Cancer of the Esophagus

Cancer of the esophagus develops in the esophagus, the muscular tube that connects the throat to the stomach. Located just behind the trachea (windpipe), the esophagus is 10 to 13 inches in length and carries food from the mouth to the stomach for digestion. The wall of the esophagus is made up of several layers and cancers generally start in the inner layer and grow out. There are two main types of cancer of the esophagus: squamous cell carcinoma and adenocarcinoma and more rare types, including melanoma, small cell carcinoma and leiomyosarcoma. Learn more about esophageal cancer.

Board certified surgeons at Brigham and Women’s Hospital (BWH) specialize in surgical techniques for esophageal cancer. We offer the most current diagnostic methods and proven treatments, including minimally invasive surgical approaches aided by video technology. We are the surgical team for the Center for Esophageal and Gastric Cancer at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC), an exceptional collaboration between two world-class medical centers.

Cancer of the Esophagus Topics

Types of Cancer of the Esophagus

There are two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. Although the overall rate of esophageal cancer has remained the same, adenocarcinoma has increased in incidence and squamous cell carcinoma has seen a decrease.

Squamous Cell Carcinoma
Squamous cell carcinoma begins in the flat cells of the esophagus. These cells line the entire esophagus. Less than half of all cancers in the esophagus begin in the squamous cells. The cause of squamous cell cancer is unclear, but seems to be associated with a history of smoking and alcohol intake. The incidence of squamous cell carcinoma has slightly decreased over the past two decades in the United States, but continues to be common in many other countries.

Adenocarcinoma
Adenocarcinoma develops in the glandular tissue in the lower part of the esophagus, near the opening of the stomach. While the incidence of squamous cell carcinoma has been decreasing in the United States, the incidence of adenocarcinoma has been rising rapidly. This switch in incidence may be related to gastroesophageal reflux disease and certain lifestyle changes, including diet, that are associated with western cultures.

Risk Factors for Cancer of the Esophagus

Squamous Cell Carcinoma

  • Older than 55
  • Male
  • Diet deficient in fruits and vegetables
  • Drinking very hot liquids frequently
  • High intake of alcohol over prolonged periods
  • Tobacco use, including cigarettes, cigars and chewing tobacco
  • History of combined alcohol and tobacco use
  • Swallowing or breathing caustic irritants such as lye and other chemicals
  • History of achalasia, a disease of the muscle of the esophagus
  • History of head and neck cancers

Adenocarcinoma

  • Older than 55
  • Male
  • Smoking
  • Obesity
  • Heartburn or reflux disease
  • Barrett’s esophagus, a condition caused by prolonged acid reflux
Symptoms of Cancer of the Esophagus

People with early stage esophageal cancer usually have minimal symptoms. Symptoms typically do not appear until the disease is more advanced. The most common symptoms are:

  • Painful swallowing
  • Difficulty swallowing (dysphagia)
  • Heartburn
  • Regurgitation of undigested food
  • Coughing up blood
  • Hoarseness or persistent chronic cough
  • Pneumonia
  • Hiccups that persist
  • Blood in stools or black-looking stools
  • Pain in chest, throat, back, behind breastbone, between shoulder blades
  • Vomiting
  • Weight loss
  • Anemia
Diagnosis of Cancer of the Esophagus

There is no routine screening examination for cancer of the esophagus. However, people with Barrett's esophagus should be examined regularly (with endoscopy) because they are at greater risk for developing the disease. When esophageal cancer is found very early, there is a better chance of recovery. Esophageal cancer is often in an advanced stage when diagnosed, though treatments can help manage all stages.

In addition to a complete medical history and physical examination, diagnostic procedures for esophageal cancer may include:

Watch this video of an upper endoscopy (EGD).

Stages of Cancer of the Esophagus

The process used to find out if cancer has spread within the esophagus or to other parts of the body is called staging. The stage is determined from the results of physical exams, imaging tests and biopsies that have been performed.

Learn more about stages of esophageal cancer.

Treatment for Cancer of the Esophagus

Surgical Treatment

Surgery is the most common treatment for cancer of the esophagus. The goal of surgery is to completely remove the cancer and all surrounding lymph nodes. Surgery is most effective with early disease, but can be used in conjunction with chemotherapy and radiation for advanced cancer. Surgery also provides relief of symptoms such as obstruction and dysphagia (difficulty swallowing). Brigham and Women’s Hospital surgeons use the most advanced technology available, performing leading-edge, minimally invasive surgeries when appropriate. Types of surgery include:

  • Minimally invasive esophagectomy is the approach of choice that our surgeons use to remove esophageal cancer. Instead of large incisions and cutting ribs, our surgeons are able to perform this operation through small incisions using video scopes to guide them. These video and laparoscopic, and occasionally robotic techniques, allow for fewer complications, less pain and faster recovery.
  • Esophageal staging and jejunostomy. Patients may present with intermediate stage esophageal cancer which is best treated by first shrinking the cancer with chemotherapy and radiation therapy and then taking the remaining cancer out by surgery as described above. Patients who have difficulty eating may benefit from a minimally invasive video laparoscopy with placement of a feeding tube prior to therapy so that they can continue to receive nutrition while receiving chemotherapy, and be strong enough to later tolerate the esophagectomy operation.

Additional surgical options:

  • Three hole esophagectomy
  • Ivor-Lewis esophagectomy
  • Transhiatal esophagectomy
  • Thoracoabdominal esophagectomy
  • Subtotal gastrectomy
  • Total gastrectomy

In all of these operations, the esophagus is removed and reconstructed by elongating the stomach. In some cases, the colon or small bowel may be used as an esophageal replacement. A feeding tube is placed during surgery to provide nutrition until you can eat adequately.

Surgical Procedures

  • Photodynamic therapy (PDT), an endoscope with a laser on the end is used to eradicate cancer cells on or near the inner lining of the esophagus. This approach is used to relieve blockage of the esophagus caused by cancer.
  • Esophageal stent To overcome obstruction from a tumor, our surgeons will occasionally place a cylindrical stent that crosses the obstruction in the esophagus using an endoscope. This is usually done under anesthesia as an outpatient procedure.

Non-Surgical Cancer Treatments

What You Should Expect

You will receive a thorough diagnostic evaluation by an experienced surgeon who specializes in cancer of the esophagus. Your experience post-treatment will vary depending upon the stage of your cancer. Early detection and the involvement of an experienced surgeon are important to the successful outcome for esophageal cancer treatment.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be cared for in the operating room by surgeons, anesthesiologists and nurses who specialize in surgery for patients with esophageal cancer. After surgery, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Learn more about your hospital stay and returning home.

Multidisciplinary care

Brigham and Women’s Hospital provides a multidisciplinary approach to patient care, collaborating with colleagues in other medical specialities. The Center for Esophageal and Gastric Cancer at Dana-Farber/Brigham and Women’s Cancer Center includes surgeons, medical and radiation oncologists, nutritionists, pathologists, anesthesiologists and gastroenterologists. In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.

Cancer Surgery Appointments and Locations

Contact one of our cancer surgeons in the list at the top of the page to make an appointment.

Cancer Surgery Locations

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