The esophagus is a part of your digestive tract. It is a muscular tube that connects the stomach and the mouth by extending through the neck. When cells begin to grow out of control within the esophagus, esophageal cancer may occur. Cancers often begin in the lining of the esophagus, when squamous cells (the normal cells in the lining) degenerate into a malignant tumor (called squamous cell cancer). Some cancers, called adenocarcinomas, also begin in the bottom of the esophagus next to the stomach. The type of treatment depends on the size of the cancer, the extent of the esophagus affected and the type of cancer.
Diagnosis
Esophageal cancer must be properly diagnosed before it can be treated. Initially, an endoscopy is used to diagnose esophageal cancer. In this test, a doctor uses telescope to look in your esophageal lining to try to detect abnormal areas. If the doctor sees abnormal areas, he takes a small piece of tissue to be biopsied from the area. Cancer can also be diagnosed using X-rays, after a special liquid is swallowed that allows abnormal cell groupings to show up in X-rays.
Treatment
There are numerous factors that go into determining the appropriate treatment for esophageal cancer. The doctor considers the stage of the cancer; stage I cancer is typically much easier to treat than stage IV cancer, which is no longer curable and instead is only manageable. Because most esophageal cancers are not detected until they are quite advanced and symptoms begin to appear, esophageal cancers are often diagnosed at a late stage.
Non-Metastatic Esophageal Cancer
Non-metastatic esophageal cancer refers to cancer that remains local to the esophagus; it has not spread to other organs. The goal of treating non-metastatic esophageal cancer is to cure the cancer by removing any traces of cancer cells from the body. Treatment usually involves a combination of surgery, chemotherapy and radiotherapy. The chemotherapy and radiation may be administered before the surgery or after the surgery, depending on the needs of the patient and the decision of the physician providing care.
Surgery
The surgery performed to remove cancer that is local to the esophagus is called an esophagogastrectomy. In an esophagogastrectomy, the affected part of the esophagus containing the cancer is removed. The top of the stomach and lymph nodes near the cancer are also removed. The lower stomach is then attached to the remaining part of the esophagus (using a piece of the colon if necessary) to allow food to continue to pass through the digestive system.
Metastatic Esophageal Cancer
Metastatic esophageal cancer is not curable. Chemotherapy and radiation are administered to try to kill the cancer cells and slow the growth of the cancer cells both in the esophagus and in the areas of metastases. If symptoms, including difficulty swallowing, begin to impede patient quality of life, certain treatments are available to try to minimize these symptoms. These treatments include a stretching of the esophagus to allow food to pass more easily, the use of laser treatment to burn away portions or all of the tumor in the esophagus or the insertion of a tube inside the esophagus to facilitate swallowing.
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