus. This type is becoming less common among Americans. Around the world, however, squamous cell carcinoma is the most common type.

Risk Factors

A risk factor is something that may increase the chance of getting a disease. Studies have found the following risk factors for esophageal cancer:

• Age 65 or older: Age is the main risk factor for esophageal cancer. The chance of getting this disease goes up as you get older. In the United States, most people are 65 years of age or older when they are diagnosed with esophageal cancer.
• Being male: In the United States, men are more than three times as likely as women to develop esophageal cancer.
• Smoking: People who smoke are more likely than people who don't smoke to develop esophageal cancer.
• Heavy drinking: People who have more than 3 alcoholic drinks each day are more likely than people who don't drink to develop squamous cell carcinoma of the esophagus. Heavy drinkers who smoke are at a much higher risk than heavy drinkers who don't smoke. In other words, these two factors act together to increase the risk even more.
• Diet: Studies suggest that having a diet that's low in fruits and vegetables may increase the risk of esophageal cancer. However, results from diet studies don't always agree, and more research is needed to better understand how diet affects the risk of developing esophageal cancer.
• Obesity: Being obese increases the risk of adenocarcinoma of the esophagus.
• Acid reflux: Acid reflux is the abnormal backward flow of stomach acid into the esophagus. Reflux is very common. A symptom of reflux is heartburn, but some people don't have symptoms. The stomach acid can damage the tissue of the esophagus. After many years of reflux, this tissue damage may lead to adenocarcinoma of the esophagus in some people.
• Barrett esophagus: Acid reflux may damage the esophagus and over time cause a condition known as Barrett esophagus. The cells in the lower part of the esophagus are abnormal. Most people who have Barrett esophagus don't know it. The presence of Barrett esophagus increases the risk of adenocarcinoma of the esophagus. It's a greater risk factor than acid reflux alone.