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Cancer that begins in the esophagus is divided into two major types: squamous cell carcinomas, tumors that develop in the tissue lining the hollow organs of the body, and adenocarcinoma, depending on the type of cells that are malignant. Squamous cell carcinomas arise in the squamous cells that line the esophagus. These cancers usually occur in the upper and middle part of the esophagus. Adenocarcinomas usually develop in the glandular tissue in the lower part of the esophagus.
Incidence; Causes & Development; Risk Factors
Approximately 11,000 - 13,000 new cases of esophageal cancer are diagnosed each year in the United States.
The exact causes of cancer of the esophagus are not known.
It is more common in men than women, and is more likely to occur at you get older; most people who develop esophageal cancer are over age 60.
Smoking cigarettes or using smokeless tobacco is one of the major risk factors for esophageal cancer. Chronic and/or heavy use of alcohol is another major risk factor for esophageal cancer. People who use both alcohol and tobacco have an especially high risk of esophageal cancer. Scientists believe that these substances increase each other's harmful effects. Studies have shown these other factors to increase your risk of developing cancer of the esophagus:- Barrett's Esophagus. Long-term irritation can increase your risk of esophageal cancer. Tissues at the bottom of the esophagus can become irritated if stomach acid frequently "backs up" into the esophagus -- a problem called gastric reflux (GERD). Over time, cells in the irritated part of the esophagus may change and begin to resemble the columnar cells that line the stomach. This condition, known as Barrett's esophagus, is a pre-malignant condition that may develop into adenocarcinoma of the esophagus.
- Other types of irritation. Other causes of significant irritation or damage to the lining of the esophagus, such as swallowing lye or other caustic substances, can increase the risk of developing esophageal cancer.
- History of head/neck cancers. People who have had other head and neck cancers have an increased chance of developing a second cancer in the head and neck area, including esophageal cancer.
Other risk factors include achalasia and a history of gastroesophageal reflux (GERD). It is important to bear in mind that most people with one or even several of these factors do not get the disease, and that most people who do get esophageal cancer have none of the known risk factors.
Signs & Symptoms
Esophageal cancer symptoms become progressively worse as tumor size increases. Initially, a patient may not notice esophageal cancer symptoms at all, as the tumors are too small to cause problems. As tumors grow, esophageal cancer symptoms appear, beginning with difficulty swallowing. This may come and go, generally growing worse each time it returns.
The signs and symptoms may include, but are not limited to, the following:- Difficulty swallowing
- Feelings of fullness, pressure, and burning as food travels down the esophagus
- The sensation of having a piece of food stuck behind the breastbone
- Weight loss, caused by a change in eating habits, which is in turn due to the discomfort from other esophageal cancer symptoms such as heartburn, indigestion, and vomiting
- Regurgitation of food
- Coughing and hoarseness
- Blood found in vomit or in stool.
Many of the various symptoms mimic symptoms of other disorders, so it is important to have the disease properly diagnosed. Esophageal cancer symptoms are generally investigated by a gastroenterologist. Diagnosis of esophageal cancer symptoms is usually conducted through an X-ray method known as the barium swallow, and may also include endoscopy along with a biopsy, and a CT scan of the chest and abdomen. Analysis of esophageal cancer symptoms may also be accomplished using a thin, lighted tube known as an esophagoscope. Properly diagnosing esophageal cancer symptoms is critical to ensuring patients' chances for survival.
Treatment & Prevention
Treatment methods vary depending upon a patient's condition, but is similar for both types of esophageal cancer. The most common surgical treatment for esophageal cancer is laparoscopic esophagectomy.
The best ways to prevent this type of cancer are to quit (or never start) smoking cigarettes or using smokeless tobacco and to drink alcohol only in moderation.
Complementary and alternative esophageal cancer treatment options include:- Nutritional Therapy
According to the National Cancer Institute, about one-third of all cancer deaths are related to malnutrition. For cancer patients, optimal nutrition is important. Cancer can deplete your body's nutrients and cause weight loss. Cancer and cancer treatment can also have a negative effect on your appetite, and your body's ability to digest foods. These factors may leave you in a vulnerable condition - high nutrient need, and low nutrient intake.
Vitamin and mineral supplements help provide nutrients that diet alone may not, and offer a boost where illness may have depleted your body. A supplementation plan should include nutrients that help support your immune system and reduce toxic side-effects, including:
- Pain Management
Most patients with advanced cancer experience pain during the course of their disease. Cancer pain may be acute or chronic. Acute pain generally results from tissue damage and is of limited duration. Once the cause of pain has been identified, it can be successfully managed. Chronic pain, on the other hand, is persistent -- usually greater than three months in duration. Because the cause of chronic pain often cannot be altered, your nervous system will adapt, which may cause depression, anxiety and/or insomnia.
The severity and prevalence of pain you may experience depend on many factors, including the site and stage of your disease and the location of metastases. Cancer-related pain can result from both the disease process and treatment. Pain affects each person differently, depending upon factors such as age, personality, perception, pain threshold and past experiences with pain. Psychological factors such as fear, worries or knowledge of impending death can also influence the effect of pain. Insomnia, fatigue and anxiety may lower the pain threshold, while rest, sleep and diversion can raise it.
The goal of pain management is not only relief from pain, but also the maintenance of your normal quality of life. All methods of pain management attempt to either control the cause of the pain or alter your perception of it. Although pain management techniques are many and varied, therapeutic approaches can be classified as either pharmacological or non-pharmacological. Pharmacological pain control involves the use of analgesics, as well as other medications that intensify the analgesics' effects or modify your mood or pain perception. Non-pharmacological approaches include:
- Behavioral techniques
- Radiation
- Surgery
- Neurological and neurosurgical interventions
- Traditional nursing and psychosocial interventions
Because of the complex nature of cancer-related pain, successful management usually involves a combination of techniques.
Complications
If the cancer spreads outside the esophagus, it often goes to the lymph nodes first. Esophageal cancer can also spread to almost any other part of the body, including the liver, lungs, brain, and bones.
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Risk factors for Esophageal Cancer: | | | | | Addictions |  Cigarette Smoke Damage | Nearly 80% of all deaths from esophageal cancer are attributable to cigarette smoking. Smokers have an 8- to 10-fold greater risk of developing esophageal cancer than nonsmokers. |
Alcohol-related Problems| | If you are a smoker then heavy alcohol consumption can increase risk of esophageal cancer by 25% to 50%. |
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Lifestyle |
(History of) chewing tobacco use |
Organ Health |
 Barrett's Esophagus| | The changes in the cells lining the esophagus pose an increased risk for esophageal cancer. For unknown reasons, the incidence of cancers arising in Barrett's esophagus is increasing more rapidly than that of any other cancer in the United States. Unfortunately, most of these cancers are not detected until they have become so large that they are incurable. However, cancers in Barrett's esophagus that are detected when they are early and of small size, have a cure rate that is improved dramatically.
If Barrett's esophagus is diagnosed, regular follow-up endoscopic biopsy evaluations are recommended for the early detection of changes that could lead to cancer. Surgery is the only therapy that has been proven to cure early adenocarcinoma arising in Barrett's esophagus. Therefore, if an early cancer is detected in endoscopic biopsies, surgery is generally recommended to remove the cancer and the premalignant Barrett's epithelium. |
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Supplements and Medications |
Counter-indicators:
 Selenium supplementation |
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Esophageal Cancer suggests the following may be present:
Recommendations and treatments for Esophageal Cancer:
Preventive measures against Esophageal Cancer: | | | | | Botanical |  Green Tea| | Regular and substantial consumption of green tea may provide protective effect against this type of cancer. |
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Diet |
Increased Fish Consumption| | Study subjects who ate two or more servings of fish weekly had a much lower risk for esophageal, stomach, colon, rectum, and pancreatic cancers than those who avoided fish. In fact, the rates of these types of cancer were 30 to 50 percent lower among fish eaters. High fish consumption was also associated with lower risks for cancers of the larynx (30 percent lower risk), endometrial cancer (20 percent lower risk), and ovarian cancer (30 percent lower risk). |
 Plant-Based Nutrition |
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KEY | | Weak or unproven link | | | Strong or generally accepted link |  | | Proven definite or direct link | | | Weakly counter-indicative | | | May do some good | | | Likely to help |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Beta-Carotene (Beta Carotene)
The most abundant of the carotenoids, beta-carotene has strong provitamin A activity and is a stronger antioxidant than vitamin A. It is widely accepted today as a cancer preventative. It is found in leafy green and yellow vegetables, often missing in children's diets. Beta-Carotene is believed to be a superior source of Vitamin A because it is readily converted into a more active form of the substance: your body converts it to Vitamin A as needed.
Biopsy
Removal of a sample of tissue from a living being for diagnosis. A pathologist later uses a microscope to look for certain features, such as cancer cells, in the sample. A fine-needle aspiration biopsy involves inserting a thin needle to remove a small amount of tissue, sometimes using CT or ultrasound to guide the needle. A core biopsy involves obtaining a sample of tissue with a thick needle or by inserting a thin, lighted tube (laparoscope) into a small incision in the abdomen. Another biopsy method is to remove tissue during an operation.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Colon (Colonic)
The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.
Computerised Tomography (CAT Scan, Computed Tomography, Computerized Axial Tomography, CT Scan)
A scanning procedure using X-rays and a computer to detect abnormalities of the body's organs. This technique provides cross-sectional images of body organs, which is much clearer than those provided by conventional X-rays.
Endoscopy
A procedure that uses an Endoscope: Examination with a flexible viewing tube.
EPA
Environmental Protection Agency. Also: Eicosapentanoic Acid. A metabolite of the omega-3 fatty acid alpha-linolenic acid.
Esophagus (Esophageal)
Commonly called the "food pipe", it is a narrow muscular tube, about nine and a half inches long, that begins below the tongue and ends at the stomach. It consists of an outer layer of fibrous tissue, a middle layer containing smoother muscle, and an inner membrane, which contains numerous tiny glands. It has muscular sphincters at both its upper and lower ends. The upper sphincter relaxes to allow passage of swallowed food that is then propelled down the esophagus into the stomach by the wave-like peristaltic contractions of the esophageal muscles. There is no protective mucosal layer, so problems can arise when digestive acids reflux into the esophagus from the stomach.
Gastric Reflux Disease (Gastric Reflux, Gastroesophageal Reflux, Gastro-Esophageal Reflux Disease, GERD)
A common relapsing condition affecting approximately 10% of the U.S. population and caused by an abnormal exposure of the lower esophagus to refluxed gastric contents, causing irritation and injury to the esophageal tissues. GERD develops as a result of relaxations of the transient lower esophageal sphincter. Typical presenting symptoms are heartburn, an epigastric burning sensation and acid regurgitation. However, some patients may present with atypical symptoms such as chest pain, shortness of breath, wheezing, and coughing.
Gastroenterologist (Gastroenterologists)
A doctor specializing in digestive tract diseases.
Glandular (Glandulars, Raw Glandulars)
Either referring to a gland, OR glands and organs from animals specially processed at temperatures not exceeding body heat and put into supplement form.
Immune System (Immune Response, Immunity)
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation. The process may involve acquired immunity (the ability to learn and remember a specific infectious agent), or innate immunity (the genetically programmed system of responses that attack, digest, remove, and initiate inflammation and tissue healing).
Larynx (Laryngeal, Voice Box)
The short passageway shaped like a triangle that is just below the pharyx in the neck.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Lung (Lungs, Pulmonary)
Organ of the body, located in the chest cavity which is designed to bring oxygen from the air into the blood stream, while also expelling carbon dioxide and other waste gases out of the body. Pulmonary: Related to the lungs.
Lymph Nodes (Axillary Nodes, Inguinal Nodes, Lymph Gland, Lymph Glands, Lymph Node, Lymphatic)
Small, bean-shaped nodes at various points throughout the body that function to filter the lymph fluid and attempt to destroy the microorganisms and abnormal cells which collect there. The most common locations are the neck (both sides and front), armpit (axillary) and groin (inguinal), but also under the jaw and behind the ears. Swollen or painful lymph nodes generally result from localized or systemic infection, abscess formation, or malignancy. Other causes of enlarged lymph nodes are extremely rare. Physical examination for lymph nodes includes pressing on them to check for size, texture, warmth, tenderness and mobility. Most lymph nodes can not be felt until they become swollen, and then will only be tender when pressed or massaged. A lymph node that is painful even without touching indicates greater swelling. Lymph nodes can usually be distinguished from other growths because they generally feel small, smooth, round or oval-shaped and somewhat mobile when attempts are made to push them sideways. Because less fat covers the lymph nodes in children, they are easier to feel, even when they are not busy filtering germs or making antibodies. Childrens' nodes enlarge faster, get bigger in response to an infection and stay swollen longer than an adult's. Also known (incorrectly) as lymph glands.
Malignant (Cancerous)
Dangerous. Mainly used to describe a cancerous growth -- when used this way, it means the growth is cancerous and predisposed to spreading.
Metastasize (Metastases, Metastasized, Metastasizes, Metastasizing, Metastatic)
Usually in reference to cancer: to spread, especially destructively.
Mineral (Minerals)
Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.
Nervous System
A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.
Pancreas (Pancreatic)
Opposite the liver and behind the stomach, the pancreas has two main functions - to manufacture various enzymes for digestion, and to release hormones to help control the body's use of carbohydrates. It releases insulin to help each cell absorb glucose to burn as energy. In this way, insulin controls the amount of sugar (glucose) in the blood. Proper pancreatic function is very important: too much, too little, or no insulin production can be life-threatening. Some of the chemicals released by the pancreas are not hormones, but stimulate other glands to make hormones. Once again, balance is necessary. Nutritional requirements for the pancreas are many. Research indicates that chromium vitamins C, E, B-complex, calcium, magnesium and potassium are especially important.
Pharmacological
Involving the use of drugs.
Selenium
An essential element involved primarily in enzymes that are antioxidants. Three selenium- containing enzymes are antioxidant peroxidases and a fourth selenium-containing enzyme is involved in thyroid hormone production. The prostate contains a selenium-containing protein and semen contains relatively large amounts of selenium. Clinical studies show that selenium is important in lowering the risk of several types of cancers. In combination with Vitamin E, selenium aids the production of antibodies and helps maintain a healthy heart. It also aids in the function of the pancreas, provides elasticity to tissues and helps cells defend themselves against damage from oxidation.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Vitamin C (Ascorbic Acid)
A water-soluble antioxidant vitamin essential to the body's health. When bound to other nutrients, for example calcium, it would be referred to as "calcium ascorbate". As an antioxidant, it inhibits the formation of nitrosamines (a suspected carcinogen). Vitamin C is important for maintenance of bones, teeth, collagen and blood vessels (capillaries), enhances iron absorption and red blood cell formation, helps in the utilization of carbohydrates and synthesis of fats and proteins, aids in fighting bacterial infections, and interacts with other nutrients. It is present in citrus fruits, tomatoes, berries, potatoes and fresh, green leafy vegetables.
Vitamin E
An essential fat-soluble vitamin. As an antioxidant, helps protect cell membranes, lipoproteins, fats and vitamin A from destructive oxidation. It helps protect red blood cells and is important for the proper function of nerves and muscles. For Vitamin E only, 1mg translates to 1 IU.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: Apr 13, 2008
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