Cancer Information:
Esophageal Cancer

Overview
The esophagus is the swallowing tube that connects the pharynx (throat) with the stomach in the abdomen. It is a relatively narrow tube whose active muscle propels a bolus of food from the mouth to the stomach. Cancer of the esophagus is a relatively uncommon disease in the United States compared to other cancer sites. Patients with cancer of the esophagus frequently have difficulty swallowing and can often localize a specific site where the food seems to have difficulty passing. At its most extreme, the obstruction results in difficulty swallowing liquids and saliva. Risk factors for esophageal cancer include use of tobacco and alcohol, obesity, and caustic injuries such as lye exposure.

Pathology 
The esophagus is normally lined by a layer of flat (squamous) cells which give rise to squamous cell carcinoma. These cancers usually occur in the middle and upper third of the esophagus. Adenocarcinomas arise from the tall (columnar) cells of glands or around the junction with the stomach which is normally lined by columnar cells. Irritation of the lower portion of the esophagus by chronic reflux of stomach acid gives rise to a condition known as Barrett’s esophagus in which the normal flat cells of the esophagus are replaced by tall cells like those of the stomach. This is commonly associated with adenocarcinomas of the lower third of the esophagus.

Cancers of the esophagus can penetrate deeply into or through the muscular tube and can spread to lymph nodes in the abdomen, chest or neck. Early diagnosis of esophageal cancer is uncommon except in patients who are undergoing regular esophagoscopies to follow Barrett’s esophagus. Esophageal cancer, is common in Japan, where it is often found through an endoscopic screening program.

Diagnosis
The diagnosis of esophageal cancer is usually made by biopsy through a flexible, fiberoptic endoscope passed into the esophagus through the mouth. Other diagnostic tests include the following: injuries such as lye exposure.

Endoscopic ultrasound 
A device used to measure the depth or penetration of tumor into the wall of the esophagus and to biopsy enlarged lymph nodes adjacent to the stomach or esophagus.

CT Scan 
Shows the extent of tumor up and down the esophagus, the relationship of the tumor to adjacent organs and possible spread (metastases) to the liver or lungs.

Magnetic Resonance Imaging (MRI)
Similar to CT Scan

Barium Swallow 
An xray study which is sometimes helpful in the evaluation of symptoms.

Laparoscopy 
Insertion of a small tube into the abdomen to view the liver and lining of the abdomen directly. A feeding tube in the small intestine is sometimes placed laparoscopically.

Bronchoscopy
A small tube inserted into the air passages. This tests is sometimes performed to see if the tumor has invaded into the trachea which lies adjacent to a portion of the esophagus.