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Esophageal Cancer Treatment (PDQ®)
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General Information About Esophageal Cancer
Key Points:
Esophageal cancer is a disease in which malignant (cancer)
cells form in the tissues of the esophagus.
The esophagus is the hollow, muscular tube that moves food and
liquid from the throat to the stomach. The wall of the esophagus is made up of several layers of tissue,
including mucous membrane, muscle, and connective tissue. Esophageal cancer
starts at the inside lining of the esophagus and spreads outward through the
other layers as it grows.
Gastrointestinal (digestive) system anatomy; shows esophagus, liver, stomach, large intestine, and small intestine.
The two most common forms of esophageal cancer are named for the
type of cells that become malignant (cancerous):
-
Squamous cell carcinoma: Cancer that forms in squamous cells,
the thin, flat cells lining the esophagus. This cancer is most often found
in the upper and middle part of the esophagus, but can occur anywhere along the esophagus. This is also called epidermoid
carcinoma.
-
Adenocarcinoma: Cancer that begins in
glandular (secretory) cells.
Glandular cells in the lining of the esophagus produce and release fluids such
as mucus. Adenocarcinomas usually form in the lower part of the esophagus, near
the stomach.
Smoking, heavy alcohol use, and Barrett esophagus can affect the
risk of developing esophageal cancer.
Risk factors include the following:
- Tobacco use.
- Heavy alcohol use.
-
Barrett esophagus: A condition in which the cells lining
the lower part of the esophagus have changed or been replaced with abnormal
cells that could lead to cancer of the esophagus. Gastric reflux (the backing
up of stomach contents into the lower section of the esophagus) may irritate
the esophagus and, over time, cause Barrett esophagus.
- Older age.
- Being male.
- Being African-American.
The most common signs of esophageal cancer are painful or
difficult swallowing and weight loss.
These and other symptoms may be caused by esophageal cancer or by
other conditions. A doctor should be consulted if any of the following problems
occur:
- Painful or difficult swallowing.
- Weight loss.
- Pain behind the breastbone.
- Hoarseness and cough.
- Indigestion and heartburn.
Tests that examine the esophagus are used to detect (find) and
diagnose esophageal cancer.
The following tests and procedures may be used:
-
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
-
Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and x-rays are taken. This procedure is also called an upper GI series.
Barium swallow; shows barium liquid flowing through the esophagus and into the stomach.
-
Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope (a thin, lighted tube) is inserted through the mouth or nose and down the throat into the esophagus. Tissue samples may be taken for biopsy.
Esophagoscopy; shows endoscope inserted through the mouth and into the esophagus. Inset shows patient on table having an esophagoscopy.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. The biopsy is usually done during an esophagoscopy.
Sometimes a biopsy shows changes in the esophagus that are not cancer but may
lead to cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on
the following:
- The stage of the cancer (whether it affects part of the esophagus, involves the
whole esophagus, or has spread to other places in the body).
- The size of the tumor.
- The patient’s general health.
When esophageal cancer is found very early, there is a better
chance of recovery. Esophageal cancer is often in an advanced stage when it is
diagnosed. At later stages, esophageal cancer can be treated but rarely can be
cured. Taking part in one of the clinical trials being done to improve treatment should be considered. Information about ongoing clinical trials is available from the
NCI Web site.
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Stages of Esophageal Cancer
Key Points:
After esophageal cancer has been diagnosed, tests are done to
find out if cancer cells have spread within the esophagus or to other parts of
the body.
The process used to find out if cancer cells have spread within the
esophagus or to other parts of the body is called staging. The information
gathered from the staging process determines the stage of the disease. It is
important to know the stage in order to plan treatment.
The following tests and procedures may be used in the staging process:
-
Bronchoscopy: A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope (a thin, lighted tube) is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for biopsy.
-
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
-
Laryngoscopy: A
procedure in which the doctor examines the larynx (voice box) with a mirror or
with a laryngoscope (a thin, lighted
tube).
-
CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This test is also called computed tomography,
computerized tomography, or computerized axial tomography.
-
Endoscopic ultrasound (EUS): A procedure in which an endoscope (a thin, lighted tube) is inserted into the body. The endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
-
Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs and a thoracoscope (a thin, lighted tube) is inserted into the chest. Tissue samples and lymph nodes may be removed for biopsy. In some cases, this procedure may be used to remove portions of the esophagus or lung.
-
Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen, and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.
-
PET scan (positron
emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells. The use of PET for staging esophageal cancer is being studied in clinical
trials.
The following stages are used for esophageal cancer:
Esophageal cancer staging; shows tumors growing through layers of the esophagus wall for Stage 0, Stage I, Stage II, Stage III, and Stage IV esophageal cancer. Inset shows muscle, submucosa, and mucosa layers of the esophagus wall, and lymph nodes.
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the innermost layer of tissue lining the esophagus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer has formed and spread beyond the innermost layer of tissue to
the next layer of tissue in the wall of the esophagus.
Stage II
Stage II esophageal cancer is divided into stage IIA and
stage IIB, depending on where the cancer has spread.
Stage III
In stage III, cancer has spread to the outer wall of the
esophagus and may have spread to tissues or lymph nodes near the esophagus.
Stage IV
Stage IV esophageal cancer is divided into stage IVA and stage
IVB, depending on where the cancer has spread.
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Recurrent Esophageal Cancer
Recurrent esophageal cancer is cancer that has recurred (come back)
after it has been treated. The cancer may come back in the
esophagus or in other parts of the body.
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Treatment Option Overview
Key Points:
There are different types of treatment for patients with
esophageal cancer.
Different types of treatment are available for patients with
esophageal cancer. Some treatments are standard (the currently used treatment),
and some are being tested in clinical
trials. Before starting treatment, patients may want to think
about taking part in a clinical trial. A treatment clinical trial is a research
study meant to help improve current treatments or obtain information on new
treatments for patients with cancer. When clinical trials show that a new
treatment is better than the standard treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country.
Information about ongoing clinical trials is available from the
NCI Web site. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care
team.
Five types of standard treatment are used:
Surgery
Surgery is the most common treatment for cancer of the esophagus.
Part of the esophagus may be removed in an operation called an esophagectomy.
Three panel drawing showing esophageal cancer surgery; first panel shows area of esophagus with cancer, middle panel shows cancer and nearby tissue removed, last panel shows the stomach pulled up and joined to the remaining esophagus.
The doctor will connect the remaining healthy part of the esophagus to the
stomach so the patient can still swallow. A plastic tube or part of the
intestine may be used to make the connection.
Lymph nodes near the esophagus
may also be removed and viewed under a microscope to see if they contain
cancer. If the esophagus is partly blocked by the
tumor, an expandable metal
stent (tube) may be placed inside the esophagus to help keep it open.
Esophageal stent. Shows cancer blocking esophagus. Insets show enlarged area of cancer and a stent placed in the esophagus to keep it open.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
A plastic tube may be 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 the cells from dividing. When chemotherapy is taken 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 spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Laser therapy
Laser therapy is a cancer treatment that uses a laser beam (a narrow beam of intense light) to kill cancer cells.
Electrocoagulation
Electrocoagulation is the use of an electric current to kill
cancer cells.
Other types of treatment are being tested in clinical trials.
Information about ongoing clinical trials is available from the
NCI Web site.
Patients have special nutritional needs during treatment for
esophageal cancer.
Many people with esophageal cancer find it hard to eat because
they have difficulty swallowing. The esophagus may be narrowed by the tumor or
as a side effect of treatment. Some patients may receive nutrients directly
into a vein. Others may need a feeding tube (a flexible plastic tube that is
passed through the nose or mouth into the stomach) until they are able to eat on
their own.
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Treatment Options By Stage
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Stage 0 (Carcinoma in Situ)
Treatment of stage 0 is usually surgery.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage 0 esophageal cancer.
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Stage I Esophageal Cancer
Treatment of stage I esophageal cancer may include the
following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I esophageal cancer.
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Stage II Esophageal Cancer
Treatment of stage II esophageal cancer may include the
following:
- Surgery.
- Clinical trials of chemotherapy plus radiation therapy, with or without
surgery.
- Clinical trials of new therapies used before or after
surgery.
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II esophageal cancer.
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Stage III Esophageal Cancer
Treatment of stage III esophageal cancer may include the
following:
- Surgery.
- Clinical trials of chemotherapy plus radiation therapy, with or without
surgery.
- Clinical trials of new therapies used before or after
surgery.
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III esophageal cancer.
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Stage IV Esophageal Cancer
Treatment of stage IV esophageal cancer may include the
following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV esophageal cancer.
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Treatment Options for Recurrent Esophageal Cancer
Treatment of recurrent esophageal cancer may include the
following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent esophageal cancer.
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Changes to This Summary (09/20/2007)
The PDQ cancer information summaries are reviewed regularly and updated as
new information becomes available. This section describes the latest
changes made to this summary as of the date above.
Editorial changes were made to this summary.
This information is provided from the PDQ® database in collaboration with the NCI.
