Important Facts About Esophageal Cancer

by Jane Ashley

April is the month that we highlight esophageal cancer, one of the faster increasing cancer diagnoses in the Western world, increasing 600 percent in the last 35 years. Most of us hear about breast, colorectal and lung cancers, but every adult needs to be aware of the risk factors and early symptoms of esophageal cancer.


What is the Esophagus?

The esophagus is the narrow, muscular tube that connects our mouth to our stomach. The muscular walls of our esophagus push food from our mouth and the liquids we drink into our stomach. The esophagus is between 11 and 13 inches long (28-33 cm) and about three-quarters of an inch in diameter (2 cm).

Our esophagus consists of four layers.

Inner lining. This lining is moist to help the food pass into the stomach.
Submucosa. The glands that produce the moist mucous are located here.
Muscle layer. These muscles push the food we eat down in our stomach.
Outer layer. The layer that covers our esophagus.

These layers are important because different types of esophageal cancer attack different layers and sections of the esophagus.

About 17,650 people (13,750 men and 3,900 women) will be diagnosed in the U.S. during 2019. Given the disproportionate number of men diagnosed with esophageal cancer, it is not surprising that it the seventh most common cause of cancer death in men in the U.S. Every 36 minutes, someone dies of esophageal cancer in the U.S.

Risk Factors for Esophageal Cancer

There are two types of esophageal cancer. Risk factors vary by which type of esophageal cancer a patient has.

Squamous cell carcinoma. Begins in the squamous cells of the lining of the esophagus and is usually located in the upper and middle regions of the esophagus.

Alcohol Tobacco Risk Factors

Alcohol consumption (particularly heavier consumption) – alcohol contains two substances that cause changes in our DNA – ethanol and acetaldehyde.

Achalasia – a condition when the lower ring of the esophagus does not during the swallowing of food.
Diet – low consumption of fruits and vegetables.
Hot liquids – drinking liquids at extremely high temperatures.
Lye – children who accidentally swallowed lye are at increased risk.
Race – African-Americans are twice as likely to develop squamous cell esophageal cancer.
Tobacco – using any type of tobacco increases the risk, whether it’s cigarettes, cigars, pipes or smokeless tobacco products like chewing tobacco or snuff.

Adenocarcinoma. Begins in the glandular tissue in the lower portion of the esophagus.

Acid reflux – especially if frequent and severe. Presence of a hiatal hernia can increase acid reflux. Some people with acid reflux develop Barrett's esophagus, which is a risk factor for esophageal cancer.
Obesity – being overweight increases the risk of adenocarcinoma of the esophagus.
Men are 3 to 4 times more likely to develop either type of esophageal cancer. Growing older is an unavoidable risk factor. Esophageal cancer occurs most often in people, aged 45 to 70.

What Are the Symptoms of Esophageal Cancer?

The sad reality of esophageal cancer is that there are few, if any symptoms, in its earliest stages. Most people don’t have symptoms until the tumor is large enough to block the esophagus making swallowing difficult.

Pressure or burning in the chest
Difficulty swallowing
Indigestion or heartburn
Frequent choking on food
Unexplained weight loss
Coughing or hoarseness
Pain behind the breastbone or in the throat

Diagnostic Tests

Some specialized tests help doctors determine if you have esophageal cancer. They will take a complete medical history and evaluate any risk factors you have. Your risk factors and symptoms help your physician determine what tests to perform.

Barium swallow. Patients swallow a liquid containing barium. The barium coats the esophagus. Then X-rays are taken – a tumor or other abnormality will stand out on the X-ray.

Upper endoscopy. Sometimes, called an “upper GI” — this test allows a gastroenterologist to look at the esophagus through a thin, flexible tube. A suspicious area can be biopsied.

Endoscopic ultrasound. This ultrasound is perform at the same time as the upper endoscopy. The ultrasound produces a picture/map of the walls of the esophagus and near-by lymph nodes. The ultrasound shows how deep a tumor has grown into the wall of the esophagus. The ultrasound also helps in getting a biopsy of lymph nodes.

Imaging tests. Imaging tests allow your medical team to see if a tumor has spread to local areas or other parts of your body. These tests include CT scans, PET scans and MRIs.

These diagnostic tests also provide sufficient information for staging of esophageal cancer.

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What Treatments Are Available?

Surgery may be all that is needed for early-stage esophageal cancer. Surgery may also provide relief of symptoms — this is known as palliative care. A feeding tube may be placed before beginning chemotherapy or radiation so that a patient receives the nutrition they need.

Palliative endoscopy includes an endoscopic procedure to dilate their esophagus, or physicians may place an expandable, metal mesh stent to keep the esophagus open. Specialized procedures to freeze or heat cancer cells may provide symptom relief before and during treatment.

Radiation therapy aims X-ray beams at the tumor to shrink the tumor. Occasionally, internal radiation to the tumor by temporarily inserting a radioactive wire into the esophagus. Clinical trials are underway using proton therapy.

Chemotherapy, targeted therapy and immunotherapy are other tools to treat esophageal cancer. Every patient’s particular circumstances differ so treatment is personalized for the patient. If a patient has metastatic esophageal cancer, genetic testing helps oncologists choose a targeted therapy or immunotherapy which will be effective.

Clinical trials. Many patients opt for a clinical trial to have access to new cutting-edge medication and radiation therapies.


Patients at high risk may want to consider chemoprevention. Patients who have Barrett’s esophagus may want to talk to their gastroenterologist about this pro-active method of preventing the development of esophageal cancer.

New chemotherapy combinations offer new hope. More patients with genetic mutations will benefit from targeted therapy and immunotherapy. Never underestimate the value of a second opinion.

Esophageal Resources Pages

Esophageal Cancer Awareness Association
Esophageal Cancer Education Association
Esophageal Cancer Action Network

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