About Esophageal Cancer

About Esophageal Cancer

At Penn Medicine's Abramson Cancer Center, patients with esophageal cancer receive their care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of gastrointestinal cancer.

Esophageal cancer is cancer that develops within the lining of the esophagus, the muscular tube through which food passes from the mouth to the stomach.

There are two types of esophageal cancer:

  • Squamous cell carcinoma: Cancer that begins in the flat skin-like cells lining the esophagus.
  • Adenocarcinoma: Cancer that begins in the intestinal-type cells that make and release mucus and other fluids.

Penn Medicine's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).


Esophageal Cancer Risk and Prevention

There are risk factors that can increase the chance of developing cancer. Having a risk factor, or even several, does not mean that someone will get cancer. There are different kinds of risk factors.

Some risk factors for cancer, like age and family history, cannot be prevented. Patients who feel they are at risk may benefit from consulting with a risk assessment specialist within Penn Medicine’s GI genetics program.

Esophageal Cancer Risk Factors

Researchers believe chronic irritation of the esophagus may affect esophageal tissue and put some people at higher risk for developing esophageal cancer.

Some other risk factors include:

  • Alcohol use
  • Tobacco use
  • Barrett’s esophagus
  • Gastroesophageal reflux disease (GERD)
  • Eating a diet low in fruits and vegetables
  • Obesity
  • African Americans (greater risk for developing squamous cell esophageal cancer)
  • Caucasians (greater risk for developing adenocarcinoma)
  • Overall, men are about three times more likely than women to develop esophageal cancer

Barrett’s esophagus is a condition in which the lining of the esophagus is damaged by stomach acid. Barrett’s esophagus is the body’s way of repairing the damage and this may increase the risk for developing esophageal cancer.

People diagnosed with Barrett's should be monitored for precancerous cells in the lining of the esophagus. If precancerous cells are found, they can be treated endoscopically to help prevent cancer.

Esophageal Cancer Prevention

The risk of esophageal cancer may be lowered by making several lifestyle changes:

  • Limiting or eliminating alcohol use: Moderate or no consumption of alcohol can decrease the risk of developing cancer.
  • Eliminating tobacco use: Smoking or chewing tobacco can increase the risk of developing cancer. Patients can get help to stop smoking through Penn Medicine’s Lung Center or through a smoking cessation research program at the Abramson Cancer Center.
  • Eating a diet rich in fruits and vegetables: This includes fruits and vegetables that are green and yellow, and cruciferous vegetables such as cabbage, broccoli and cauliflower.
  • Maintaining a healthy weight: Research has shown that obesity is a risk factor for developing esophageal cancer. A physician can help patients learn strategies to lose weight.

Esophageal Cancer Risk Assessment

Penn Medicine offers programs for patients who want to determine their risk of developing gastrointestinal cancer through the Penn GI genetics group.

This program offers knowledge about the presence of genetic risk factors for cancer and provides patients with important, sometimes life-saving options.

Types of Esophageal Cancer

There are two main types of esophageal cancer and they are named for how the cancer cells look under a microscope. Both types begin in the cells in the inner lining of the esophagus, and are diagnosed, treated and managed in similar ways.

  • Squamous cell
  • Adenocarcinoma

Adenocarcinoma of the esophagus: Adenocarcinoma is usually found in the lower part of the esophagus, near the stomach. In the United States, adenocarcinoma is the most common type of esophageal cancer.
Squamous cell carcinoma of the esophagus: Squamous cell carcinoma is usually found in the upper part of the esophagus. This type is becoming less common among Americans, but around the world it is the most common type of esophageal cancer.

Esophageal Cancer Symptoms

The symptoms for esophageal cancer may include:

  • Dysphagia, problems swallowing or feeling like food gets stuck.
  • Pain when swallowing.
  • Pain in the chest or back.
  • Losing weight without trying.
  • Heartburn.
  • A hoarse voice or cough that doesn’t go away in two weeks.

An early diagnosis can improve outcomes for esophageal cancer treatment. Patients with these symptoms should consult their physician.

Staging Esophageal Cancer

After esophageal cancer is first diagnosed, a series of tests are used to investigate the extent of the cancer and to see whether it has spread to other parts of the body from where it started. Staging is a way of recording the size and growth of a cancer, and determining the plan for treatment.

  • Stage 0. Abnormal cells are found only in the inner layer of the esophagus.
  • Stage I. The cancer has grown through the inner layer into the submucosa.
  • Stage II. One of the following:
    • Cancer has grown into submucosa and has spread to lymph nodes.
    • Cancer has invaded the muscles. Cancer cells are found in lymph nodes.
    • Cancer has grown through outer layer of esophagus.
  • Stage III. One of the following:
    • Cancer has grown through outer layer of esophagus and has spread to lymph nodes.
    • Cancer has invaded nearby structures. Cancer cells may have spread to lymph nodes.
  • Stage IV. The cancer has spread (metastasized) from where it started to other organs, such as the liver, bones or lungs.

 

Esophageal Treatment

After being diagnosed with esophageal cancer, patients at the Abramson Cancer Center may be evaluated through the Gastrointestinal Cancer Evaluation Center (GICEC). The center provides patients with expert support and evaluation to discuss treatment options and individualized treatment plans.

ADAM Image

Patients with esophageal cancer are treated by a multidisciplinary team of cancer specialists who see more patients with gastrointestinal (GI) cancers in one year than many doctors see in their careers.

Penn Medicine’s GI cancer program has physicians nationally recognized for their expertise in the diagnosis and treatment of cancer.

Penn’s GI cancer treatment team includes:

  • Nationally recognized medical experts with years of experience in diagnosing and treating GI cancer.
  • Nurses with advanced training and experience.
  • Oncology Navigation Specialists to help patients navigate the health system.
  • Registered dietitians to provide nutrition counseling.
  • Cancer counselors to provide individual or family counseling for issues many cancer patients face.
  • Rehabilitation therapists who specialize in the diagnosis and treatment of physical effects from cancer and its treatment.
  • An esophageal cancer support group for patients and their loved ones.

Patients at Penn Medicine can benefit from participating in clinical trials that take place at Penn. Patients interested in learning more about clinical trials should speak with someone on their treatment team.

Oncology Navigation Specialists

Every step of cancer treatment – from cancer diagnosis, to surgery and treatment to forming a survivorship plan – comes with different needs and issues that should be addressed.

Oncology Navigation Specialists at the Abramson Cancer Center are available to make a patient’s experience as seamless as possible. As experts in navigating complex health care situations, patient support specialists serve as a consistent point of contact and a reliable source for advice, support and direction for patients and families. They can help in a variety of ways including; provide emotional support, identify resources, and ensure access to information, support services, educational programs and community resources.

Learn more about Patient Navigation specialists at the Abramson Cancer Center.

Diagnosing Esophageal Cancer

An accurate cancer diagnosis from trusted cancer specialists is the first step in developing personalized treatment options for esophageal cancer.

Patients who choose Penn’s Abramson Cancer Center benefit from a multidisciplinary team of cancer specialists including gastroenterologists, radiologists, pathologists and surgeons who work together to provide a diagnosis and treatment plan custom designed for each patient with esophageal cancer.

Cancer specialists at Penn Medicine are highly experienced in using the most advanced techniques for diagnosing esophageal cancer and are actively researching better and more precise ways to detect esophageal cancer.

An accurate diagnosis is a critical step in planning cancer treatment, so it’s important patients know that when they come to the Abramson Cancer Center, they are taking an important step in getting the best cancer treatment available.

Navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more Diagnosing Esophageal Cancer

Esophageal Cancer Treatment

Following the diagnosis and staging of esophageal cancer, cancer specialists at Penn's Abramson Cancer Center develop a personalized treatment plan. Penn's treatment options for esophageal cancer include:

  • Surgery
    • Esophagectomy
  • Radiation therapy
    • 3-D conformal radiation therapy
    • Intensity-modulated radiation treatment (IMRT)
    • Volumetric-modulated arc therapy (VMAT)
    • Proton therapy
  • Chemotherapy
  • Endoscopy
    • Endoscopic mucosal resection
    • Radiofrequency ablation
    • Integrative medicine and wellness
    • Palliative care
    • Penn Home Care and Hospice

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more Esophageal Cancer Treatment

Esophageal Cancer Survivorship

Survivorship programs at Penn Medicine are a distinct phase of esophageal cancer care and are designed to help patients' transition from their cancer treatment routine to a post-cancer care lifestyle. There are more than 12 million cancer survivors living and thriving today as a result of advances in cancer treatment. However, cancer treatments can result in physical, emotional and financial complications long after the therapy is complete.

Read more Esophageal Cancer Survivorship


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