If You Have Esophagus Cancer
What is esophagus cancer?
Cancer can start any place in the body. Cancer that starts in the esophagus is also called esophageal cancer. It starts when cells in the esophagus grow out of control and crowd out normal cells. This makes it hard for the body to work the way it should.
Cancer cells can spread to other parts of the body. Cancer cells in the esophagus can sometimes travel to the liver and grow there. When cancer cells do this, it’s called metastasis (pronounced meh-TAS-tuh-sis). To doctors, the cancer cells in the new place look just like the ones from the esophagus.
Cancer is always named for the place where it starts. So when esophagus cancer spreads to the liver (or any other place), it’s still called esophagus cancer. It’s not called liver cancer unless it starts from cells in the liver.
Ask your doctor to use this picture to show you where the cancer is.
The esophagus (ih-SOF-uh-gus) is the soft tube that connects the mouth to the stomach.
Are there different kinds of esophagus cancer?
There are 2 main types of esophagus cancer. Your doctor can tell you more about the type you have. Here are the medical names for the most common types. (Carcinoma is another name for cancer. It’s pronounced CAR-sin-O-muh.)
Squamous cell carcinoma (SKWAY-mus sell CAR-sin-O-muh): Squamous cells line the inside of the esophagus. Cancer that starts in these cells can grow anywhere along the esophagus.
Adenocarcinoma (AD-no-KAR-suh-NO-muh): These cancers start in gland cells. These cancers are mainly in the lower part of the esophagus, near the stomach.
Questions to ask the doctor
- Why do you think I have cancer?
- Is there a chance I don’t have cancer?
- Would you please write down the kind of cancer you think I might have?
- What will happen next?
How does the doctor know I have cancer of the esophagus?
Esophagus cancer is often found because it causes symptoms. Some symptoms of esophagus cancer may be trouble swallowing, chest pain, weight loss, hoarse voice, and constant cough. Your doctor will ask you questions about your health and will use exams and tests to find out what’s causing your symptoms.
If signs are pointing to esophagus cancer, here are some of the tests you may need:
Tests that may be done
Barium swallow (BEAR-ee-um swallow): This is often the first test done in people who have trouble swallowing. It’s a series of x-rays taken after you swallow barium, a thick, chalky liquid that shows up on x-rays. Any lumps on the inner lining of the esophagus show up on the x-ray.
Upper endoscopy (upper en-DAHS-kuh-pee): To do this test, a flexible, thin tube with a tiny light and video camera on the end is put in your mouth and passed down into your esophagus and stomach. If there are any spots that look like cancer, a small piece of tissue can be taken out through the tube and checked for cancer cells.
CT or CAT scan: Uses x-rays to make detailed pictures of your insides. This can show where the cancer is in the esophagus and if it has spread.
MRI scan: Uses radio waves and strong magnets instead of x-rays to make detailed pictures. This test may be used to see if nearby lymph nodes (limf nodes) are swollen, which might mean the cancer has spread there.
PET scan: PET scans use a special kind of sugar that can be seen inside your body with a special camera. If there is cancer, this sugar shows up as “hot spots” where the cancer is found. This test can help show if the cancer has spread.
In a biopsy (BY-op-see), the doctor takes out a small piece of tissue where the cancer seems to be. The tissue is checked for cancer cells. A biopsy is the only way to tell for sure if you have cancer. For esophagus cancer, a biopsy is most often done during an endoscopy.
Grading esophagus cancer
The cancer cells in the biopsy sample will be graded. This helps doctors predict how fast the cancer is likely to grow and spread. Cancer cells are graded based on how much they look like normal cells. Grades 1, 2, and 3 are used. Cells that look very different from normal cells are given a higher grade (3) and tend to grow faster. Ask the doctor to explain the grade of your cancer. The grade helps the doctor decide which treatment is best for you.
Questions to ask the doctor
- What tests will I need to have?
- Who will do these tests?
- Where will they be done?
- Who can explain them to me?
- How and when will I get the results?
- Who will explain the results to me?
- What do I need to do next?
How serious is my cancer?
If you have esophagus cancer, the doctor will want to find out how far it has spread. This is called staging. You may have heard other people say that their cancer was “stage 1” or “stage 2.” Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.
The stage describes the growth or spread of the cancer through the esophagus. It also tells if the cancer has spread to other organs of your body that are close by or farther away.
Your cancer can be stage 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread beyond the esophagus. Be sure to ask the doctor about the cancer stage and what it means for you.
Questions to ask the doctor
- Do you know the stage of the cancer?
- If not, how and when will you find out the stage of the cancer?
- Would you explain to me what the stage means in my case?
- Based on the stage of the cancer, how long do you think I’ll live?
- What will happen next?
What kind of treatment will I need?
The main ways to treat esophagus cancer are surgery (SUR-jur-ee), radiation therapy, chemotherapy and targeted therapy.
The treatment plan that’s best for you will depend on:
- The stage and grade of the cancer
- The chance that a type of treatment will cure the cancer or help in some way
- Your age
- Other health problems you have
- Your feelings about the treatment and the side effects that come with it
Surgery for esophagus cancer
Surgery is used to try to remove all the cancer if it’s small has not spread.
Surgery to remove all or part of the esophagus is called an esophagostomy (ee-SAH-fuh-JEK-toh-mee). There are many ways to do this surgery. Talk to your doctor about what will be done and what you can expect.
Side effects of surgery
Any type of surgery can have risks and side effects. Ask the doctor what you can expect. If you have problems, let your doctors know. Doctors who treat people with esophagus cancer should be able to help you with any problems that come up.
Radiation (pronounced RAY-dee-A-shun) uses high-energy rays (like x-rays) to kill cancer cells. There are 2 main ways radiation can be given.
It can be aimed at the esophagus from a machine outside the body. This is called external beam radiation. This kind is used most often for esophagus cancer.
Brachytherapy (BRAKE-ee-THAIR-uh-pee) is another kind of radiation. To do this, the doctor uses the endoscope (a long, flexible tube) to put radioactive seeds very close to the cancer. The seeds are taken out when treatment is done.
Side effects of radiation treatments
If your doctor suggests radiation treatment, ask about what side effects might happen. Side effects depend on the type of radiation that’s used. The most common side effects of radiation are:
- Skin changes where the radiation is given
- Feeling very tired (fatigue, which is pronounced fuh-TEEG)
- Nausea and vomiting
- Painful sores in the mouth and throat
- Dry mouth or thick saliva
Most side effects get better after treatment ends and many can be treated. Some might last longer. Talk to your cancer care team about what you can expect.
Chemo (pronounced KEY-mo) is the short word for chemotherapy (pronounced KEY-mo-THAIR-uh-pee) – the use of drugs to fight cancer. The drugs may be given into a vein or taken as pills. These drugs go into the blood and spread through the body. Chemo is given in cycles or rounds. Each round of treatment is followed by a break. Most of the time, 2 or more chemo drugs are given. Treatment often lasts for many months.
Many times chemo is given along with radiation. This is called chemoradiation (KEY-mo-RAY-dee-A-shun).
Side effects of chemo
Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out. But these problems go away after treatment ends.
There are ways to treat most chemo side effects. If you have side effects, talk to your cancer care team so they can help.
Targeted therapy drugs are newer treatments that may be used for certain types of esophagus cancer. These drugs affect mainly cancer cells and not normal cells in the body. They may work even if other treatment doesn’t. These drugs have different side effects than chemo and they are often not as bad.
Other treatments for cancer of the esophagus
There are other types of treatment that may be used for esophagus cancer. Many of these treatments are done through an endoscope (a long, flexible tube) that’s put down the throat and into the esophagus. Some of these can be used to try to cure cancer or ease problems caused by the cancer.
Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better.
If you would like to be in a clinical trial, start by asking your doctor if your clinic or hospital takes part in clinical trials. You can also call our clinical trials matching service at 1-800-303-5691 or go online at www.cancer.org/clinicaltrials to find studies near you.
Clinical trials are one way to get the newest cancer treatment. They are the best way for doctors to find better ways to treat cancer. If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.
What about other treatments that I hear about?
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.
Questions to ask the doctor
- What treatment do you think is best for me?
- What’s the goal of this treatment? Do you think it could cure the cancer?
- Will treatment include surgery? If so, who will do the surgery?
- What will the surgery be like?
- Will I need other types of treatment, too?
- What’s the goal of these treatments?
- What side effects could I have from these treatments?
- What can I do about side effects that I might have?
- Is there a clinical trial that might be right for me?
- What about special vitamins or diets that friends tell me about? How will I know if they are safe?
- How soon do I need to start treatment?
- What should I do to be ready for treatment?
- Is there anything I can do to help the treatment work better?
- What’s the next step?
What will happen after treatment?
You’ll be glad when treatment is over. But it’s hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of these follow-up visits. Your doctors will ask about symptoms, examine you, and may order blood tests, endoscopies, barium swallows, or CT scans.
At first, your visits may be every 3 to 6 months. Then, the longer you’re cancer-free, the less often the visits are needed.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
You can’t change the fact that you have cancer. What you can change is how you live the rest of your life – making healthy choices and feeling as good as you can.
Adenocarcinoma (AD-no-KAR-suh-NO-muh): Cancers that start in gland cells.
Biopsy (BY-op-see): Taking out a small piece of tissue to see if there are cancer cells in it.
Endoscopy (en-DOS-koh-pee): The use of a thin, flexible tube with a lens or tiny video camera on the end to look inside the body.
Esophagostomy (ee-SAH-fuh-JEK-toh-mee): Surgery to take out all or part of the esophagus.
Metastasis (muh-TAS-tuh-sis): Cancer cells that have spread from where they started to other places in the body
Radiation (RAY-dee-A-shun): Use of high-energy rays (like x-rays) to kill cancer cells.
Squamous cell carcinoma: (SKWAY-mus sell KAR-suh-NO-muh): Cancer that starts in the cells that line the inside of the esophagus.
Last Medical Review: February 23, 2016 Last Revised: February 23, 2016