There are two main types of esophageal cancer, squamous cell carcinoma and adenocarcinoma. Less common forms of cancer of the esophagus include leiomyosarcoma, which is a cancer of the smooth muscle of the esophagus, metastatic cancer, which is cancer that has spread to the esophagus from the original tumor elsewhere in the body, and esophageal lymphoma, which is extremely rare in occurrence.
Squamous Cell Carcinoma
The esophagus, which is the part of the digestive system that transports swallowed food to the stomach, is composed of distinctive cells. The epithelium, or lining of the esophagus, is made up of thin, flat cells called squamous cells. A malignant lesion that develops in these cells is called squamous cell carcinoma. Though this form of cancer can occur in any section of the esophagus, it is more commonly found in the upper and middle sections. Squamous cell carcinoma is more common among males than females and more common among African-Americans than Caucasians.
Risk factors for developing squamous cell carcinoma include tobacco use and heavy alcohol use. Receiving radiation treatment to the esophagus for head and neck cancers increases the risk of developing esophageal cancer. Human papilloma virus has been linked to squamous cell carcinoma of the esophagus. An additional risk factor is the narrowing of the esophagus from damage sustained by the ingestion of a caustic liquid.
Difficulty swallowing is the most common symptom of esophageal cancer. The earliest sign is trouble swallowing solid foods. Within a few weeks, an individual is unable to swallow soft foods and fluids. Though the patient maintains a healthy diet, there will be noticeable weight loss. Chest pain that radiates to the back is a reported symptom. As the tumor grows, the vocal chord nerve is affected, and hoarseness is experienced. In the late stages of esophageal cancer, blockage of the esophagus occurs, and swallowing is impossible.
Endoscopic examination of the esophagus and the microscopic examination of biopsies or the tissue samples obtained during the procedure are means of diagnosing esophageal cancer. The use of advanced imaging such as a PET and CT scan assists the physician in staging or documenting the advancement of the disease.
Depending on the stage of the cancer, surgery can involve removal of the tumor to removal of a portion of the esophagus and as much as part of the upper stomach. Chemotherapy and radiation therapy are modes of treatment used separately or in combination to destroy the cancer cells.
Adenocarcinoma
The glandular cells of the esophagus secrete mucus. An adenocarcinoma is the most common malignant form of esophageal cancer in the United States and develops in the glandular cells. It is more common among males than females and more common among Caucasians than African-Americans. The risk of developing adenocarcinoma of the esophagus increases with the diagnosis of gastroesophageal reflux disease. Barrett's esophagus is a precursor to adenocarcinoma of the esophagus. Barrett's esophagus is a condition caused by chronic acid reflux. The long-term exposure to stomach acid causes the normal squamous cells to transform to glandular cells. These changed cells resemble the glandular cells of the stomach and intestines, which are more resistant to stomach acid. Adenocarcinomas are formed in the lower portion of the esophagus.
Difficulty swallowing is also a symptom of an adenocarcinoma of the esophagus. An individual may experience chest discomfort that radiates to the back.
Examination with an endoscope allows the gastroenterologist to examine the esophagus and obtain tissue samples to make a diagnosis. Surgery, chemotherapy and radiation therapy are the treatments for adenocarcinoma of the esophagus.
Leiomyosarcoma of the Esophagus
Leiomyosarcoma is a rare malignant lesion that affects the smooth muscles of the esophagus. A patient has difficulty swallowing and may experience pain when attempting to swallow. This symptom leads to a deterioration in the person's nutritional status. Diagnosis is made by endoscopic examination. Surgical removal of the tumor and affected esophageal muscle is usually followed by the use of chemotherapy and radiation treatment.
Esophageal Lymphoma
Esophageal lymphoma is a rare form of esophageal cancer and is the result of the spread or metastasis of a lesion that begins in the stomach or surrounding lymph nodes or cervical lymph nodes. Lymph nodes are part of the immune system and occur throughout the body. Difficulty swallowing is a presenting symptom. Patients can experience weight loss, chest pain, hoarseness and fatigue. Endoscopic examination and advanced imaging are used to confirm a diagnosis. Surgery, chemotherapy and radiation therapy are treatments for esophageal lymphoma.
Metastatic Cancer to the Esophagus
Metastasis is the spread of a malignant lesion from a primary site to other parts of the body. Melanoma, breast and lung cancer are three forms of cancer that can spread to any organ in the body. Once the cancer invades the esophagus, symptoms, diagnosis and treatment are similar to the other forms of esophageal cancer.
