Esophageal Cancer

Table of Contents

Esophageal cancer is cancer that occurs in the esophagus – a long, hollow tube that helps move the food you swallow from your throat to your stomach to be digested. This type of cancer typically has no symptoms. However, some may experience symptoms such as:

  • Pain or difficulty swallowing
  • Weight loss
  • Hoarseness or a cough that does not go away

You run a higher risk of esophageal cancer if you smoke, drink excess amounts of alcohol, or have a history of acid reflux. The risk of esophageal cancer also increases with age.

In general, doctors will use imaging tests and biopsy to diagnose esophageal cancer. Treatment includes surgery, radiation, and chemotherapy. You may also need meal replacement or nutritional supplements because you have trouble swallowing. 

Overview of Esophageal Cancer

Key Points

  • Esophageal cancer is a disease in which malignant cancer cells form in the tissues of the esophagus.
  • Smoking, heavy drinking, and Barrett’s esophagus may increase your risk of esophageal cancer.
  • The signs and symptoms of esophageal cancer include weight loss and difficulty swallowing.
  • Tests that examine the esophagus are used to detect and diagnose esophageal cancer.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

Esophageal cancer is a disease in which malignant tumor forms in the tissues of the esophagus.

The esophagus is a hollow, muscular tube that allows food to pass from the mouth to the stomach. The esophageal wall is made up of several layers of tissue, including mucous membranes, muscle, and connective tissue. Esophageal cancer begins in the inner lining of the esophagus and spreads to the outside through other layers as it grows.

The two most common forms of esophageal cancer gets its names from the type of cell that has become cancerous:

  • Squamous cell carcinoma: Cancer that forms in the squamous cells – the thin flat cells that line the esophagus. This cancer usually occurs in the top and middle of the esophagus, but it can occur anywhere along the esophagus. This is also called epidermoid carcinoma.
  • Adenocarcinoma: Cancer that starts in glandular (secretory) cells. The glandular cells in the lining of the esophagus produce and release fluids such as mucus. Adenocarcinoma usually forms in the lower part of the esophagus, near the stomach.

Smoking, drinking excess amounts of alcohol, and Barrett’s esophagus may increase your risk of esophageal cancer.

Anything that increases your risk of developing a disease is called a risk factor. Having risk factors does not mean you will get cancer; not having risk factors does not mean you won’t get cancer. Talk to your doctor if you think you might be at risk. Possible risk factors include the following:

  • Use of tobacco
  • Overuse of alcohol
  • Barrett’s Esophagus: A condition in which the cells lining the lower part of the esophagus have changed or been replaced with abnormal cells that can lead to esophageal cancer. Acid reflux (a condition in which the stomach contents leak backward from the stomach into the lower part of the esophagus) can irritate the esophagus and eventually may lead to Barrett’s esophagus.
  • Advancing age.

Signs and symptoms of esophageal cancer.

These and other signs and symptoms may be caused by esophageal cancer or other conditions. Check with your doctor if you have any of the following:

  • Pain or difficulty swallowing.
  • Weight loss.
  • Sternum pain (behind the breastbone)
  • Hoarseness and cough .
  • Indigestion – such as heartburn.

Tests that examine the esophagus are used to detect and diagnose esophageal cancer.

The following tests and procedures may be used:

  • Physical exam and health history: An exam of the body to check for general signs of health, including checking for signs of disease, such as lumps or anything that seems unusual. A history of the patient’s health habits and previous illnesses and treatments will also be taken.
  • Chest x-ray: X-ray of the organs and bones inside the chest. X-rays are a type of energy beam that can penetrate the body and onto film – creating images of areas inside the body.
  • Swallow Barium: A series of X-rays of the esophagus and stomach. The patient will be asked to drink fluids containing barium (a silver-white metal compound). Fluid coats the esophagus and stomach, and X-rays are taken. This procedure is also called the upper GI series.
  • Esophagoscopy: A procedure done to look inside the esophagus to check for abnormal areas. The esophagoscope is inserted through the mouth or nose and down the throat into the esophagus. An esophagoscope is a thin, tube-like instrument with a light and lens for viewing. It may also have a tool to remove tissue samples, which are examined under a microscope for signs of cancer. When your doctor looks at your esophagus and stomach, the procedure is called an upper endoscopy
  • Biopsy: The removal of cells or tissue, which are for viewing under a microscope by a pathologist to check for signs of cancer. A biopsy is usually done during an esophagoscopy. In some cases, a biopsy shows changes to the esophagus that are not cancerous, but may cause cancer.

Certain factors affect prognosis (chances of recovery) and treatment options

Prognosis (chances of recovery) and treatment options depend on the following:

  • Stage of cancer (whether the cancer has affected part of or the entire esophagus, or has spread to other parts in the body).
  • Whether the tumor can be completely removed with surgery.
  • The patient’s general health.

Stages of Esophageal Cancer 

Key Points

  • After the esophageal cancer is diagnosed, tests are done to find out if cancer cells have spread in the esophagus or to other parts of the body.
  • There are three ways cancer can spread in the body.
  • Cancer can spread from where it started to other parts of the body.
  • Cancer staging is also used to describe the severity of the tumor/cancer and suggest the right treatment.
  • The following are stages to describe esophageal squamous cell carcinoma:
    • Stage 0 (high-stage dysplasia)
    • Stage I esophageal squamous cell carcinoma
    • Stage II esophageal squamous cell carcinoma
    • Stage III esophageal squamous cell carcinoma
    • Stage IV esophageal squamous cell carcinoma
  • The following are stages to describe esophageal adenocarcinoma:
    • Stage 0 (high-stage dysplasia)
    • Stage I esophageal adenocarcinoma
    • Stage II esophageal adenocarcinoma
    • Stage III esophageal adenocarcinoma
    • Stage IV esophageal adenocarcinoma

After esophageal cancer is diagnosed, tests are done to find out if cancer cells have spread into the esophagus or to other parts of the body.

Cancer staging is to find out if cancer cells have spread within the esophagus or to other body parts. Staging determines the severity of the disease as well as suggests the treatment option. It is important to know the stage for planning treatment. The following tests and procedures may be used to determine the cancer stages:

  • Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body – usually through the mouth or rectum. For esophageal cancer, the endoscope is inserted by mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form an image of body tissue called a sonogram. This procedure is also called endosonography.
  • CT scan (CAT scan): A procedure that creates a series of detailed images of areas inside the body, such as the chest, abdomen, and pelvis, that are taken from different angles. The images are created by a computer connected to an x-ray machine. The dye can be injected into a vein or swallowed to help an organ or tissue appear more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • PET scan (positron emission tomography scan): A PET scan is a procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and creates images of where glucose is being used in the body. Malignant tumor cells appear brighter in the image because they are more active and take up more glucose than normal cells. PET scan and CT scan can be done at the same time. This is called PET-CT.
  • MRI (magnetic resonance imaging): A procedure that uses magnets, radio waves, and a computer to create a series of detailed images of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision is made between the two ribs and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a device to remove tissue or lymph node samples – which are examined under a microscope for signs of cancer. In some cases, this procedure may be used to remove part of the esophagus or lungs.
  • Laparoscopy: A surgical procedure to look at the organs in the stomach to check for signs of disease. A small incision is made in the abdominal wall and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments can be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples to be examined under a microscope for signs of disease.

There are three ways for cancer to spread in your body. 

Cancer can spread through the tissues, lymph system, and blood:

  • Tissues. Cancer spreads from where it started by spreading to nearby areas. 
  • Lymph system. The cancer spreads from where it started by getting into the lymph system. Cancer spreads through lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it started by getting into the blood. Cancer spreads through the blood vessels to other body parts

Cancer can spread from the part of the body where it started to other parts of the body

When cancer spreads to other parts of the body, it is called metastasis. Cancer cells break away from where they started (the main tumor) and travel through the lymph or blood system.

  • Lymph system. Cancer gets into the lymph system, spreads through the lymph vessels, and forms tumors (metastatic tumors) in other parts of the body.
  • Blood. Cancer enters the blood, spreads through the blood vessels, and forms tumors (metastatic tumors) in other parts of the body.

Metastatic tumors are the same type of cancer as primary tumors. For example, if colon cancer spreads to the lungs, the cancer cells in the lungs are actually colon cancer cells. This disease is metastatic colon cancer, not lung cancer

Cancer staging helps describe the extent of cancer and suggest the right treatment. It is also used to describe the severity of cancer and determine treatment options.

Cancer staging describes how abnormal cancer cells look under a microscope and how fast the tumor will grow and spread. The following are stages of esophageal cancer:

  • In stage I, the cancer cells look more like normal cells under a microscope. The tumor grows and spreads more slowly compared to stage II and III.
  • In stage II, the cancer cells look more abnormal under a microscope and grow and spread faster compared to stage I
  • In stage III, cancer cells look more abnormal under a microscope and grow and spread faster compared to stage II and II.

The following stages are used to describe esophageal squamous cell carcinoma:

Stage 0 (High-stage Dysplasia)

In stage 0, abnormal cells are found in the mucosal or submucosal lining of the esophagus. These abnormal cells may become cancerous and spread to normal tissue nearby. Stage 0 is also called high-stage dysplasia.

Stage I esophageal squamous cell carcinoma

Stage I is divided into Stage IA and Stage IB – depending on where the cancer is located.

  • Stage IA: Cancer has formed in the mucosal or submucosal layer of the esophageal wall. The cancer cells are stage I. Stage I cancer cells look more like normal cells under a microscope – they grow and spread more slowly than stage II and III cancer cells.
  • Stage IB: Cancer has formed:
    • In the mucosal or submucosal layer of the esophageal wall. The cancer cells are stage II and III; or
    • In the mucosal or submucosal layer and spreads to the muscle layer or the connective tissue layer of the esophageal wall. The cancer cells are stage I. The tumor may be in the lower esophagus or unknown.
Stage II esophageal squamous cell carcinoma

Stage II is divided into Stage IIA and Stage IIB, depending on where the cancer has spread.

  • Stage IIA: Cancer has spread:
    • Into the muscle layer or the connective tissue layer of the esophageal wall. The cancer cells are stage I. The tumor is in the upper or middle esophagus; or
    • Into the muscle layer or the connective tissue layer of the esophageal wall. The cancer cells are stage II and III. The tumor may be in the lower esophagus or unknown. 
  • Stage IIB: Cancer:
    • Has spread to the muscle layer or a layer of connective tissue layer of the esophageal wall. The cancer cells are stage II and III. stage II and III cancer cells look more abnormal under a microscope and grow and spread faster than stage I cancer cells. The tumor is in the upper or middle esophagus; or
    • It is in the mucosal or submucosal layer and may have spread to the muscle layer of the esophageal wall. Cancer is found in I or II lymph nodes near the tumor.
Stage III squamous cell carcinoma of the esophagus

Stage III is divided into Stage IIIA, Stage IIIB, and Stage IIIC, depending on where the cancer has spread.

  • Stage IIIA: Cancer:
    • It is in the mucosal or submucosal layer and may have spread to the muscle layer of the esophageal wall. Cancer is found in 3 to 6 lymph nodes near the tumor; or
    • Has spread to the connective tissue lining of the esophageal wall. Cancer is found in I or II lymph nodes near the tumor; or
    • Has spread to the diaphragm, pleura (tissue that covers the lungs and lines the inner wall of the chest cavity), or the sac around the heart. Cancer can be removed surgically.
  • Stage IIIB: Cancer has spread to the connective tissue lining of the esophageal wall. Cancer is found in 3 to 6 lymph nodes near the tumor.
  • Stage IIIC: Cancer has spread:
    • into the diaphragm, pleura (tissue that covers the lungs and lines the inner wall of the chest cavity), or the sac around the heart. Cancer can be removed surgically. Cancer is found in I to 6 lymph nodes near the tumor; or
    • To other nearby organs such as the aorta, trachea, or spine, and the cancer cannot be removed surgically; or
    • The 7 or more lymph nodes near the tumor.
Stage IV esophageal squamous cell carcinoma

In Stage IV, the cancer has spread to other parts of the body such as the lungs, liver, adrenal glands, kidneys, or bones.

The following stages are used for esophageal adenocarcinoma:

Stage 0 (High-stage Dysplasia)

In stage 0, abnormal cells are found in the mucosal or submucosal lining of the esophagus wall. These abnormal cells can become cancerous and spread to nearby normal tissue. Stage 0 is also called high-stage dysplasia.

Stage I esophageal adenocarcinoma

Stage I is divided into Stage IA and Stage IB, depending on where the cancer is found

  • Stage IA: Cancer has formed in the mucosal or submucosal layer of the esophageal wall. The cancer cells are stage I or II. Stage I and II cancer cells look more like normal cells under a microscope and grow and spread more slowly than stage III
  • Stage IB: Cancer has formed:
    • In the mucosal or submucosal layer of the esophageal wall. The cancer cells are stage III; or
    • In the mucosal or submucosal layer and spreads to the muscle layer of the esophageal wall. The cancer cells are stage I or II.
Stage II esophageal adenocarcinoma

Stage II is divided into Stage IIA and Stage IIB, depending on where the cancer has spread.

  • Stage IIA: Cancer has spread to the muscle layer of the esophageal wall. The cancer cells are  at stage III. Stage III cancer cells look more abnormal under a microscope and grow and spread faster than stage I and II.
  • Stage IIB: Cancer:
    • Has spread to the connective tissue lining of the esophageal wall; or
    • It is in the mucosal or submucosal layer and may have spread to the muscle layer of the esophageal wall. Cancer is found in I or II lymph nodes near the tumor.
Stage III esophageal adenocarcinoma

Stage III is divided into Stage IIIA, Stage IIIB, and Stage IIIC, depending on where the cancer has spread.

  • Stage IIIA: Cancer:
    • It is in the mucosal or submucosal layer and may have spread to the muscle layer of the esophageal wall. Cancer is found in 3 to 6 lymph nodes near the tumor; or
    • Has spread to the connective tissue lining of the esophageal wall. Cancer is found in 1or 2 lymph nodes near the tumor; or
    • Has spread to the diaphragm, pleura (tissue that covers the lungs and the innermost lining of the chest wall), or the sac around the heart. Cancer can be removed surgically. 
  • Stage IIIB: Cancer has spread to the connective tissue lining of the esophageal wall. Cancer is found in 3 to 6 lymph nodes near the tumor
  • Stage IIIC: Cancer has spread:
    • To the diaphragm, pleura (tissue that covers the lungs and the innermost lining of the chest wall), or the sac around the heart. Cancer can be removed surgically. Cancer is found in I to 6 lymph nodes near the tumor; or
    • To other nearby organs such as the aorta, trachea, or spine, and the cancer cannot be removed surgically; or
    • The 7 or more lymph nodes near the tumor.
Stage IV esophageal adenocarcinoma

In Stage IV, the cancer has spread to other parts of the body such as the lungs, liver, adrenal glands, kidneys, or bones.

Recurrent Esophageal Cancer

Recurrent esophageal cancer is cancer that comes back after being treated. Cancer can come back in the esophagus or in other parts of the body.

Treatment for Esophageal Cancer 

Key Points

  • There are various types of treatment for esophageal cancer
  • Patients have special nutritional needs during treatment for esophageal cancer.
  • Six types of standard treatment are used:
    • Surgery 
    • Radiation therapy
    • Chemotherapy
    • Chemoradiation therapy
    • Laser therapy
    • Electrocoagulation
  • New types of treatment are being tested in clinical trials.
    • Targeted therapy
  • Treatment for esophageal cancer can cause side effects.
  • Patients may intend to take part in clinical trials.
  • Patients can enter clinical trials before, during, or after starting their cancer treatment.
  • Follow-up tests may be required

There are various types of treatment for esophageal cancer patients

Different types of treatment are available to treat esophageal cancer . Some are standard treatments, and some are still in clinical trials. A clinical trial is research intended to help improve current treatments or gather information about new treatments for cancer patients. When clinical trials show that the new treatment is better than standard treatment, the new treatment can become standard treatment. Patients may want to take part in clinical trials. Certain clinical trials are only open to patients who have not undergone any treatment. 

Patients have special nutritional needs during treatment for esophageal cancer.

Many people with esophageal cancer find it difficult to eat due to the difficulty swallowing. The esophagus can be narrowed by a tumor or as a side effect of treatment. Some patients may be given food or nutrients intravenously. Other people may need a feeding tube (a flexible plastic tube that passes through the nose or mouth into the stomach) until they no longer have trouble swallowing. 

Six types of standard treatment are used:

Surgery 

Surgery is the most common treatment for esophageal cancer. Part of the esophagus can be removed through a surgical procedure called an esophagectomy.

A part of the esophagus is removed and the stomach is pulled up and joins the remaining esophagus.

The doctor will rejoin the remaining part of the esophagus to the stomach to help the patient swallow. A plastic tube or part of the intestine can be used to create the incision. Lymph nodes near the esophagus may also be removed and viewed under a microscope to see if they contain cancer. If the esophagus is partially blocked by a tumor, an expandable metal stent (tube) can be placed in the esophagus to help it stay open.

A device (stent) is placed in the esophagus to keep it open for food to enter the stomach.

Small, early-stage cancers and high-stage esophageal dysplasia can be removed by endoscopic resection. An endoscope (a thin, tube-like instrument with a light and a viewing lens) is inserted through a small incision in the skin or through an opening in the body, such as the mouth. The instrument attached to the endoscope is used to remove tissue.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or prevent them from growing. There are two types of radiation therapy:

  • External radiation therapy uses a machine outside the body to send radiation towards the cancer.
  • Internal radiation therapy uses a radioactive substance that is sealed in a needle, granule, cable, or catheter that is placed directly into or near the cancer.

Radiation therapy is given based on the type and stage of cancer being treated. External and internal radiation therapy are used to treat esophageal cancer.

A plastic tube is inserted into the esophagus to keep it open during radiation therapy. This is called intraluminal intubation and dilation.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is administered by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, organs, or body cavities such as the stomach, the drugs primarily affect the cancer cells in those areas (regional chemotherapy). The way chemotherapy is given depends on the type and stage of cancer being treated.

Chemoradiation therapy

Chemoradiation therapy combines chemotherapy and radiation therapy to enhance the effects of both.

Laser therapy

Laser therapy is a cancer treatment that uses a laser beam (a narrow, intense beam of light) to kill cancer cells.

Electrocoagulation

Electrocoagulation is the use of an electric current to kill cancer cells.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapy usually causes less damage to normal cells than chemotherapy or radiation therapy. Monoclonal antibody therapy is a type of targeted therapy used in the treatment of esophageal cancer.

Monoclonal antibodies are made in the laboratory from one type of immune system cell. These antibodies can identify substances in cancer cells or normal substances that can help cancer cells grow. Antibodies attach to the substance and kill cancer cells, block their growth, or prevent them from spreading. Monoclonal antibodies are given through intravenous infusion. Antibodies can be used independently or are delivered directly to the cancer cells through medications, toxins, or radioactive materials. Trastuzumab is a monoclonal antibody being studied in esophageal cancer. It may be given to block the effects of the growth factor protein HERII, which sends growth signals to esophageal cancer cells.

Treatment for esophageal cancer may have side effects.

Follow-up tests may be required.

Some of the tests done to diagnose cancer or to identify the stage of the cancer can be repeated. Several tests will be repeated to see how well the treatment is working. The decision on whether to continue, change, or stop treatment can be determined based on the results of the tests.

Certain tests will continue from time to time after treatment ends. The results of tests can show whether your condition has changed or whether the cancer has recurred (returned). This test is sometimes called a follow-up test.

Stage-based Treatment for Esophageal Cancer

Stage 0 (High-stage Dysplasia)

Stage 0 treatment may include the following:

  • Surgery
  • Endoscopic resection.

Stage I Esophageal Cancer

Treatment for stage I esophageal squamous cell carcinoma or adenocarcinoma may include the following:

  • Chemoradiation therapy followed by surgery.
  • Surgery only.

Stage II Esophageal Cancer

Treatment for stage II esophageal squamous cell carcinoma or adenocarcinoma may include the following:

  • Chemoradiation therapy followed by surgery.
  • Surgery only.
  • Chemotherapy followed by surgery.
  • Chemoradiation therapy only.

Stage III Esophageal Cancer

Treatment for stage III esophageal squamous cell carcinoma or adenocarcinoma may include the following:

  • Chemoradiation therapy followed by surgery.
  • Chemotherapy followed by surgery.
  • Chemoradiation therapy only.

Stage IV Esophageal Cancer

Treatment for stage IV esophageal squamous cell carcinoma or adenocarcinoma may include the following:

  • Chemoradiation therapy followed by surgery.
  • Chemotherapy.
  • Laser surgery or electrocoagulation as palliative therapy to relieve symptoms and improve quality of life.
  • Esophageal stents as palliative therapy to relieve symptoms and improve quality of life.
  • External or internal radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
  • Chemotherapy clinical trials.
  • Clinical trials of targeted therapy combined with chemotherapy

Prevention of Esophageal Cancer

Key Points

  • Avoiding risk factors and increasing protective factors can help prevent cancer
  • The following risk factors increase the risk of esophageal squamous cell carcinoma:
    • Smoking and use of alcohol
  • The following protective factors may lower the risk of squamous cell carcinoma of the esophagus::
    • Avoid tobacco and alcohol use
    • Chemoprevention with nonsteroidal anti-inflammatory drugs
  • The following risk factors increase the risk of esophageal adenocarcinoma
    • Acid reflux
  • The following protective factors may lower the risk of esophageal adenocarcinoma.
    • Chemoprevention with nonsteroidal anti-inflammatory drugs
    • Radiofrequency of esophageal ablation
  • Cancer prevention clinical trials are being studied to prevent cancer.
  • New ways to prevent esophageal cancer are being studied in clinical trials.

Avoiding risk factors and increasing protective factors can help prevent cancer.

Avoiding cancer risk factors can help prevent certain cancers. Risk factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking and doing physical exercises may also help prevent certain types of cancer. Talk to your doctor or other health care professional about how you can lower your risk of cancer.

The risk factors and protective factors for esophageal squamous cell carcinoma and esophageal adenocarcinoma are different.

The following protective factors may lower the risk of esophageal squamous cell carcinoma:

Avoid smoking and use of alcohol

Studies have shown that the risk of squamous cell carcinoma of the esophagus is lower in people who do not smoke and consume alcohol. 

Chemoprevention with nonsteroidal anti-inflammatory drugs

Chemoprevention is the use of drugs, vitamins, or other agents to try to reduce the risk of cancer. Nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin and other drugs that reduce swelling and pain.

Several studies have shown that the use of NSAIDs may reduce the risk of squamous cell carcinoma of the esophagus. However, NSAID use increases the risk of heart attack, heart failure, stroke, gastrointestinal bleeding, and kidney damage.

Esophageal radiofrequency ablation

Patients with Barrett’s esophagus who have abnormal cells in the lower esophagus may be treated with radiofrequency ablation. This procedure uses radio waves to heat and destroy abnormal cells, which may become cancerous. Risks of using radiofrequency ablation include narrowing of the esophagus and bleeding in the esophagus, stomach, or intestines.

The study of patients with Barrett’s esophagus and abnormal cells in the esophagus compared patients who undergo radiofrequency ablation with patients who do not. Patients who receive radiofrequency ablation are less likely to be diagnosed with esophageal cancer. However, researchers are still trying to find out whether radiofrequency ablation reduces the risk of esophageal adenocarcinoma in patients with this condition.

Screening Test for Esophageal Cancer 

Screening test is done to find cancer before a person develops any symptoms. Screening can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, the cancer may have started to spread.

Scientists are trying to better understand who are more likely to develop certain types of cancer. They also study the things that people do and the things around you to see if they cause cancer. This information helps doctors recommend who should get a screening test for cancer, what screening tests to use, and how often to be tested.

It is important to remember that your doctor does not always think you have cancer if he or she recommends a screening test. Screening tests are given when you have no symptoms of cancer.

If the results of the screening tests are abnormal, you may need to do more tests to find out if you have cancer. This is called a diagnostic test.

Key Points 

  • Tests are used to screen for many types of cancer.
  • There is no standard or routine screening test for esophageal cancer.
  • Tests that can detect esophageal cancer are being studied:
    • Esophagoscopy
    • Biopsy
    • Brush cytology
    • Balloon cytology
    • Chromoendoscopy
    • Fluorescence spectroscopy

Screening tests are used to detect many types of cancer.

Several screening tests are used because they have been shown to be helpful in finding cancer early and reducing the chances of dying from the cancer. Other tests are used because they have been shown to detect cancer in some people; however, it has not been proven in clinical trials that the use of this test reduces the risk of dying from cancer.

Scientists study screening tests to find people with the least risk and best benefit. Cancer screening tests are also intended to show whether early detection (finding cancer before it causes symptoms) reduces a person’s chances of dying from the disease. For some types of cancer, the chance of recovery is higher if the disease is detected and treated at an early stage.

There is no standard or routine screening test for esophageal cancer.

Screening test for esophageal cancer is being researched with screening clinical trials that take place in many parts of the country.

Tests that can detect esophageal cancer are being studied

Esophagoscopy

A procedure to look inside the esophagus to check for abnormal areas. The esophagoscope is inserted through the mouth or nose and down the throat into the esophagus. An esophagoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a device to remove tissue samples — which are examined under a microscope for signs of cancer.

Biopsy

Removal of cells or tissue to be viewed under a microscope by a pathologist to check for signs of cancer. Taking biopsy samples from several different areas in the lining of the lower esophagus can detect Barrett’s esophagus early. This procedure can be used for patients who have risk factors for Barrett’s esophagus.

Brush cytology

A procedure in which cells are brushed from the lining of the esophagus and viewed under a microscope to see if they are abnormal. This can be done during the esophagoscopy.

Balloon cytology

A procedure in which cells are collected from the lining of the esophagus using an inflated balloon that is swallowed by the patient. The balloon is then inflated and pulled out of the esophagus. The esophageal cells in the balloon are viewed under a microscope to see if they are abnormal.

Chromoendoscopy

A procedure in which dye is sprayed onto the lining of the esophagus during esophagoscopy. Increased staining of specific areas of the lining may be a sign of early Barrett’s esophagus.

Fluorescence spectroscopy

A procedure that uses a special light to view tissue in the lining of the esophagus. The light probe is passed through the endoscope and shines on the lining of the esophagus. The light released by the cells lining the esophagus is then measured. Malignant tissue releases less light than normal tissue.

Risks of Esophageal Cancer Screening Tests 

Key Points

  • Screening tests come with risks.
  • The risks of the esophageal cancer screening test include the following:
    • Finding esophageal cancer may not improve health or help a person live longer.
    • False negative test results may occur.
    • False positive test results can occur.
    • The side effects may be caused by the test itself.

Screening tests have risks.

Making the decision about screening tests may be difficult. Not all screening tests are helpful – most of them are risky. Before doing any screening tests, you may want to discuss the tests with your doctor. It is important to know the risk of the test and whether it has been shown to reduce the risk of dying from cancer.

The risks of the esophageal cancer screening test include the following:

Finding esophageal cancer may not improve health or help a person live longer.

Screening may not improve your health or help you live longer if you have advanced esophageal cancer or if it has spread to other parts in your body.

Certain cancers never cause symptoms or become life-threatening, but if found by screening tests, they may be treated. It is unknown whether this cancer treatment will help you live longer.  Furthermore, treatment for cancer may have serious side effects.

False negative test results may occur.

The results of the screening tests may appear normal even though esophageal cancer is present. A person who receives a false negative test result (which indicates no cancer, but actually there is) may delay seeking medical care even if symptoms are present.

False positive test results may occur.

The results of the screening tests may appear abnormal even though there is no cancer. A false positive test result (which indicates cancer is present when it is not) can cause anxiety and is usually followed by more tests – such as a biopsy – which are also risky.

The side effects may be caused by the test itself.

There are rare but serious side effects that may occur with esophagoscopy and biopsy. This includes the following:

  • A small hole (leak) in the esophagus.
  • Difficulty breathing.
  • Heart attack.
  • Aspiration (entry of food and liquids in the airways)
  • Heavy bleeding that may require medical attention

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