Esophageal Cancer Expertise With a Multidisciplinary Care Team

Esophageal cancer describes the formation of malignant cancer cells in the muscular tube that moves food from your throat to your stomach. Esophageal cancer typically comes in two types. The most common is adenocarcinoma, which forms in the glandular cells in the esophageal lining.

Esophageal adenocarcinoma typically affects the lower esophagus, near where it meets your stomach. It is strongly associated with gastroesophageal reflux disease (GERD) and a condition known as Barrett’s esophagus, where the lining of the esophagus develops abnormal cells due to chronic acid exposure.

The other type is squamous cell carcinoma, which forms in the flat cells that line the esophagus. Esophageal squamous cell carcinoma tends to develop in the middle to upper sections of the esophagus.

Esophageal cancer can be complex. At Norton Cancer Institute, you’ll see a multidisciplinary team of surgical oncologists, medical and radiation oncologists, nurse navigators, registered dietitians, pathologists, interventional radiologists, gastroenterologists and more to evaluate and guide your treatment. All bring their own areas of expertise to your case at weekly meetings to review and plan treatment. Our multidisciplinary team works together at the same location, allowing you to schedule multiple appointments for the same day.

Your care will be coordinated by our gastrointestinal cancer patient navigator who will guide you through treatment. Our navigator is a registered nurse and advocate for patients and families and can help coordinate scheduling and provide information and support throughout your diagnosis, treatment and beyond.

In addition to our current leading-edge treatments, we offer our patients the opportunity to participate in innovative National Cancer Institute and industry-sponsored clinical trials and studies.

Esophageal Cancer Symptoms

The most common first symptom of esophageal cancer is difficulty swallowing or the feeling that food is lodged in the throat or chest. This will get worse as time goes on. Other signs of esophageal cancer include chest pain or discomfort that feels like acid reflux pain, or burning or a pressure feeling in the middle of the chest, especially after swallowing.

No two cancers are alike — you may have no symptoms, your symptoms may be a sign of something other than esophageal cancer, or you may have a unique combination of symptoms.

Although doctors aren’t sure exactly what causes esophageal cancer, there are many known risk factors that can increase the likelihood of developing this type of cancer, including:

Diagnosing Esophageal Cancer

The first thing your doctor will do if you have esophageal cancer symptoms is take a detailed medical history, including any risk factors or symptoms you may have. From there, your health care provider will determine the appropriate next step. Those steps might include:

• Endoscopy with biopsy, a flexible, narrow tube with a tiny video camera and light on the end that is used to look inside the body. Tests that use endoscopes can help diagnose esophageal cancer or determine the extent of its spread.
• Imaging studies, including a CT scan, positron-emission tomography scan or endoscopic ultrasound can help diagnose and properly stage the cancer.
• Blood tests, including a complete blood count, show whether you have low red blood cell counts, which can mean the tumor is bleeding. A liver enzyme test helps the doctor understand whether cancer has affected the liver.
• Swallow tests, which can be done alone or with other tests, involve drinking a thick, chalky liquid called barium to coat the walls of the esophagus. When X-rays are taken, the barium outlines the esophagus.

Esophageal Cancer Staging

Proper cancer staging helps your team determine the most effective treatment options for you. Stages of esophageal cancer may be grouped into three main categories based on the cancer size and whether or not it has spread to other areas of the body.

• Early-stage cancer has not grown beyond the inner lining of the esophagus, is small (less than 2 centimeters in diameter) and does not involve any lymph nodes.
• Locoregional or locally advanced cancer invades the esophagus wall and/or involves nearby lymph nodes.
• Metastatic cancer has spread to other parts of the body away from the esophagus. The most common sites include the liver, lungs, distant lymph nodes, bone and brain.

Esophageal cancer also may be staged using the tumor, node, metastasis (TNM) system. The letters T, N and M describe different areas of cancer growth. A number is assigned to each letter, based on imaging and pathology results. A TNM example may look like: T2N1M0 or T2, N1, M0.

• T (tumor) – depth and spread of the main (primary) tumor in the wall of the esophagus
• N (node) – if cancer has spread to nearby lymph nodes
• M (metastasis) – if cancer has spread to other parts of the body away from the esophagus

Esophageal Cancer Treatment Options

There are many options for treating esophageal cancer, depending on the cancer stage, whether the cancer has spread and your overall health. Treatment options include:

• Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) use an endoscope passed down the esophagus to visualize the tumor then remove it through suction or cutting away (early-stage cancers).
• Endoscopic ablation uses extreme cold or heat, microwaves or chemicals to destroy cancer cells (early-stage cancers).
• Chemoradiation therapy combines radiation and chemotherapies.
• Esophageal cancer surgery treats the cancer by removing small tumors, part of the esophagus (esophagectomy) or the upper part of the stomach and affected lymph nodes (esophagogastrectomy). Surgery is typically used to treat early-stage or locally advanced cancer.
• Radiation therapy uses high-energy X-ray beams to precisely target the cancer.
• Chemotherapy uses powerful drugs to kill cancer cells.
• Immunotherapy helps your body’s natural immune system fight cancer and may be recommended following surgery.
• A clinical trial may offer access to the latest research and an innovative treatment option for your specific type of cancer.