Esophageal cancer occurs when cancer cells develop in the esophagus, a tube-like structure that runs from your throat to your stomach. Food goes from the mouth to the stomach through the esophagus. The cancer starts at the inner layer of the esophagus and can spread throughout the other layers of the esophagus and to other parts of the body (metastasis).

There are two main types of esophageal cancer. One typeis squamous cell carcinoma. Squamous cells line the inner esophagus, and cancer developing from squamous cells can occur along the entire esophagus. The other type is called adenocarcinoma. This is cancer that develops from gland cells. To develop adenocarcinoma of the esophagus, squamous cells that normally line the esophagus are replaced by gland cells. This typically occurs in the lower esophagus near the stomach and is believed to be largely related to acid exposure to the lower esophagus.

What Causes Esophageal Cancer?

It’s not exactly clear what causes esophageal cancer.

Esophageal cancer occurs when cells in your esophagus develop errors (mutations) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells form a tumour in the esophagus that can grow to invade nearby structures and spread to other parts of the body.

Symptoms

Early on there may be no symptoms. In more advanced cancers, symptoms of esophageal cancer include:

  • Difficulty or pain when swallowing
  • Weight loss
  • Pain in the chest, behind the breastbone
  • Coughing
  • Hoarseness
  • Indigestion and heartburn

Diagnosis

To diagnose esophageal cancer, your doctor will review your symptoms, medical history, and examine you. In addition, he or she may order certain blood tests and X-rays.

Tests for esophageal cancer may include:

  • Barium swallow X-ray, in which you drink a liquid that coats your esophagus. This makes the esophagus stand out on the X-ray so that your doctor can identify certain problems.
  • Endoscopy: the doctor passes an endoscope, a thin, lighted tube, down your throat into your esophagus to examine it. Endoscopic ultrasound uses sound waves to provide more information about the extent of tumour involvement in nearby tissues.
  • Biopsy: during an endoscopy, the doctor can take cells or tissue from your esophagus. The cells are examined under a microscope for the presence of cancer.

Other tests, including computed tomography (CT) scans, positron emission tomography (PET) scan, thoracoscopy, and laparoscopy, may be performed to determine if the cancer has spread, or metastasized, outside of the esophagus. This process is called “staging.” The doctor needs this information in order to plan your treatment.

Staging

The stages of esophageal cancer are given a number (I through IV); the higher the number, the more advanced the cancer. The stages are:

  • Stage 0: Abnormal cells (not yet cancer) are found only in the layer of cells that line the esophagus.
  • Stage I: Cancer cells are found only in the layer of cells that line the esophagus.
  • Stage II: The cancer has reached the muscle layer or the outer wall of the esophagus. In addition, the cancer may have spread to 1 to 2 nearby lymph nodes (small glands that are part of the immune system).
  • Stage III: The cancer has reached deeper into the inner muscle layer or the connective tissue wall. It may have spread beyond the esophagus into surrounding organ and/or has spread to more lymph nodes near the esophagus.
  • Stage IV: This is the most advanced stage. The cancer has spread to other organs in the body and/or to lymph nodes far from the esophagus.

Treatment

Surgery

Part or all of the esophagus may be removed.

Chemotherapy

Chemotherapy refers to anticancer drugs used to shrink/kill cancer cells. The drugs enter the bloodstream and can affect cancer cells all over the body.

Targeted Cancer Therapy

Targeted therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules involved in tumour growth and spread.

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area.

Immunotherapy

Helps the immune system to attack cancer cells.

Screening and Prevention

You can take steps to reduce your risk of esophageal cancer. For instance:

  • Quit smoking. If you smoke, talk to your doctor about strategies for quitting. Medications and counselling are available to help you quit. If you don’t use tobacco, don’t start.
  • Drink alcohol in moderation, if at all. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.
  • Eat more fruits and vegetables. Add a variety of colourful fruits and vegetables to your diet.
  • Maintain a healthy weight. If you are overweight or obese, talk to your doctor about strategies to help you lose weight. Aim for a slow and steady weight loss of 1 or 2 pounds a week.
  • There is at present no specific screening tool available.

What Kind of Support is Available?

CanHOPE is a non-profit cancer counselling and support service provided by Parkway Cancer Centre, Singapore. CanHOPE consists of an experienced, knowledgeable and caring support team with access to comprehensive information on a wide range of topics in education and guidelines in cancer treatment.

CanHOPE provides:

  • Up-to-date cancer information for patients including ways to prevent cancer, symptoms, risks, screening tests, diagnosis, current treatments and research available.
  • Referrals to cancer-related services, such as screening and investigational facilities, treatment centres and appropriate specialist consultation.
  • Cancer counselling and advice on strategies to manage side effects of treatments, coping with cancer, diet and nutrition.
  • Emotional and psychosocial support to people with cancer and those who care for them.
  • Support group activities, focusing on knowledge, skills and supportive activities to educate and create awareness for patients and caregivers.
  • Resources for rehabilitative and supportive services
  • Palliative care services to improve quality of life of patients with advanced cancer.

The CanHOPE team will journey with patients to provide support and personalised care, as they strive to share a little hope with every person encountered.