If you or a loved one is dealing with a diagnosis of esophageal or gastric cancer, our comprehensive care team of gastrointestinal cancer specialists at West Cancer Center & Research Institute is here to surround you with the latest treatments and technology to design a personalized treatment plan specific for your disease. Our goal is to also provide resources and information to better help you understand and manage your disease.

What is Esophageal Cancer?

Esophageal cancer develops in the lining of the esophagus, a hollow tube that carries liquids and food from your mouth to your stomach, and usually starts in the innermost layer. Since 2 types of cells can line the esophagus, there are 2 main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma.

Types of Esophageal Cancer

ADENOCARCINOMA

This is the most common form of esophageal cancer which starts off in the glandular cells, mainly at the lower end of the esophagus and upper region of the stomach. While most prevalent in overweight, middle-aged white men, this cancer has been on the increase in recent years due to the increase in people with gastroesophageal reflux disease (GERD)

SMALL CELL CARCINOMA

This rare form of esophageal cancer begin in the cells that release hormones into your bloodstream in response to signal waves (neuroendocrine cells)

SQUAMOUS CELL CARCINOMA

The thin, flat cells that line the inside of your esophagus (squamous cells) is where this form of esophageal cancer originates and it is strongly linked to drinking too much alcohol and smoking.

Stages of Esophageal Cancer

Squamous Cell carcinoma of the Esophagus:

Stage 0 (High-Grade Dysplasia)

In stage 0, cancer has formed in the inner lining of the esophagus wall. Stage 0 is also called high-grade dysplasia.

Stage I (Squamous Cell Carcinoma of the Esophagus)

Cancer has spread

  • into the mucosa layer or thin muscle layer of the esophagus wall or
  • into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall or
  • into the thick muscle layer of the esophagus wall.

Stage II (Squamous Cell Carcinoma of the Esophagus)

Cancer has spread:

  • into the thick muscle layer of the esophagus wall, or
  • into the connective tissue layer of the esophagus wall. The tumor is in the lower esophagus; or
  • into the connective tissue layer of the esophagus wall. The tumor is in either the upper or middle esophagus; or
  • into the connective tissue layer of the esophagus wall . The tumor is in either the upper or middle esophagus; or
  • into the connective tissue layer of the esophagus wall. The grade of the cancer cells is not known, or it is not known where the tumor has formed in the esophagus; or
  • into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. Cancer is found in 1 or 2 lymph nodes near the tumor.

Stage III (Squamous Cell Carcinoma of the Esophagus)

Cancer has spread:

  • into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. Cancer is found in 3 to 6 lymph nodes near the tumor; or
  • into the thick muscle layer of the esophagus wall. Cancer is found in 1 or 2 lymph nodes near the tumor.
  • into the thick muscle layer or the connective tissue layer of the esophagus wall. Cancer is found in 1 to 6 lymph nodes near the tumor; or
  • into the diaphragm, pleura, sac around the heart, azygos vein, or peritoneum. Cancer may be found in 1 or 2 lymph nodes near the tumor.

Stage IV (Squamous Cell Carcinoma of the Esophagus)

Cancer has spread:

  • into the diaphragm, pleura, sac around the heart, azygos vein, or peritoneum. Cancer is found in 3 to 6 lymph nodes near the tumor; or
  • into nearby structures, such as the aorta, airway, or spine. Cancer may be found in 1 to 6 lymph nodes near the tumor; or
  • to 7 or more lymph nodes near the tumor.
  • Cancer has spread to other parts of the body, such as the liver.

Adenocarcinoma of the Esophagus:

Stage O (High-grade Dysplasia)

Cancer has formed in the inner lining of the esophagus wall. Stage 0 is also called high-grade dysplasia.

Stage I (Adenocarcinoma of the Esophagus)

Cancer has spread:

  •  into the mucosa layer or thin muscle layer of the esophagus wall. The cancer cells are grade 1 or the grade is not known.
  • into the mucosa layer or thin muscle layer of the esophagus wall. The cancer cells are grade 2; or
  • into the submucosa layer of the esophagus wall or
  • into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall; or
  • into the thick muscle layer of the esophagus wall.

Stage II (Adenocarcinoma of the Esophagus)

Cancer has spread:

  • into the thick muscle layer of the esophagus wall; or
  • into the connective tissue layer of the esophagus wall; or
  • into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. Cancer is found in 1 or 2 lymph nodes near the tumor.

Stage III (Adenocarcinoma of the Esophagus)

Cancer has spread:

  • into the mucosa layer, thin muscle layer, or submucosa layer of the esophagus wall. Cancer is found in 3 to 6 lymph nodes near the tumor; or
  • into the thick muscle layer of the esophagus wall. Cancer is found in 1 or 2 lymph nodes near the tumor.
  • into the thick muscle layer of the esophagus wall. Cancer is found in 3 to 6 lymph nodes near the tumor; or
  • into the connective tissue layer of the esophagus wall. Cancer is found in 1 to 6 lymph nodes near the tumor; or
  • into the diaphragm, pleura, sac around the heart, azygos vein, or peritoneum. Cancer may be found in 1 or 2 lymph nodes near the tumor.

Stage IV (Adenocarcinoma of the Esophagus)

Cancer has spread:

  • into the diaphragm, pleura, sac around the heart, azygos vein, or peritoneum. Cancer is found in 3 to 6 lymph nodes near the tumor; or
  • into nearby structures, such as the aorta, airway, or spine. Cancer may be found in 1 to 6 lymph nodes near the tumor; or
  • to 7 or more lymph nodes near the tumor; or
  • spread to other parts of the body, such as the liver.

*Source: National Cancer Institute, August 26, 2018

Symptoms of Esophageal Cancer

If you are experiencing any of these symptoms, we urge you to speak to your provider as soon as possible for further examination.

  • Difficulty swallowing
  • Chest pain or discomfort, such as pressure or a burning sensation
  • Weight loss and lack of appetite (often related to difficulty swallowing)
  • Hoarseness
  • A persistent cough
  • Hiccups
  • Pneumonia
  • Bone pain
  • Bleeding in the esophagus

How to Diagnose Esophageal Cancer

If your provider would like to further investigate the possibility of esophageal cancer, one or more of the following diagnostic procedures may be performed:

BIOPSY

Tissue is collected using an endoscope (a thin, lighted tube) for visibility and analyzed under a microscope.

BRONCHOSCOPY

This endoscopic procedure examines your airway or windpipe to see if the cancer has spread.

COMPUTERIZED TOMOGRAPHY (CT)

A donut-shaped piece of equipment uses low dose radiation, either with or without a contrast fluid to detect abnormalities in your esophagus.

ENDOSCOPIC ULTRASOUND

This procedure uses an endoscope with a small ultrasound probe to see if the cancer has spread to the lymph nodes and wall of the esophagus and measure the thickness of your tumor.

POSITRON EMISSION TOMOGRAPHY (PET)

A radioactive substance is injected into your bloodstream to collect in cancerous cells and identify the exact location of your cancer.

Types of Esophageal Cancer Treatments

Your esophageal cancer treatment plan will vary depending on multiple factors, including but not limited to your stage of diagnosis, as well as the location of your cancer. Your dedicated team of cancer experts will discuss your treatment options and plan with you, allowing you and your loved ones to consider all possible treatment options for your diagnosis.

CHEMOTHERAPY

Powerful drugs are specifically designed to destroy your cancer cells that are dividing rapidly. These drugs may be given before or during radiation to improve your outcome and care.

CLINICAL TRIAL

Ask your physician if you would benefit from a clinical trial.

ESCOPHAGECTOMY

This surgical procedure removes the section of the esophagus with cancer plus a small margin of healthy tissue and nearby lymph nodes and the stomach is re-attached to the remaining esophagus. Sometimes part of the stomach that contains cancer is removed (subtotal gastrectomy) or the entire stomach, lymph nodes, small intestine and surrounding tissue (total gastrectomy)

IMMUNOTHERAPY

This targeted therapy assist your immune system to find and eliminate  the tumor cells. Late stage esophageal cancer with MMR (DNA mismatch repair) deficiency or high MSI (microsatellite instability) are approved for immunotherapy.

RADIATION THERAPY

High powered beams (x-rays and protons) are directed to the cancerous tissue to destroy the cancer cells.

TARGETED THERAPY

Targeted therapies, a new form of chemotherapy, allow our doctors to create personalized treatments to target specific genetic differences by using Genomic testing.

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