Esophageal cancer is cancer that occurs in the esophagus — a long, hollow tube that runs from your throat to your stomach. Your esophagus carries food you swallow to your stomach to be digested. Esophageal cancer usually begins in the cells that line the inside of the esophagus. Signs and symptoms of esophageal cancer include:
- Difficulty swallowing (dysphagia)
- Weight loss without trying
- Chest pain, pressure or burning
- Frequent choking while eating
- Indigestion or heartburn
- Coughing or hoarseness
Early esophageal cancer typically causes no signs or symptoms.
When to see a doctor
Make an appointment with your doctor if you have any persistent signs and symptoms that worry you.
If you’ve been diagnosed with Barrett’s esophagus, a precancerous condition that increases your risk of esophageal cancer caused by chronic acid reflux, ask your doctor what signs and symptoms to watch for that may signal that your condition is worsening. Screening for esophageal cancer isn’t done routinely because of a lack of an easily identifiable high-risk group and the possible risks associated with endoscopy. If you have Barrett’s esophagus, discuss the pros and cons of screening with your doctor.
It’s thought that chronic irritation of your esophagus may contribute to the DNA changes that cause esophageal cancer. Factors that cause irritation in the cells of your esophagus and increase your risk of esophageal cancer include:
- Drinking alcohol
- Having bile reflux
- Chewing tobacco
- Having difficulty swallowing because of an esophageal sphincter that won’t relax (achalasia)
- Drinking very hot liquids
- Eating few fruits and vegetables
- Eating foods preserved in lye, such as lutefisk, a Nordic recipe made from whitefish, and some olive recipes
- Having gastroesophageal reflux disease (GERD)
- Being obese
- Having precancerous changes in the cells of the esophagus (Barrett’s esophagus)
- Undergoing radiation treatment to the chest or upper abdomen
Other risk factors include
- Being male
- Being between the ages of 45 and 70
As esophageal cancer advances, it can cause complications, such as:
- Obstruction of the esophagus. Cancer may make it difficult or impossible for food and liquid to pass through your esophagus.
- Cancer pain. Advanced esophageal cancer can cause pain.
- Bleeding in the esophagus. Esophageal cancer can cause bleeding. Though bleeding is usually gradual, it can be sudden and severe at times.
- Severe weight loss. Esophageal cancer can make it difficult and painful to eat and drink, resulting in weight loss.
- Coughing. Esophageal cancer can erode your esophagus and create a hole into your windpipe (trachea). Known as a tracheoesophageal fistula, this hole can cause severe and sudden coughing whenever you swallow.
Tests and procedures used to diagnose esophageal cancer include:
- Using a scope to examine your esophagus (endoscopy). During endoscopy, your doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your esophagus. Using the endoscope, your doctor examines your esophagus looking for cancer or areas of irritation.
- X-rays of your esophagus. Sometimes called a barium swallow, an upper gastrointestinal series or an esophagram, this series of X-rays is used to examine your esophagus. During the test, you drink a thick liquid (barium) that temporarily coats the lining of your esophagus, so the lining shows up clearly on the X-rays.
- Collecting a sample of tissue for testing (biopsy). A special scope passed down your throat into your esophagus (endoscope) or down your windpipe and into your lungs (bronchoscope) can be used to collect a sample of suspicious tissue (biopsy). What type of biopsy procedure you undergo depends on your situation. The tissue sample is sent to a laboratory to look for cancer cells.
Esophageal cancer staging
When you’re diagnosed with esophageal cancer, your doctor works to determine the extent (stage) of the cancer. Your cancer’s stage helps determine your treatment options. Tests used in staging esophageal cancer include computerized tomography (CT) and positron emission tomography (PET).
What treatments you receive for esophageal cancer are based on the type of cells involved in your cancer, your cancer’s stage, your overall health and your preferences for treatment. Treatments include surgery, radiation, and chemotherapy.