Esophageal cancer refers to the growth of abnormal (malignant or cancerous) cells in the esophagus. The esophagus is a tube that carries food from the mouth down to the stomach. It is also known as the “food pipe.”

• The esophagus contains muscles that move the food in one direction, from the mouth to the stomach.
• The muscles in the esophagus also help stop food from backing up into the throat and mouth (reflux).

Esophagus cancer is one of two types. The cells that make up these two types of cancer look different when they are examined under a microscope. The two types of esophageal cancer are:

• Squamous cell carcinoma
• Adenocarcinoma

Your healthcare providers will look to see if your esophageal cancer has spread to other areas of the body. This process is called “staging.”

• In advanced cases, cancer of the esophagus can involve other organs.
• Metastatic esophageal cancer is cancer that started in the esophagus and has spread to other organs.

In order to decide what type of surgical and non-surgical treatment is ideal for a specific esophageal cancer, your healthcare provider will need the following clinical information.

• What does the cancer look like under the microscope?
• Does the cancer invade outside the esophagus?
• How large is the primary cancer in the esophagus?
• Has the cancer spread anywhere else in the body?
• What is the overall condition of your health?

Radiation therapy involves the use of various forms of radiation, or high-energy x-ray beams, to kill cancer cells in a specific area of the body. Radiation therapy can be used:

Before surgery to make a tumor smaller

• To cure a cancer that cannot be removed by surgery
• After surgery to prevent a cancer from returning
• As an alternative to surgery
• To decrease symptoms that are related to a tumor or aggressive cancer
• With chemotherapy

Radiation therapy can be given in various ways, depending on what type of cancer you have and where it is located in your body.

• Radiation therapy to treat esophageal cancer is usually given externally by a machine that is located outside the body. The x-ray beams can kill the cancer cells and shrink a tumor or even make it disappear.
• The x-ray beams must pass through normal tissue on their way to the cancer and out of the body. The radiation that passes through normal organs can cause damage, which can be temporary or permanent.
• Radiation oncologists plan treatments to minimize exposure to normal organs.
• The treatments must be given daily over several weeks because normal tissues don't tolerate a large dosage given at one time.

Some types of radiation therapy include:

• Three-dimensional (3D) conformal radiation is tailored to adapt to the size and shape of a tumor. The patient's position is changed so the beam goes through the tumor from two or three different angles. The approach is planned to allow the maximum exposure of radiation to the tumor.
• Intensity-modulated radiation therapy (IMRT) uses hundreds of angles to accomplish the same task. It is far more expensive and is used when many angles are necessary. This approach helps to spare an important organ that is not affected by the cancer. In IMRT the intensity of the beam is varied to conform to the shape of the tumor. The aim is to limit damage to surrounding healthy tissues, while effectively treating the cancer. IMRT is a valuable technique for treating a small percentage of cancerous tumors, but adds little value in the treatment of others. IMRT may not be covered by your health plan unless certain criteria are met.

Radiation can also be given internally by placing special radioactive source near a tumor (called brachytherapy), orally in the form of a pill or capsule that is swallowed or an infusion of a radioactive substance into a vein. The decision to administer radiation therapy will depend on the individual circumstances.

Esophageal cancer accounts for about 1% of cancers occurring in the U.S. The occurrence is greatest in men over the age of fifty. The risk factors for esophageal cancer depend on the specific type of cancer.

• Squamous cell carcinoma of the esophagus has been associated with smoking and excessive alcohol intake.
• Adenocarcinoma of the esophagus has been associated with Barrett's esophagus (a complication of GERD, or gastroesophageal reflux disease), male sex, obesity and smoking. This type of esophageal cancer is more common than squamous cell carcinoma of the esophagus.

To decrease your risk of developing cancer of the esophagus, you should quit or avoid smoking and limit the amount of alcohol you drink - or not drink at all. If you have chronic reflux or have a diagnosis of Barrett's esophagus, you may need to undergo periodic screenings for esophageal cancer. Screenings are often done with an upper endoscopy and biopsy and can lead to an early diagnosis and improved survival. The symptoms of esophageal cancer can include:

• Reflux, or backwards movement of stomach contents into the esophagus
• Trouble swallowing food or liquids, including pain on swallowing
• Heartburn
• Blood in vomit
• Unexplained loss of weight

Contact your healthcare provider if you have any of the above symptoms. He or she will review your symptoms and perform a physical examination. They may also recommend one of the following tests:

• A barium swallow to see the lining of the esophagus
• A CT scan of the chest and/or abdomen area, typically to identify the stage of the cancer
• An ultrasound of the esophagus, typically to identify the stage of the cancer
• An upper endoscopy or EGD (esophagogastroduodenoscopy) with the removal of tissue for examination under a microscope (biopsy)

If you have specific symptoms or a large cancer, your healthcare provider may also recommend:

• A CT scan to determine if the cancer has spread
• A positron emission tomography (PET) scan to determine if the cancer has spread
• A lymph node biopsy to determine if the cancer has spread to the lymph nodes

Treatments for cancer of the esophagus are either local (only affects the area of the cancer) or systemic (affects all areas of the body). Local treatments include:

• Surgery to remove the cancer (esophagectomy, or removal of part or all of the esophagus)
• Radiation to kill the cancer cells

Systemic treatments include:

• Chemotherapy to kill the cancer cells
• Targeted, or biologic, therapy to interfere with the changes in cells has been approved for a certain type of cancer of the esophagus

Treatment for esophageal cancer may involve a combination of local and systemic treatments. You may also have more than one type of cancer treatment at a time.

• Radiation and chemotherapy are usually given in a physician clinic or hospital by specially trained medical personnel.
• In some cases, you may be able to receive chemo at home with the help of specially trained nurses.

To get a full range of opinions and perspectives, you may want to consider input from a variety of doctors. This includes:

• Your primary care physician
• A medical oncologist (a doctor who specializes in the treatment of cancer)
• A surgeon with experience in esophageal cancer
• A radiation oncologist (a doctor who specializes in treating cancer with radiation therapy)
• A genetic counselor

It is important to remember that the total cost of this care path does not include all possible medications, lab work or imaging studies. Those charges can add up. If your healthcare provider recommends any lab work or imaging studies, you may need to search for their costs separately.

Contact your healthcare provider if you have symptoms of esophageal cancer. Be prepared to discuss your symptoms and how long you've had them.

• Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations)/
• Make a list of your medications (including over-the-counter).
• Write down any questions, symptoms or concerns you want to talk about.
• If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).

What should I ask my healthcare provider before having radiation therapy?

• How will radiation improve my prognosis?
• What specific precautions do I need to take after receiving radiation therapy?
• What are the possible complications?
• How will I feel after radiation therapy? Will I have to modify my activity?
• What type of radiation will I receive? What symptoms should I report to my healthcare provider before my next appointment?
• Is there a reason you are recommending one form of radiation therapy over another?
• Will I be receiving other treatments along with the radiation therapy?

It is important you understand all home care instructions (including medications and side effects) and follow-up plans. Don't forget to make arrangements for help at home.

Source UHC.com

Also known as:

Radiotherapy

Radio Therapy

In Situ

Esophagus Cancer

Cancer of Esophagus

Cancer - Esophagus - Radiation

Cancer