Although your esophagus is essentially a hollow tube, its walls are
composed of a number of highly-specialized layers, including an inner
lining made up of thin, flat cells (squamous cells), a layer below the
inner lining (submucosa) that contains mucus-secreting glands, and a
thick band of muscle tissue.
When you eat or drink, a muscle in the upper part of your esophagus
(upper esophageal sphincter) relaxes, allowing food and liquid to enter.
Smooth muscles in the esophagus wall then move the food along in a
series of rhythmic contractions a process called peristalsis. It
usually takes four to 10 seconds for food to flow through your
Another ring of muscle, the lower esophageal sphincter, sits at the
junction where your esophagus and stomach connect. It opens to allow
food into your stomach and then clamps shut so that corrosive stomach
acids and digestive enzymes don't back up into the esophagus.
Cancer can occur almost anywhere along the length of the esophagus and
is classified according to the types of cells in which it originates:
or epidermoid carcinoma.
The most common esophageal cancer in black Americans, squamous cell
carcinoma develops in the flat squamous cells that line the
This arises in the glandular tissue in the lower part of the
esophagus nearest the stomach.
Although squamous cell and adenocarcinoma are the primary types of
esophageal cancer, other, rare forms of the disease sometimes occur.
These include sarcoma, lymphoma, small cell carcinoma and spindle
cell carcinoma. In addition, cancer that starts in the breast or
lung can spread (metastasize) through the bloodstream or lymph
system to the esophagus.
Healthy cells grow and divide in an orderly way. This process is
controlled by DNA the genetic material that contains the instructions
for every chemical process in your body. When DNA is damaged, changes
occur in these instructions. One result is that cells may begin to grow
out of control and eventually form a tumor a mass of malignant cells.
Although researchers don't know all the causes of esophageal cancer,
they have identified several factors that can damage DNA in your
esophagus. These factors include:
cell carcinomas is a result from chronic alcohol abuse. Long-term heavy
drinking irritates the lining of the esophagus, leading to
inflammation that eventually may cause malignant changes in the
Using tobacco in any form, including cigarettes, cigars, pipes and
chewing tobacco, increases the likelihood of developing esophageal
squamous cell carcinoma. The risk increases with long-term use and
rises dramatically for people who both smoke and drink.
Sometimes the lower esophageal sphincter relaxes abnormally or
weakens, allowing caustic stomach acids to back up into your
esophagus (esophageal reflux). The result is
heartburn a burning
chest discomfort that in severe cases may mimic the symptoms of a
heart attack. Occasional heartburn usually isn't serious, but
chronic acid reflux can lead to Barrett's esophagus, a condition in
which cells similar to the stomach's glandular cells develop in the
lower esophagus. These new cells are resistant to stomach acid, but
they also have a high potential for malignancy.
Each year, nearly 1 million children under age 5 accidentally drink
toxic household substances. Some of these chemicals, especially
drain cleaners that contain lye, burn the lining of the esophagus
and may contribute to esophageal cancer later in life.
Eating a diet low in fruits and vegetables appears to contribute to
esophageal cancer. Especially implicated are diets lacking in
vitamins A, C, B1 (riboflavin), the mineral selenium, and
beta-carotene a substance found especially in orange and yellow
fruits and vegetables that is converted into vitamin A in your body.
Weighing 20 to 30 pounds more than your ideal weight has been linked
to an increased risk of adenocarcinoma.
Sometimes esophageal cancer is associated with certain rare medical
In this disorder, food collects at the bottom of the esophagus, both
because the esophagus lacks normal peristalsis to move food along
and because the lower esophageal sphincter doesn't relax normally.
For reasons that aren't clear, having achalasia seems to increase
your risk of esophageal cancer.
These thin protrusions of tissue can appear anywhere in the
esophagus. Some webs cause no symptoms, but others can make
swallowing difficult. When other problems including anemia and
abnormalities of the tongue, fingernails and spleen occur in
conjunction with esophageal webs, the condition is called
Plummer-Vinson or Paterson-Kelly syndrome. People with this syndrome
are at risk of developing esophageal cancer.
This rare, inherited disorder causes excess skin to form on the
soles and palms. Close to half the people with tylosis eventually
develop esophageal cancer. A genetic defect appears to be
responsible for both tylosis and the associated cancer.
Heavy drinking and smoking are the two greatest risk factors for
esophageal squamous cell carcinoma. The risk increases substantially if
you drink as well as smoke. If you drink heavily every day for several
years, your risk of esophageal cancer is 18 times greater than it is for
someone who drinks in moderation or not at all. When you also smoke,
your risk nearly doubles.
Other risk factors for esophageal cancer include:
Your risk of developing esophageal cancer increases as you grow
older. Most people with the disease are between 45 and 70. The risk
is much less if you're under 40.
Men are three times as likely to develop esophageal cancer as women
Squamous esophageal cancer affects three times as many black
Americans as whites, whereas whites have much higher rates of
esophageal adenocarcinoma than do blacks. Although the reason for
this disparity isn't known, genetic factors may play a role.
If your diet is low in fruits and vegetables, or you're very
overweight, you're at increased risk of esophageal cancer.
heartburn or Barrett's esophagus.
Both conditions, which occur when stomach acid backs up into your
esophagus, increase your risk of esophageal cancer.
When to seek medical advice
See your doctor if you have difficulty swallowing, a chronic cough or
unintended weight loss. Having these signs and symptoms doesn't mean you
have esophageal cancer. A number of other conditions can cause similar
problems, and your doctor can perform tests to help determine the cause.
Also seek treatment if you experience chronic
heartburn, which can cause
inflammation in your esophagus and increase your risk of esophageal
cancer. In many cases, you can control mild or moderate
changing your diet and using over-the-counter antacids. When these
measures aren't enough, your doctor may recommend stronger medications.
Signs and symptoms of gastroesophageal reflux include:
A sour taste and
the sense of food re-entering your mouth (regurgitation)
pain, especially after meals or at night when lying down
swallowing, often due to a spasm or stricture in your esophagus
wheezing, asthma, hoarseness or sore throat, often resulting from
acid reflux in your throat or windpipe
Screening and diagnosis
To help find the cause of your symptoms, your doctor will take a
complete medical history and perform a physical exam. You're also likely
to have a chest X-ray and other diagnostic tests, such as:
A diagnostic test often given to people who have difficulty
swallowing, a barium swallow uses a series of X-rays to examine the
esophagus. Before the test, you'll drink a thick liquid (barium)
that temporarily coats the lining of your esophagus so that the
lining shows up clearly on the X-rays. You may also have air blown
into your esophagus, to help push the barium against the esophagus
walls. Although a barium swallow can help diagnose cancer, it may
not show whether a tumor has spread beyond the esophagus. After the
test you can eat normally and resume your daily activities, although
you'll need to drink extra water to help flush the barium from your
system and prevent constipation. A barium swallow briefly exposes
you to ionizing radiation. The danger from this exposure is small
and doesn't appear to increase even if you have a number of X-rays.
Even so, care is taken to produce the best images with the lowest
amount of radiation and the fewest possible X-rays.
During this procedure, your doctor examines the inside of your
esophagus using an endoscope a thin, lighted tube with a tiny
camera on the end that sends images to a TV monitor. Your throat
will likely be sprayed with a topical anesthetic before you're asked
to swallow the tube, and you may also receive medication through
your veins (intravenously) to keep you relaxed and comfortable. The
endoscope allows your doctor to clearly see any masses in the wall
of your esophagus as well as to take a tissue sample (biopsy) if
abnormal cells are found. The samples are then sent to a laboratory
for analysis. Risks of the procedure include a reaction to the
medication and bleeding at a biopsy site. If your doctor needs to
make a wider opening (dilate) your esophagus because of a stricture
or narrowing, there's also a small risk of creating a hole in your
esophagus (esophageal perforation).
Screening tests check for a disease in its early stages, before you
develop symptoms. If you're at high risk of esophageal cancer,
especially if you have Barrett's esophagus or tylosis, you're likely to
have regular endoscopic examinations and biopsies. Many doctors
recommend having these tests every two to three years if you don't have
cell abnormalities (dysplasia). When cell abnormalities are present,
you'll usually need tests more often.
If cancer is diagnosed, you're likely to have more tests to determine
whether and where the cancer has spread (metastasized), a process known
as staging. This step is especially important because it helps your
doctor determine the best possible treatment. Esophageal cancers are
staged using the numbers 0 through IV. In general, the higher the number
the more advanced the cancer.
(carcinoma in situ).
These cancers, also called noninvasive or in situ (in one
place) cancers or high-grade dysplasia, don't have the ability to
spread to other parts of your body. Still, it's important to have
them followed closely or removed because they eventually may become
This cancer occurs only in the top layer of cells lining your
At this stage, the cancer has invaded deeper layers of your
esophagus lining and may have also spread to nearby lymph nodes.
The cancer has spread even more deeply into the wall of your
esophagus and to nearby tissues or lymph nodes.
At this stage, the cancer has spread to other parts of your body.
To help stage esophageal cancer, you may have one or more of these
In this procedure, which is similar to esophagoscopy, your doctor
uses an endoscope to examine your windpipe (trachea) and the air
passages leading to your lungs (bronchi) to determine whether cancer
has spread to these areas.
tomography (CT) scan.
This X-ray technique produces more detailed images of your internal
organs than do conventional X-ray studies. That's because a computer
translates information from X-rays into images of thin sections
(slices) of your body at different levels. CT scans can confirm the
location of a tumor within the esophagus and whether cancer has
spread to nearby lymph nodes or other organs. A CT scan exposes you
to more ionizing radiation than plain X-rays do and usually isn't
recommended if you're pregnant.
This procedure may prove to be more accurate than either CT scans or
upper endoscopy in determining how far an esophageal cancer has
spread into nearby tissues. During the test, a tiny ultrasound probe
is passed through an endoscope into your esophagus. The probe
produces very sensitive sound waves that penetrate deep into
tissues. A computer then translates the sound waves into close-up
images of your esophagus and nearby tissues. Your doctor can also
take biopsies of lymph nodes and other tissues during the procedure.
Endoscopic ultrasound uses sound waves rather than X-rays to create
images, and the risks of the procedure, such as bleeding or
perforation of the esophagus, are slight.
emission tomography (PET) scan.
During this test, your doctor injects a small amount of a
radioactive tracer typically a form of glucose into your body.
All tissues in your body absorb some of this tracer, but tumors
absorb greater amounts and appear brighter on the scan than healthy
tissue does. A PET scan exposes you to a small amount of radiation,
but because the radioactivity is short-lived, your overall exposure
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