Esophageal Cancer Symptoms

What Is Esophageal Cancer?

Esophagus is a hollow tube that connects the throat with the stomach. When you eat or drink, this muscular tube allows you to swallow food and pass it on to the stomach. If we speak about the structure of the tube, it is made of multiple tissue layers, including mucous membrane, connective tissue, and muscle. When esophageal cancer occurs, the inner lining of the tube develops malignancy which grows and spreads to the outer layers.

While many factors can influence malignancy growth, esophageal cancer has increased the chances of occurrence in smokers and heavy alcohol users.

Types of Esophageal Cancer

Esophageal cancer has two main types based on the origin of malignancy [¹]. We have covered the details of each to give you a better idea.

Squamous Cell Carcinoma

Squamous cell carcinoma occurs when malignant cells develop in the esophageal lining. If we divide the tube into two sections (upper and lower half), this type of internal cancer develops in the upper and middle parts of the esophagus.

Adenocarcinoma

Adenocarcinoma develops in the lower part of the tube where the esophagus connects with the stomach. This type of esophageal cancer may affect the stomach sooner due to the location of the malignancy.

How Is Esophageal Cancer Diagnosed?

Doctors diagnose esophageal cancer based on the signs or symptoms of the disease. Once suspected, the doctor may run medical exams, blood tests, and a biopsy to determine the condition of the malignancy. Doctors also ask patients about their medical history to determine the cause. Many tests can confirm the presence and condition of cancer cells [²]. We have listed them below for a quick idea.

• Imaging Tests
• Barium Swallow Test
• CT Scan
• MRI
• PET Scan
• Endoscopy
• Bronchoscopy
• Thoracoscopy
• Laparoscopy
• Blood Tests

Esophageal Cancer Staging

When you notice the warning signs of cancer, your doctor may run tests and evaluate the cancer stage. To understand the staging of esophageal cancer, you may need to familiarize yourself with the TNM system of evaluation.

• Tumor (T) indicates the depth of the tumor (in the wall of the esophagus and other tissues).
• Node (N) indicates the spread of the tumor to the lymph nodes.
• Metastasis (M) indicates whether cancer has spread to other body parts.

Squamous Cell Carcinoma Stages

If a patient is diagnosed with squamous cell carcinoma, the staging depends on the location of the tumor and its grade (G). [³]

Stage 0

In stage 0, the cancer cells develop and stay only in the top lining of the esophagus. It is the earliest cancer stage and may be treated using appropriate techniques.

Stage IA

In stage IA, the tumor develops and remains in the top layers of the esophagus. It is the next stage to the initial phase in which malignant cells stick to the top lining alone.

Stage IB

When in stage IB, the cancer cells may be in the top layers of the esophagus with less differentiated cells or in the third layer with no cells spreading to the lymph nodes or other body parts.

Stage IIA

When in stage IIA, cancer fulfills one of the following conditions.

• The malignant cells are in the third layer of the esophagus and are spread into the tube but not through the muscular wall of the esophagus.
• The tumor is present in the outer layer of the middle or upper part of the tube.
• The tumor is present in the outer layer of the lower tube part.

Stage IIB

When in stage IIB, cancer fulfills one of the following conditions.

• The malignant cells are in the outer layer of the middle or upper part of the tube with less differentiated cells.
• The tumor is present in the outer layer of any part of the tube.
• The tumor is present in any part of the tube, and the malignant cells have spread into the esophageal lining (and its layers) and have also affected 1-2 lymph nodes in the region.

Stage IIIA

When in stage IIIA, the tumor meets one of the following conditions.

• The cancer cells are in any part of the tube, spread into the esophageal lining (and other layers), and affect 3-6 lymph nodes in the region.
• The tumor is present in any part of the esophagus, has developed into the third esophageal layer, and has spread to 1-2 lymph nodes.
• The cancer cells have spread out of the esophagus and affected nearby tissues but not the lymph nodes and other body parts.

Stage IIIB

When in stage IIIB, the malignancy meets one of the following conditions.

• The cancer cells are in any part of the tube, have grown into the third esophageal layer, and spread to 3-6 lymph nodes.
• The tumor is present in any part of the tube, has developed into the outer layer, and affected 1-2 or 2-6 lymph nodes.
• The tumor is present in any part of the esophagus, has spread to surrounding structures, and has affected 1-2 or none of the lymph nodes.

Stage IVA

When in stage IVA, the tumor meets one of the following conditions.

• The tumor is present in any part of the tube, has spread to nearby structures, and may have affected 3-6 lymph nodes.
• The cancer cells have spread to the region's 7 or more lymph nodes.

Stage IVB

When in stage IVB, the cancer cells have spread to other body parts.

Adenocarcinoma Stages

Stage 0

The cancer is present only in the top lining of the esophagus.

Stage IA

The cancer cells have developed into the lining of the esophagus and underneath layers.

Stage IB

When in stage IB, the tumor meets one of the following conditions.

• The malignant cells have spread to the underneath layers of the tube and are moderately differentiated.
• The malignant cells have developed into the submucosa (a layer of the esophagus).

Stage IC

When in stage IC, the tumor meets one of the following conditions.

The tumor has developed into the underneath layers of the tube lining or the submucosa with poorly differentiated cells.

The tumor has grown into the third layer of the esophagus with well- or moderately-differentiated cells.

Stage IIA

The cancer cells are in the third layer of the esophagus with poorly differentiated cells and no chances of grade evaluation.

Stage IIB

When in stage IIB, the tumor meets one of the following conditions.

• Cancer is present in the outer layer of the esophagus.
• Cancer is present in an inner layer of the esophagus and has affected 1-2 lymph nodes.

Stage IIIA

When in stage IIIA, the tumor meets one of the following conditions.

• The tumor is present in the inner layers of the tube and has spread to 3-6 lymph nodes in the region.
• The tumor is in the third layer of the tube and has spread to 1-2 lymph nodes.

Stage IIIB

When in stage IIIB, the tumor meets one of the following conditions.

• The tumor is in the third layer of the tube and has affected 3-6 lymph nodes.
• The tumor is in the outer esophageal layer and has spread to 1-2 or 3-6 lymph nodes.
• The tumor has developed in the nearby structures and has affected 1-2 or none of the lymph nodes.

Stage IVA

When in stage IVA, the tumor meets one of the following conditions.

• The tumor has developed in the nearby structures and affected 3-6 or none of the lymph nodes.
• The tumor has developed in 7 or more lymph nodes.

Stage IVB

The tumor has spread to another body part. [⁴]

Is Esophageal Cancer Hereditary?

Cancers develop due to mutations in a person’s DNA. Since genetic mutations can be inherited, a small number of esophageal cancer cases occur due to inheritance. We have covered a few cases below as an example. [⁵]

• Tylosis: Caused by inherited mutations in the RHBDF2 gene.
• Bloom Syndrome: Caused by mutations in the BLM gene.
• Fanconi Anemia: Mutations in FANC genes can lead to cancer development.
• Familia Barrett’s Esophagus: Caused by inherited genes of affected patients.

Esophageal Cancer Symptoms

Esophageal cancer is mostly diagnosed due to the presence of the symptoms. The symptoms of esophageal cancer help doctors pick a direction and run necessary tests. In rare cases, esophageal cancer may be detected without symptoms due to accidental detection in tests conducted for other purposes. Here are the esophageal cancer symptoms you should know.

• Difficulty swallowing
• Chest pain
• Weight loss
• Chronic cough
• Hoarseness
• Vomiting
• Bone pain (if spread to the bones)
• Esophageal bleeding

Please note that many of these esophageal cancer symptoms can occur due to other diseases. If you notice them, you may consult your doctor for a thorough diagnosis.

What Are the Symptoms of Esophageal Cancer?

The symptoms of esophageal cancer can vary depending on the stage and origin of the malignancy. While the above list highlights most of the symptoms, here are a few common ones you should closely monitor.

Problems in Swallowing Food

Dysphagia is the most common symptom of esophageal cancer. Patients may face difficulty swallowing food due to the feeling of it getting stuck in the throat. Some patients may choke when eating due to the blockage. As cancer develops in the tube, it gradually narrows down the path to the stomach, making it worse for patients to swallow food.

Chest Pain

Esophageal cancer symptoms list chest pain as one of the common ones. Patients may notice chest pain in the middle of the chest due to a feeling of burning or pressure. Painful swallowing is referred to as odynophagia. While it is a common symptom, chest pain may occur due to many other reasons, such as heartburn.

Weight Loss

Esophageal cancer patients often lose significant weight due to a decreased diet. The presence of tumors in the tube makes it difficult to swallow food and meet the body's caloric requirements.

What Are Some Signs of Esophageal Cancer?

The signs of esophageal cancer appear after initial testing. Since this cancer type mostly occurs with obvious symptoms, doctors look for esophageal cancer signs by running a few tests. [⁶]

Barium Swallow Test (Esophagram)

Doctors use X-rays to graph images of a patient’s esophagus as they swallow a chalky liquid known as barium [⁷]. The X-rays help to determine the signs of esophagus cancer in the patient.

CT Scan

Doctors use X-rays to graph an image of the esophagus and surrounding tissues to identify the esophageal cancer signs while conducting a CT scan. [⁸]

MRI

Health experts use MRI for a better view of the esophageal lining using magnetic fields [⁹]. Patients receive an injection of a contrasting liquid to identify the signs of cancer cells in the tube.

PET/CT Scans

When doctors face difficulty in determining the area of cancer development, they opt for PET/CT combined scan to identify the signs of esophageal cancer in the body [¹⁰]. Typically, doctors inject a small amount of radioactive sugar to develop a clear scanned image.

Blood Tests

A blood test alone may not be sufficient to detect the signs of cancer in the esophageal lining. Doctors may prescribe a complete blood count (CBC) and a liver panel test to diagnose cancer signs. [¹¹]

If basic detection tests identify the signs of esophageal cancer, doctors subject the patient to further testing, including the following.

• Endoscopy (Upper, EUS, and Bronchoscopy)
• Biopsy

Symptoms of Esophageal Cancer in Women Vs. Symptoms of Esophageal Cancer in Men

According to recent research on the occurrence of esophageal cancer in males and females (biological genders), men are more likely to develop esophageal cancer than women (3:1). [¹²]

However, the symptoms for both genders are the same. We have covered them below for a quick review.

• Trouble swallowing food
• Chest pain
• Weight loss
• Hoarseness
• Vomiting
• Coughs (chronic)
• Bone pain
• Bleeding esophagus

Risk Factors for Esophageal Cancer

The risk factors for esophageal cancer can be classified as changeable and non-changeable factors. For instance, smoking is a changeable risk factor for esophageal cancer. Stopping it can eliminate the risk associated with smoking. On the other hand, inherited gene mutations and age cannot be changed. We have covered the common risk factors below for a better understanding. [¹³]

Age

The chances of developing esophageal cancer increase with age.

Gender

Males are more likely to have esophageal cancer than females.

Use of Alcohol and Tobacco

Using tobacco products, including cigarettes, cigars, chewing tobacco, and pipes, is a crucial risk factor for esophageal cancer. Moreover, alcohol consumption also increases the risk of developing esophageal cancer (squamous cell carcinoma).

Gastroesophageal Reflux Disease

The stomach produces strong acids to digest food. In some people, these acids can escape into the lower esophageal lining, increasing the risk of cancer development.

Obesity

Obese people are more likely to develop adenocarcinoma of the esophagus due to the increased chance of gastroesophageal reflux.

Apart from these major risk factors, there are a few others that we have listed below for your ease.

• Unhealthy Diet (highly processed meat and too hot drinks)
• Lack of Physical Activity
• Achalasia
• Tylosis
• Plummer-Vinson Syndrome
• Esophageal Injury
• History of Other Cancers
• Human Papilloma Virus (HPV)

Esophageal Cancer Prevention

Adults can prevent esophageal cancer by carefully monitoring the risk factors. Avoiding risky habits can help people prevent the development of malignancy in the esophageal lining. Here are some important prevention tips. [¹⁴]

• Limiting or stopping the use of tobacco.
• Limiting or stopping the consumption of alcohol.
• Avoid foods that trigger GERD.
• Maintain a healthy body weight.
• Periodic blood and other tests.

Esophageal Cancer Prognosis and Treatment

The prognosis for esophageal cancer majorly depends on the type and stage of cancer. Generally, esophageal cancers diagnosed at earlier stages have a better outlook. If esophageal cancer metastasizes, treating it becomes more challenging. However, patients must maintain hope in all cases.

The treatment of esophageal cancer varies for each case. Doctors thoroughly evaluate the options and discuss them with the patient for a mutual decision.

Esophageal Cancer Survival Rate

The esophageal cancer survival rate depends on how groups of patients have dealt with the disease in the past. Overall, the five-year survival rate for esophageal cancer is nearly 20%. However, the rates can range from 5% to 47% based on the complexity of the cases. [¹⁵]

Esophageal Cancer Treatment Options

Esophageal cancer treatment varies for each patient. The doctor can best advise the optimal path to treatment and recovery. While valid, the common treatment options most doctors have for patients with esophageal cancer are mentioned below. [¹⁶]

Surgery

Doctors may perform surgery to remove the tumor (as much as possible). Surgeries work well when the tumor is restricted to a certain location in the esophagus.

Radiation Therapy

Many doctors use radiation therapy to kill cancer cells. Radiation therapy uses high-energy X-rays or other radiation types to kill tumors.

Chemotherapy

Chemotherapy uses chemical-based drugs to kill the malignant cells in the esophageal lining and other body parts. Doctors opt for chemotherapy when cancer spreads to other body parts.

Targeted Therapy

Targeted therapy is a cell-focused therapy that eliminates the factors influencing the growth of malignant cells.

Conclusion

Takeaway

Esophageal cancer is a common cancer type among adults. When occurred, it can directly impact eating habits and overall body health. The above comprehensive guide can help you determine the causes, risks, prevention, and treatment factors for esophageal cancer. You can consult your doctor for thorough assistance.