Esophageal Cancer, From Diagnosis to Treatment

A diagnosis of esophageal cancer can bring up many questions and concerns. Our goal is to provide you with clear, accurate and educational information to help you understand your diagnosis and partner effectively with your oncologist throughout your treatment journey.

Overview of Esophageal Cancer

Esophageal cancer begins in the esophagus, the long, muscular tube that connects your throat to your stomach and moves swallowed food down for digestion.

There are two main types of esophageal cancer, classified by the cells involved:

• Adenocarcinoma: This type is typically found in the lower part of the esophagus and often develops from a precancerous condition called Barrett’s esophagus, which is usually linked to chronic gastroesophageal reflux disease (GERD). This is the most common type in the U.S.
• Squamous Cell Carcinoma: This type can occur along the entire length of the esophagus. Risk factors often include smoking and heavy alcohol consumption.

Early-stage esophageal cancer may not cause noticeable symptoms. As the cancer grows, the most common symptom is dysphagia, or difficulty swallowing, as one expert explained in an interview with CURE.

“One of the most common presenting symptoms of patients with esophageal cancer is dysphagia, which is difficulty swallowing,” said Dr. Nataliya Uboha. “It is not infrequent that patients initially consult their primary care providers with seemingly common symptoms such as heartburn and are treated with antacid medications. However, these symptoms ultimately progress and do not respond to treatment, leading patients to present with weight loss and an inability to swallow, especially solid food.”

Uboha is a medical oncologist at UW Health, as well as an associate professor and researcher in the Department of Medicine at the University of Wisconsin School of Medicine and Public Health.

Other possible symptoms include unintentional weight loss, pain in the chest or back, hoarseness, and persistent coughing.

Diagnosis and Staging

The journey to diagnosis involves several tests to confirm the presence of cancer and determine its stage (how far it has spread). Staging is critical because it guides the treatment plan.

Diagnostic Tools for Esophageal Cancer

• Upper Endoscopy (Esophagogastroduodenoscopy or EGD): A doctor uses a thin, flexible tube with a camera (endoscope) to examine the inside of the esophagus.
• Biopsy: During an endoscopy, small tissue samples are removed and examined under a microscope to confirm the cancer diagnosis and determine the cell type.
• Barium Swallow: You drink a liquid containing barium, which coats the esophagus and helps it show up clearly on X-rays.

Staging Tests in Esophageal Cancer

If cancer is confirmed, further imaging and procedures are performed to determine the stage:

• Endoscopic Ultrasound (EUS): An endoscope with an ultrasound probe is used to create detailed images of the esophageal wall and nearby lymph nodes, helping to determine the depth of the tumor.
• CT Scan and PET Scan: These imaging tests look for cancer spread to distant organs or lymph nodes.
• Laparoscopy/Thoracoscopy: In some cases, minimally invasive surgery is used to examine the abdomen or chest and take tissue samples for accurate staging.

Treatment Options for Esophageal Cancer

Treatment for esophageal cancer is highly individualized and depends on the type, stage and location of the cancer, as well as your overall health. Treatment is often a combination of therapies.

Surgery for Esophageal Cancer

Surgery, specifically an esophagectomy (removal of part or all of the esophagus and surrounding lymph nodes), is a common treatment for earlier-stage cancer. The remaining healthy esophagus is reconnected to the stomach.

• Minimally Invasive Esophagectomy (MIE): This approach uses smaller incisions, often leading to less pain and a quicker recovery than open surgery.

Systemic and Radiation Therapies for Esophageal Cancer

These treatments are often used to shrink a tumor before surgery (neoadjuvant therapy), to kill remaining cancer cells after surgery (adjuvant therapy) or as the main treatment if surgery isn’t an option.

• Chemotherapy: Uses drugs to kill cancer cells throughout the body. It's often combined with radiation.
• Radiation Therapy: Uses high-energy rays to kill cancer cells in a specific area.
• Chemoradiation: The combination of chemotherapy and radiation therapy given at the same time.
• Targeted Therapy: Uses drugs that focus on specific characteristics of the cancer cells, such as the HER2 protein, to stop them from growing.
• Immunotherapy: Drugs that help your body’s own immune system recognize and attack cancer cells.

Palliative and Supportive Care in Esophageal Cancer

For advanced cancers or to manage symptoms, your oncologist may recommend:

• Stent Placement: A metal mesh tube is placed in the esophagus to keep it open and allow food and liquids to pass.
• Nutritional Support: A feeding tube may be placed temporarily or long-term to ensure proper nutrition, which is vital during treatment.

Common Side Effects of Esophageal Cancer Treatment

Cancer treatments can be tough on the body. Your oncology team will work with you to anticipate and manage side effects.

General Side Effects (Chemotherapy/Radiation) of Esophageal Cancer Treatment

• Fatigue: Extreme tiredness is common.
• Nausea and Vomiting: Medications are available to manage this.
• Appetite Loss/Weight Loss: Working with a dietitian is essential.
• Painful Swallowing (Esophagitis): Radiation can cause inflammation.
• Changes in Blood Counts: Chemotherapy can affect blood cells, increasing the risk of infection or bruising.

Surgery-Related Side Effects in Esophageal Cancer

• Difficulty Eating/Dumping Syndrome: Food may move into the small intestine too quickly, causing symptoms like nausea, cramping and diarrhea. Adjusting diet and meal timing can help.
• Heartburn/Reflux: Can occur after the stomach has been moved.
• Risk of Leakage: The connection point between the esophagus and stomach (anastomosis) can sometimes leak, which requires immediate attention.

Conclusion: Driving the Conversation

This overview should serve as a foundation for your discussions with your oncologist. The most important thing is open communication.

Questions to Ask Your Oncologist

• What is the specific type and stage of my esophageal cancer?
• What are all of my treatment options, and why is one recommended over the others?
• What are the side effects I should expect from each treatment, and how can they be managed?
• Should I see a dietitian or nutritionist?
• What are the long-term effects of the recommended treatment?

Remember, you are the most important member of your health care team. By staying informed and asking questions, you ensure that your treatment aligns with your goals and quality of life.

Reference

1. “Understanding Esophageal Cancer: Early Signs, Risks and Key Insights,” CURE; https://www.curetoday.com/view/understanding-esophageal-cancer-early-signs-risks-and-key-insights

Editor’s Note: This guide is designed to be a starting point. Your personal experience will be unique. By using this information as a foundation for your discussions, you can partner with your oncologist to make the best decisions for your health.

For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.