What is esophageal cancer?
Your esophagus is the long hollow tube that runs from the back of your throat down to your stomach. This tube moves the food you eat as the digestion process begins.
Esophageal cancer symptoms
Common signs and symptoms of esophageal cancer may include:
- Difficulty swallowing
- Unintentional, significant weight loss
- Pain, pressure or burning in your chest
- Worsening indigestion or heartburn
- Coughing or hoarseness
- Frequent choking, especially with bread, raw vegetables and meat
Having these symptoms does not mean you have esophageal cancer. However, it’s still important to talk to your doctor, as these could be signs of an underlying health issue.
Esophageal cancer risk factors
Although cancers of the head and neck region (including esophageal cancer), are less common than other types of cancers, there are still risk factors. Some factors are out of your control, but there are lifestyle choices that can increase your risk of developing esophageal cancer, including smoking, alcohol use and environmental factors.
Risk factors for esophageal cancer include:
- Tobacco use: 85% percent of head and neck cancers, including esophageal cancer, are linked to tobacco use. This includes smokeless tobacco, cigarettes and pipes. Tobacco use is the single largest risk factor for cancers of the head and neck.
- Alcohol use: Prolonged, heavy alcohol use greatly increases your risk of certain types of head and neck cancer, including esophageal cancer.
- Gastroesophageal reflux disease (GERD): The stomach normally produces strong acid and enzymes to help digest food. In some people, acid can escape from the stomach up into the lower part of the esophagus. The medical term for this is gastroesophageal reflux disease (GERD), or simply reflux. Those with GERD have a slightly higher risk of developing esophageal cancer. GERD is very common, and most people who have it don’t develop esophageal cancer. GERD can also cause Barrett’s esophagus, which is linked to an even higher risk.
- Barrett’s esophagus: When the backup of stomach acid into the lower esophagus (reflux) occurs for a long period of time, it can damage the inner lining of the esophagus. This condition is known as Barrett’s esophagus. Although most people with Barrett’s esophagus don’t develop esophageal cancer, it can still increase your risk.
- Other risk factors: Other risk factors that can increase the risk of developing esophageal cancer include overconsumption of processed meats, obesity, workplace or environmental exposures or injury to the esophagus.
How is esophageal cancer diagnosed?
Our team of cancer doctors are experienced in diagnosing and treating esophageal cancer at all stages, including advanced stages. Some of the diagnostic tests your doctor may perform to test for esophageal cancer include:
- Physical examination: If your doctor suspects you have esophageal cancer, he or she will perform a physical examination, feeling for lumps in the neck and chest. To confirm an initial cancer diagnosis or to determine whether the cancer has spread, you may be asked to undergo further testing.
- Endoscopy: This procedure will allow your doctor to examine the inside of your esophageal area. During an endoscopy, your doctor will insert a small scope into your nose or mouth to examine the hard-to-see areas of your head and neck.
- Biopsy: During a biopsy, your doctor will remove a small sample of tissue to detect whether it contains cancerous cells (also called malignant cells). The tissue will be removed using a thin needle or during a surgical procedure and will be further examined beneath a microscope.
- Imaging tests: Imaging tests, such as MRIs, CT scans and PET scans, are used to produce detailed pictures of the inside of your head or neck. These tests can determine the size of tumors and whether they have grown, shrunk or spread.
Others may include:
- Barium swallow: For a barium test, you will need to swallow a chalky substance known as barium. Barium coats the lining of the esophagus, stomach and intestines so tumors or other abnormalities can be seen more clearly on an X-ray.
- Blood tests: Your doctor may order blood work to look for certain indicators of esophageal cancer or monitor how your treatment is progressing.
Treating esophageal cancer
At Geisinger, our highly trained team of esophageal cancer specialists includes surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, nurse navigators and support staff who come together to develop a personalized treatment plan around you.
Depending on the type, location and stage of your cancer, one or more of the following treatments may be recommended.
At Geisinger, our surgeons use the latest techniques to treat esophageal cancer, including minimally invasive and robotic surgery, to offer you the best outcomes and path for healing. Our surgeons are highly trained and board certified, which means they have passed an optional national exam to demonstrate their medical expertise. Many of our surgeons are also fellowship trained, holding additional training in specific types of cancer surgery.
If your cancer is small and hasn't spread, your surgeon may recommend removing the cancer as well as a portion of the healthy tissue that surrounds it. Surgery can be done using an endoscope passed down your throat and into your esophagus.
- Esophagectomy, in which your surgeon will remove the affected area of your esophagus, along with a portion of the upper part of your stomach and surrounding lymph nodes.
Chemotherapy is a drug-based treatment designed to slow the growth of or shrink tumors located in the esophagus.
Chemotherapy drugs can be given through an IV or taken in pill form.
The timing of your chemotherapy may be:
- Before your surgery, to attempt to reduce the size of the tumor
- Along with radiation therapy, which is known as chemoradiation or chemoradiotherapy
- After your surgery, to destroy any cancer that still remains in the esophagus and reduce the chances of the cancer coming back
Our team includes doctors called medical oncologists who specialize in chemotherapy. Our patients have access to clinical trials that include testing new chemotherapy drugs and combinations of medications that aren’t widely available.
Keeping you comfortable while you undergo your treatment is important to us. Our state-of-the-art clinics, many which have been recently renovated, offer heated seats and individual TVs to help you stay comfortable during treatment.
Radiation oncology uses radiation to control or destroy harmful cancer cells, with tools to treat each unique cancer.
Our board-certified cancer doctors and highly skilled clinical team deliver conventional radiotherapy treatments that include:
- External beam radiation, which uses special technology to send X-ray radiation (photons) to the tumor from outside the body
- Internal radiation (brachytherapy), which targets the tumor using safe levels of radiation inside the body through radioactive tubes placed in the esophagus
- Intensity-modulated radiation therapy (IMRT), which uses a 3D image of the tumor to deliver high-precision radiotherapy that fits its exact outline
- Image-guided radiation therapy (IGRT), which is used to localize the radiation beam daily and treat cancers in areas of the body that move during and between treatments. This includes Cone Beam CT scans to accurately view the tumor and target it during treatment.
- Stereotactic body radiation therapy (SBRT), which uses precise conformal beams of radiation to focus high doses of radiation to just the tumor, with very little damage to surrounding healthy tissues
Sometimes the esophagus will narrow as a result of a tumor. If this happens and your quality of life is affected, your surgeon may use an endoscope to place a stent into the esophagus to keep it open.
Sometimes, a person is too ill for chemotherapy or radiation and will need a feeding tube to get the nutrition their body needs. Although the thought of having a feeding tube can be scary, it is a critical tool to deliver vital nutrients and help your esophagus heal. Rest assured, your care team will work closely with you to explain your treatment and guide you throughout your entire journey.
Esophageal cancer care at Geisinger
Cancer is unique to each person, which is why Geisinger’s cancer care team gets to know you along your journey. While some of our cancer specialists are trained in treating specific cancers, our entire team works together to help you fight your cancer.
Our esophageal cancer specialists treat more cases of esophageal cancer than any other healthcare provider in the region and are dedicated to providing innovative treatments and personalized cancer care. We offer:
- Unmatched expertise – Our cancer team consists of surgeons, doctors and specialists, many of whom are fellowship trained. This team of highly trained specialists treats many patients with esophageal and other cancers each year, and is focused on delivering the most personalized, excellent care that is suited to each patient’s needs.
- Multidisciplinary care team – Those diagnosed with cancer have the opportunity to work with our experienced multidisciplinary care team, a multi-physician team that comes together to create a personalized treatment plan for each patient. This will enable you to see your care team in one location, all during the same visit.
- World-class care, close to home – With locations throughout central, northeast and south-central Pennsylvania, our experienced cancer team provides consultations and comprehensive care. We offer leading-edge treatment options and tailored-to-you care backed by the expertise and innovation of a nationally recognized health system.
- Comprehensive specialty care – From chemotherapy, radiation and minimally invasive surgery options to national clinical trials and genetic testing, our esophageal cancer specialists are dedicated to offering innovative treatment options and personalized care in convenient locations, so you don’t have to travel far.
- Leading-edge clinical trials – Our extensive history with cancer research and clinical trials gives you access to new treatments before they become widely available. Participating in a trial may help you get better even if standard approaches haven’t worked. Find a clinical trial.
- Genetic testing and counseling programs – Our cancer genetics programs determine whether you face a higher than normal cancer risk. Special programs such as MyCode®, which are only available at Geisinger, detect the earliest signs of certain cancers, so you can start treatment right away. Our care and guidance may even help you avoid a cancer diagnosis. Learn more or sign up for MyCode.
- Cancer survivorship program – Just because your treatment is complete doesn’t mean your journey has ended. We offer a variety of support resources focused on helping you live your healthiest life. Learn about patient resources.