Read more in one article: Esophageal Cancer

There are two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. Squamous cells are located in the lining of the esophagus and may gradually lead to precancerous lesions of the esophagus and even esophageal cancer if they start to proliferate abnormally under the stimulation of some triggers.

Adenocarcinoma is a cancer of the glandular cells, often caused by abnormal glandular cells replacing normal squamous cells and gradually “spreading”. It often occurs in the lower esophagus near the stomach, probably because this part of the esophagus is often exposed to stomach acid.

What are the symptoms of esophageal cancer?

Esophageal cancer may not have any symptoms in its early stages.

Symptoms of mid- to late-stage esophageal cancer include:

• Difficulty or painful swallowing
• Weight loss
• Pain behind the sternum
• Cough
• Heartiness
• Indigestion and heartburn

What are the risk factors for esophageal cancer?

The following factors are most likely to increase the risk of esophageal cancer:

• Smoking or secondhand smoke.

• Alcohol abuse.

• Gastroesophageal reflux disease (GERD), which presents as reflux of stomach contents and acid into the esophagus.
• “Barrett’s esophagus,” a condition that involves the lower esophagus and can progress to esophageal cancer. barrett’s esophagus may be caused by GERD, and over time, the refluxed stomach acid causes esophageal cells to mutate, increasing the risk of adenocarcinoma.

Various risk factors that differ in their impact on different types of esophageal cancer:

• Squamous carcinoma: Smokers or heavy drinkers are at greatest risk of developing squamous carcinoma. More than half of patients with squamous carcinoma have a history of smoking. People who smoke and drink alcohol at the same time have a much higher risk of developing this cancer than those who smoke or drink alcohol alone.

• Adenocarcinoma: Barrett’s esophagus can lead to adenocarcinoma. Smoking increases the risk of adenocarcinoma by a factor of 1, but drinking alcohol does not increase the risk of adenocarcinoma.

Also, certain groups (such as men, older adults, and obese people) have a higher risk of esophageal cancer. White men have a higher risk of esophageal adenocarcinoma, and squamous esophageal cancer is more common in Asian men and men of color.

The most vulnerable groups

How is esophageal cancer diagnosed?

To diagnose esophageal cancer, your doctor will ask about your symptoms and medical history, and perform a physical exam. In addition, your doctor may order blood tests and X-rays.

Tests related to esophageal cancer include:

• Barium contrast: You will need to swallow a liquid that attaches to the esophagus (“barium meal”), which will make the esophagus appear on an X-ray so that your doctor can recognize abnormalities.
• Endoscopy: The doctor inserts an endoscope (a thin, lighted tube) down the throat into the esophagus for examination. Sound waves are also emitted through the endoscope’s ultrasound probe to obtain details of tumor involvement of adjacent tissues.
• Biopsy: During the endoscopy, the doctor can remove cells or tissue from the patient’s esophagus and look under a microscope for cancer cells.

In addition, the doctor may perform computed tomography (CT), positron emission computed tomography (PET-CT), thoracoscopy, and laparoscopy to determine if the cancer has spread or metastasized out of the esophagus. This process is called “staging”. Doctors need to stage esophageal cancer to develop a treatment plan.

Esophageal cancer staging

Esophageal cancer staging is expressed using Roman numerals (I ~ IV), the higher the number, the more advanced the cancer stage, as follows:

• Stage 0: Only metaplastic cells are found in the inner cell layer of the esophagus (not yet cancerous).
• Stage I: Cancer cells are found only in the lining cell layer of the esophagus.
• Stage II: The cancer cells have invaded the muscle layer or outer wall of the esophagus and may have spread to 1 to 2 nearby lymph nodes.
• Stage III: Cancer cells have invaded the deeper muscular layer or connective tissue of the esophageal wall and may have spread to surrounding organs and/or more adjacent lymph nodes.
• Stage IV: This is an advanced stage of esophageal cancer in which the cancer has spread to other organs of the body and/or lymph nodes farther away from the esophagus.

The stage of esophageal cancer can be determined by the following tests:

• Chest x-ray, i.e. chest radiograph, often combined with a “barium meal”.
• Bronchoscopy.
• Bronchoscopy. A bronchoscopy is a lighted tube inserted through the nose or mouth into the airway to examine the trachea and airways. This test is used to determine if cancer cells are involved in the trachea or bronchi.
• CT exam. A test that obtains clear images by scanning the inside of the body.
• Endoscopic ultrasound technique. This test is used in endoscopy, where sound waves encounter the body’s organs and produce echoes that form an acoustic spectrum that provides more information about the size and extent of tumor invasion.
• Thoracoscopy. An endoscope is inserted into the chest cavity through an incision to check for cancer involvement of the lymph nodes and other organs in the chest cavity. A biopsy may also be performed during the examination.

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• Laparoscopy. An endoscope is inserted through an incision into the abdominal cavity to check for cancer involvement of abdominal organs, and a biopsy is performed.

How to treat esophageal cancer?

As with many cancers, the earlier esophageal cancer is detected, the better the chances of successful treatment. Unfortunately, by the time esophageal cancer is diagnosed, many patients are usually at an advanced stage, with tumors that have invaded deeper or involved other parts of the body.

The outcome of esophageal cancer treatment depends on many factors, including the stage and the patient’s overall health status.

• Surgery. Most patients in the early stages can undergo an esophagectomy. This is a more complex, major surgery that usually involves opening the chest or abdomen and removing part or all of the esophagus.
• Radiotherapy. The use of radiation to kill cancer cells is a local therapy that is very common in the treatment of esophageal cancer.
• Chemotherapy. Uses chemicals to attack cancer cells throughout the body and is often used in combination with radiation therapy and/or surgery.
• Targeted therapy. New therapies that use small molecules to target cancer cells at their “targets” and kill them with precision.
• Immunotherapy.
• Immunotherapy. It activates the immune cells that have been “put on the brakes” by the cancer cells and mobilizes the whole body’s immune system to attack the cancer cells.
• Immunotherapy.
• Endoscopic non-excisional therapy. Commonly used are.

  • Photodynamic therapy, which starts with an injection of light-sensitive chemicals that actively cluster around the cancer cells. The doctor then uses an endoscopic laser emitter to irradiate the tumor lesion, activating the killing effect of these “precursors” and “blitzing” the cancer cells.
  • Radiofrequency ablation therapy, which emits a radiofrequency energy under the endoscope that targets cancer cells, is used primarily to treat early-stage esophageal cancer.

• Endoscopic resection. The surgeon performs an endoscopic, submucosal resection of esophageal cancer to treat precancerous lesions or very small, early-stage cancers.

Because esophageal cancer usually becomes symptomatic after microscopic spread (metastasis) has occurred, which is the progressive or advanced stage. Therefore, even if surgery is successful, it is difficult to prevent cancer cells that are not “latent” in the body from growing and spreading again in some cases, leading to recurrence and metastasis after surgery. Therefore, many cancer centers combine chemotherapy, radiation therapy and surgery to treat esophageal cancer, including preoperative neoadjuvant therapy and postoperative adjuvant therapy.

In addition, physicians may recommend that patients participate in clinical trials on new drugs or new treatments. Currently, targeted therapies and immunotherapies are hot in clinical research. If there is an opportunity to participate in such clinical trials, you may want to consider it.

How to treat different stages of esophageal cancer? Can it be cured?

• Stage 0: Treatment options include surgery, photodynamic therapy, radiofrequency ablation, or endoscopic submucosal resection.
• Stages I, II, and III: Surgery, chemotherapy, and radiation therapy are the mainstays.
• Stage IV s: chemotherapy, radiation, targeted therapies, and immunotherapy may be used, but patients often have no chance of cure. The focus of treatment at this stage is on “palliative care,” which focuses on relieving dysphagia and pain caused by esophageal cancer.

According to the American Cancer Society, the 5-year survival rate for patients with locally progressive esophageal cancer is 43%, 23% for patients with local metastases, and 5% for patients with systemic metastases.