Esophageal cancer is cancer that develops in the esophagus, the muscular tube that connects the throat to the stomach. The esophagus, located just behind the trachea (wind-pipe), is about 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 from the inner layer and grow out. There are two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma and a few rare ones, including melanoma, small cell carcinoma and leiomyosarcoma. According to the American Cancer Society, 18,000 Americans are diagnosed with esophageal cancer each year and the number continues to rise.
The Division of Thoracic Surgery at Brigham and Women’s Hospital (BWH) is leading the way in esophageal cancer care with board-certified thoracic surgeons who specialize in the management of this relatively rare cancer. We operate on more than 100 patients with esophageal cancer every year, offering the most current diagnostic methods and proven treatments, including minimally invasive surgical techniques aided by video technology. We are the surgical team for Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), an exceptional collaboration between two world-class medical centers.
Over the past few decades we have operated on more than 1,300 patients with esophageal cancer, achieving extraordinary low operative mortality and excellent outcomes. The experience gained by our team in the successful management of so many patients with esophageal cancer is unique.
The Center for Esophageal and Gastric Cancer at DF/BWCC is one of the largest centers of its kind in the US. The Center includes medical, surgical, and radiation oncologists, gastroenterologists, radiologists, and pathologists who have decades of experience treating esophageal cancer and Barrett's esophagus. Our dedicated Thoracic Intensive Care Unit (ICU) and step-down unit (Thoracic Intermediate Care Unit = TICU) allow us to care for patients with esophageal cancer with expertise that focuses on preventing complications before they happen to achieve uneventful recovery and excellent outcome.
The Center for Esophageal and Gastric Cancer at Dana-Farber/Brigham and Women’s Cancer Center is one of the largest centers of its kind in the US. Watch one patient’s story.
There are two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. While overall the rate of esophageal cancer has remained the same, adenocarcinoma has increased in incidence while squamous cell carcinoma has seen a decrease.
Squamous Cell Carcinoma
Squamous cell carcinoma grows in the cells that form the top layer of the inner lining of the esophagus, known as squamous cells. This type of cancer can grow anywhere along the esophagus. 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 U.S. but continues to be common in many other countries.
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.
There is no routine screening examination for esophageal cancer; however, people with Barrett's esophagus should be examined often (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. However, there are treatments to manage and successfully treat all stages of esophageal cancer. Diagnostic tests and procedures include:
Less common tests:
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 done. Learn more about the stages of esophageal cancer.
Treatment for esophageal cancer depends on many factors including the stage of the cancer and where it is located. Your thoracic surgeon will discuss the best treatment for your particular situation. Often a combination of therapies will be recommended.
Other surgical procedures:
There are a number of ways to remove the esophagus, all of which have been previously developed by an open surgical technique and have been practiced by our surgeons using minimally invasive techniques. They generally refer to how much esophagus is removed and where the incisions are. These are usually related to the location of the tumor.
In all of these operations, the esophagus is removed and reconstructed by elongating the stomach. In some cases, however, 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.
Non-surgical cancer treatments
You will receive a thorough diagnostic and staging (determining how advanced the cancer is) evaluation and receive clinically proven treatment by a board-certified thoracic surgeon who specializes in esophageal cancer. Your experience post-treatment will vary depending upon the stage of your cancer. Early detection and the involvement of an experienced thoracic surgeon are important to the successful outcome for esophageal cancer treatment. After treatment, routine life-long surveillance is necessary.
Brigham and Women’s Hospital provides a multidisciplinary approach to patient care, collaborating with colleagues in other medical specialties. Our DF/BWCC treatment team includes thoracic surgeons, medical oncologists, radiation oncologists, nutritionists, pathologists, anesthesiologists and gastroenterologists. If your thoracic surgeon discovers an underlying illness or concern, you will be referred to a BWH physician for an expert evaluation.
Visit the Dana-Farber/Brigham and Women’s Cancer Center for more information about esophageal cancer.
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