Esophageal Cancer

Cancer is made of changed cells that grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. And they can spread to other parts of the body. This is called metastasis.

Esophageal cancer affects the long tube that connects the throat to the stomach and often doesn’t show symptoms until an advanced stage. It is not a common cancer; close to 18,000 cases are diagnosed in the U.S. each year.

There are two main types of esophageal cancer, and they occur in men more frequently than women:

• Squamous cell cancer. Occurs in the upper to middle part of the esophagus and is related to smoking and alcohol consumption.

• Adenocarcinoma. More common in the U.S., is related to obesity and reflux disease.

A condition called Barrett’s esophagus can increase your risk of getting esophageal cancer. It occurs most frequently in people with gastroesophageal reflux disease (GERD), commonly known as heartburn or acid reflux. Acid from the stomach changes the normal tissue lining the esophagus to tissue that resembles the lining of the intestine. The abnormal tissue can become cancerous over time.

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change.

The risk factors for esophageal cancer include:

• Older age.

• Being a man.

• Tobacco use.

• Heavy alcohol use.

• Barrett esophagus, a condition in which the cells in the esophagus change because of long-term acid reflux.

• Obesity.

• Certain other health conditions and syndromes.

• Exposure to certain chemicals in the workplace, such as working at a dry cleaner.

Talk with your healthcare provider about your risk factors for esophageal cancer and what you can do about them.

Esophageal cancer often doesn’t cause symptoms in its early stages. The most common signs of esophageal cancer include:

• Trouble swallowing, especially dry foods like meat, bread, or raw vegetables.

• Pressure or burning in your chest.

• Feeling like food is stuck in your throat.

• Losing weight without trying.

• Heartburn.

• Indigestion.

• Frequent choking.

As esophageal cancer gets worse and the tumor grows, symptoms can become more severe. You may have:

• Trouble swallowing liquids.

• Trouble swallowing saliva.

• Hoarseness.

• Coughing.

• Vomiting.

• Black stool, which is caused by bleeding in the esophagus.

Many of these may be caused by other health problems. But it’s important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

Specialized computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) scans produce clear, precise images of tumors in the esophagus. In addition, radiologists focus on interpreting images of the GI tract, making them more attuned to subtle differences in the images.

At UC Health, our gastrointestinal (GI) physicians specialize in viewing the esophagus endoscopically (through a scope inserted through the mouth and into the esophagus). An endoscopic ultrasound is used to bounce sound waves off of the esophagus to create images that indicate tumor size and degree of growth into surrounding tissue.

If you have Barrett’s esophagus, your doctor may recommend that you receive routine endoscopy screenings to make sure the abnormal tissue in the esophagus hasn’t become cancerous.

Other testing procedures using scopes – bronchoscopy, thoracoscopy and laparoscopy – help us check for the spread of cancer cells to the lungs, chest and abdomen by visualizing these areas and taking tissue samples called biopsies for further study.

With an accurate diagnosis, we can help you decide on the best action to take in treating your cancer.

If you have esophageal cancer, you may need a combination of surgery, chemotherapy and radiation therapy. Our center brings all of our specialists together in one place so they can work together to present you with a customized care plan that addresses your cancer and your goals for care.

At UC Health, we treat early cancers with endoscopy or surgery. Larger tumors or those that have spread to the surrounding lymph nodes generally require a combination of surgery, chemotherapy and radiation therapy. Advanced cancer that has spread will generally be treated with chemotherapy only or chemotherapy and radiation therapy (to improve swallowing).

We offer the most advanced non-surgical treatments for Barrett’s esophagus and very early esophageal cancers, many of which are available in this region only at UC Health. Non-surgical treatments include:

• Endoscopic mucosal resection (EMR). Allows us to remove small, early tumors through a scope

• Radiofrequency ablation (RFA). For Barrett’s esophagus, which uses heat energy to destroy cancerous tissue without damaging surrounding healthy tissue

• Cryotherapy. An alternative for people who can’t have RFA. The technique freezes pre-cancerous cells or the abnormal cells of Barrett’s esophagus.

• Radiation therapy. Often used with or without surgery, may be combined with chemotherapy. Radiation beams are delivered to the tumor through the skin to shrink or destroy the cancer.

• Chemotherapy. In pill form or through an IV, chemotherapy is used to kill cancer cells throughout the body. At UC Health, we have novel chemotherapy agents not generally available at other cancer treatment facilities in the Greater Cincinnati area. Our GI oncologists also offer access to the latest medications available through clinical trials.

Your surgeon will remove the part of the esophagus that contains the cancer, as well as any lymph nodes near the esophagus. You may be a candidate for minimally invasive esophagectomy. Minimally invasive techniques include laparoscopy, robotic-assisted, and video-assisted thoracoscopic surgery. Both require only a few small incisions in the abdomen and chest to insert small tools to remove all or part of the esophagus.

UC Health’s volume of esophageal surgeries is the highest in the Greater Cincinnati region. Centers with higher volumes have been proven to have fewer complications and better results following surgery. We perform the following procedures using minimally invasive and conventional surgical techniques, based on what will be best for you:

• Ivor-Lewis esophagectomy. Our most common procedure involves incisions in the abdomen and right chest. Our surgeon removes two-thirds of the esophagus and surrounding lymph nodes. The stomach is then transformed into a tube to replace the esophagus. This procedure is used for tumors at the bottom part of the esophagus.

• Three-hole esophagectomy. For longer tumors or tumors in the middle part of the esophagus, incisions are made in the abdomen, right chest and left neck to remove the esophagus and make the stomach into a new esophagus tube.

• Trans-hiatal esophagectomy. Used for earlier cancers, this procedure requires an incision in the left neck and abdomen to remove the tumor.

In rare cases, a tumor may prevent a person from eating and drinking. We can insert an expandable tube into the esophagus to restore these vital functions.

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about problems and concerns you have. Work together to ease the effects of cancer and its symptoms on your daily life.

Here are tips:

• Talk with your family or friends.

• Ask your healthcare team or social worker for help.

• Speak with a counselor.

• Talk with a spiritual advisor, such as a minister or rabbi.

• Ask your healthcare team about medicines for depression or anxiety.

• Keep socially active.

• Join a cancer support group.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.

• Drink plenty of water, fruit juices, and other liquids.

• Keep physically active.

• Rest as much as needed.

• Talk with your healthcare team about ways to manage treatment side effects.

• Take your medicines as directed by your team.

We offer you several services to help ease your journey through diagnosis and treatment.

UC Health’s Integrative Medicine team works closely with each patient who has lung cancer to provide services such as stress management, massage, yoga and acupuncture/acupressure to lessen the symptoms and side effects of your cancer.

Our oncology dietitian provides counseling to ensure that you get the nutrition you need for optimal health and healing during your cancer treatment.

We have ongoing clinical trials for evaluating new treatments for esophageal cancer including immunotherapy prior to surgery and proton radiotherapy.

Our physicians will talk with you about current trials for which you may be eligible. In addition, we offer you access to the most current therapies available through Phase I clinical trials.

We are one of only a handful of centers in the country offering a comprehensive Phase I experimental therapeutics program in which patients have access to treatment with the newest drugs and treatments that are not available elsewhere in the region.

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

• New symptoms or symptoms that get worse.

• Signs of an infection, such as a fever.

• Side effects of treatment that affect your daily function or don’t get better with treatment.

Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays.