What is Esophageal Cancer?

Cancer of the esophagus or esophageal cancer begins when cells in your esophagus grow out of control, resulting in the formation of tumors, which are lumps that may either be benign (noncancerous) or malignant (cancerous).

The esophagus is a hollow muscular tube connecting the stomach to the throat. It has a special ring of muscles at the opening called the upper esophageal sphincter that relaxes to open the esophagus when eating or drinking. The inside of the esophagus is called the lumen, and this is where food and drink pass through. The lower part of the esophagus is called the gastroesophageal junction, where a special ring of muscles called the gastroesophageal sphincter controls the movement of food to the stomach. This sphincter keeps the acids and digestive juices in the stomach from entering the esophagus.

While it can start anywhere in the esophagus, esophageal cancer usually starts in the inner layer of the esophageal wall, where it grows outward through the other layers. There are several layers in the esophagus. The mucosa lines the inner esophagus and is composed of the epithelium, lamina propria, and muscularis mucosa. Cancer usually starts at the epithelium. The next layer is the submucosa, followed by the muscular propria, and finally, the adventitia, which is the outermost layer.

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Types of Esophageal Cancer

There are 2 main types of esophageal cancer: Squamous cell carcinomas and Adenocarcinomas.

Squamous Cell Carcinoma

The mucosa is lined with squamous cells. Squamous cell carcinoma begins in these cells, usually in the neck region and the upper two-thirds of the chest cavity. This type of cancer used to be the most common type of esophageal cancer, but is now only 30% of all diagnosed cases in America.

Adenocarcinoma

This type of esophageal cancer starts in the gland cells that make the mucus. Usually, these occur in the lower third of the esophagus. This is also known as Barrett's esophagus, a condition where squamous cells that line the lower parts of the esophagus are replaced with gland cells, leading to adenocarcinoma.

Gastroesophageal junction (GE) tumors are a type of adenocarcinoma that starts in the GE junction and tends to behave like esophageal cancer.

Some rare cancers can also form in the esophagus like lymphomas, sarcomas, and melanomas.

Signs and Symptoms of Esophageal Cancer

Esophageal cancer is often diagnosed at the advanced stage when symptoms already start appearing. Asymptomatic diagnosis is rare and is often found accidentally when testing for other diseases.

The following are the common symptoms of esophageal cancer:

  • Trouble swallowing or dysphagia
  • Chest pain
  • Weight loss
  • Hoarseness
  • Chronic cough
  • Vomiting
  • Bone pain (if cancer has spread to the bone)
  • Bleeding into the esophagus and blood in the stool

Trouble swallowing can be attributed to numerous other factors. Flu or cough can cause throat dryness, for example. When this happens, people usually change their diets and eating habits to accommodate what is deemed a temporary problem. Some may opt for softer foods or even a liquid diet. This can lead to weight loss. As cancer develops, it becomes even harder to swallow, and liquid food might not even be able to pass through well. The body will compensate for this by making more saliva to help food pass through better. Excess spit or mucus can also be a sign of esophageal cancer.

Chest pain is also a common symptom of esophageal cancer, but it can often be caused by other conditions as well, like heartburn. Many who experience chest pain do not immediately get tested for esophageal cancer as a result.

Risk Factors for Esophageal Cancer

Age and sex are immutable biological factors that can help determine risk levels for esophageal cancer. Men are more likely to get diagnosed with esophageal cancer than women, and people over the age of 55 are more likely to have it.

Tobacco and Alcohol Consumption

According to the American Cancer Society, smoking a pack of cigarettes a day doubles the risk of getting adenocarcinoma of the esophagus and makes it even more likely to get squamous cell esophageal cancer.

Alcohol consumption also increases the risk of squamous cell esophageal cancer.

Diet and Obesity

Obese people are more likely to get adenocarcinoma of the esophagus, likely due to their increased chances of developing gastroesophageal reflux. According to the NIH, a diet high in processed meat is also linked to increased chances of esophageal adenocarcinoma. Regularly drinking very hot liquids (much hotter than a regular cup of coffee) can also damage the esophagus and may increase the risk of cancer development.

GERD

The stomach normally produces strong acids and enzymes to digest food, but in some people, this acid can escape into the esophagus, this is known as gastroesophageal reflux disease or GERD. This reflux causes heartburn or chest pain in many people, though some have no symptoms. People with GERD have a slightly higher risk of adenocarcinoma of the esophagus, especially those with more frequent symptoms, but most do not develop this cancer even though GERD is common. GERD can also lead to Barrett's esophagus, which carries an even higher cancer risk.

Barrett’s Esophagus Syndrome

Long-term reflux of stomach acid into the lower esophagus can damage its inner lining, replacing the normal squamous cells with more acid-resistant gland cells, a condition called Barrett's esophagus. The longer someone has acid reflux, the more likely they are to develop Barrett's esophagus, which carries a much higher risk of esophageal adenocarcinoma than those without it, though most with it do not get cancer. Over time, the gland cells in Barrett's esophagus can become increasingly abnormal, resulting in dysplasia, a precancerous condition graded by how abnormal the cells appear under a microscope. While most people with Barrett's esophagus have heartburn symptoms, many have no symptoms at all, yet their cancer risk remains elevated. High-grade dysplasia carries the highest cancer risk, as the cells appear highly abnormal compared to low-grade dysplasia's more normal-looking cells.

Achalasia

Achalasia is a condition where the muscles in the lower esophageal sphincter do not relax properly, resulting in food-collecting at the lower esophagus. Over time, this causes stretching and irritation of the cells. People with achalasia are at increased risk of esophageal cancer, with cancer being diagnosed 15-20 years from when achalasia began.

Tylosis

Tylosis is a rare heritable disease that causes extra skin growth in the hands, feet, and esophagus (papillomas). This can increase the risk of squamous cell carcinoma in the esophagus. People with this condition require regular monitoring through upper endoscopy.

Plummer Vinson-Syndrome

Also called Paterson-Kelly syndrome, this rare disease causes people to have esophageal webs, which are thin tissue extensions causing narrowing, along with anemia from low iron, tongue inflammation, brittle nails, and sometimes an enlarged spleen. Though most webs cause no issues, larger ones can trap food, leading to swallowing problems and chronic irritation. About 10% of people with this syndrome eventually develop squamous cell cancer of the esophagus or hypopharynx cancer due to chronic irritation.

History of Other Cancers

Cancers linked to smoking like lung cancer, mouth cancer, and throat cancer (which is different from esophageal cancer) are also likely to increase the chance of developing esophageal cancer.

If you or a loved one have suffered from a misdiagnosis or delayed diagnosis for your esophageal cancer, contact us at 833-PORTER9, or e-mail us at info@porterlawteam.com to discuss the details of our experience representing other clients and the results we were able to obtain in the past for clients who are suffering as you are. In many ways, our results speak for themselves, and we will stand ready to help you and your family in your time of greatest need.

Last Updated on March 1, 2024 by Michael S. Porter
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