Types of Esophageal Cancer
Esophageal cancer is a rare disease, but it can be linked to poor outcomes. It’s essential to understand the type of esophageal cancer you have and its stage in order to make treatment decisions.
“Where you go for testing and diagnosis is critical, because you don’t want to be treated based on incorrect information,” says Scott Swanson, MD, a Mass General Brigham thoracic surgeon who cares for patients at Brigham and Women’s Hospital.
Dr. Swanson advises patients to seek care at a center with plenty of experience. “Therapy is decided by the stage and the cell type. An expert team has a pathologist who examines the cancer cells, and the team can make sure the tumor has been identified and staged correctly.”
What is esophageal cancer?
Esophageal cancer is found within the lining of the esophagus, the tube that moves food and liquid from your throat to your stomach.
The condition often doesn’t cause any symptoms until it’s advanced. Those symptoms may include:
Chronic hiccups
Feeling like food is “catching” in your throat
Problems swallowing
Vomit or mucus that contains streaks of blood
Weight loss for no particular reason
Most cases of esophageal cancer are found during exams and tests for other reasons. For example, doctors may detect it during a lung cancer screening or an endoscopy to explore digestive issues. Therefore, the doctors often don’t detect the disease until it’s advanced. So even though this type of cancer is rare, it’s the seventh most common cause of cancer-related death worldwide, according to a study in CA: A Cancer Journal for Clinicians.
The only way to diagnose esophageal cancer is with an endoscopy and biopsy. A doctor directs a long, thin tube into your mouth and down your throat. The tube has a light and a camera so the doctor can see abnormal tissue.
During the endoscopy, the doctor can take a small sample of tissue for testing, called a biopsy. A pathologist examines the cells under a microscope to identify the type of esophageal cancer.
Types of esophageal cancer
There are two major types of esophageal cancer: adenocarcinoma and squamous cell carcinoma. They make up almost all cases of esophageal cancer worldwide. Two additional types of cancer in the esophagus — neuroendocrine cancer and small cell carcinoma — are extremely rare.
Adenocarcinoma of the esophagus
Esophageal adenocarcinoma is the most common form of esophageal cancer in the United States, responsible for about 8 in 10 cases, according to the National Cancer Institute (NCI).
It forms in the glandular cells in the lining of the esophagus. These types of cells are responsible for making fluids, such as mucus. It usually occurs in the lower part of the esophagus, closer to the stomach.
“The incidence of esophageal adenocarcinoma in the United States has risen dramatically in the last few decades,” Dr. Swanson says. “It’s not clear why, but it’s more common in people with obesity and bad reflux, and both of those conditions have increased significantly in the last few decades as well.”
Although it’s not clear why some people get esophageal cancer and others don’t, it occurs much more often in people who have Barrett’s esophagus. Barrett’s esophagus is a condition that happens in some people with long-term gastroesophageal reflux disease (GERD). The reflux makes cells in the lining of the esophagus change from normal to abnormal. GERD can turn into Barrett’s esophagus, and Barrett’s esophagus can turn into esophageal cancer.
Squamous cell esophageal cancer
Esophageal squamous cell carcinoma forms in the squamous cells in the esophagus and often in the upper section of the esophagus, closer to the mouth. Squamous cells are flat cells that look like scales and line the inner layer of the esophagus.
“Forty years ago, most cases of esophageal cancer were squamous, and it was most common in people who drank or smoked heavily,” Dr. Swanson says. “Recently, the incidence of esophageal squamous cell carcinoma has decreased in the United States, to around 1 in 5 of all esophageal cancers. This type of esophageal cancer is still associated with smoking, alcohol consumption, and a diet low in fruits and vegetables.”
Stages of esophageal cancer
Another way to classify esophageal cancer is by its stage, which indicates how advanced the disease is. The stage can determine your treatment options and prognosis (outcomes). Stage is determined by the following factors:
How abnormal the cells are
How much the tumor has grown into the lining of the esophagus
Size of the tumor
Where the tumor is (upper, middle, or lower esophagus)
Whether cancer has spread to nearby lymph nodes or distant sites in the body, such as the lungs or liver
Whether initial treatments have been effective
To determine stage, your doctor may order an endoscopic ultrasound to take pictures inside the esophagus and examine nearby lymph nodes. You may also need a positron emission tomography (PET) or computed tomography (CT) scan to see whether cancer has spread further. Your doctor will take all of these factors into consideration and tell you whether you have stage 1, stage 2, stage 3, or stage 4 esophageal cancer.
Treatment for esophageal cancer
Treatment options are evolving rapidly, Dr. Swanson explains, and the best course of action often involves a combination of treatments. “For many years, the treatment for esophageal cancer didn’t change, but it’s evolving, so make sure you go to someone who’s current on the latest treatment advances,” he says.
Depending on the stage of the cancer, surgery may remove part or all of the tumor. More advanced esophageal cancers usually require chemotherapy and possibly radiation therapy to destroy cancer cells and control tumor growth. New immunotherapy drugs that help recruit the immune system to fight cancer can be appropriate for some people.
Minimally invasive surgical options can help reduce the risk of complications and help you recover quickly.
“When the surgery is done well, you will rarely have any long-term problems. You may have to eat smaller meals and you may lose some weight,” Dr. Swanson says. “But most people are back to normal eating patterns and gain weight back at the 6-month mark.”
