Esophageal Cancer

The body is made up of very small cells. Normal cells in the body grow and die in a controlled way. Sometimes cells keep dividing and growing in an uncontrolled way, causing an abnormal growth called a tumor.

If the tumor does not invade nearby tissues and body parts, it is called a benign tumor, or non-cancerous growth. Benign tumors are usually not life threatening. It the tumor invades nearby tissues and body parts, it is called a malignant tumor or cancer.

Cancerous cells spread to different parts of the body through blood vessels and lymph channels. Lymph is a clear fluid produced by the body that drains waste from cells. It travels through special vessels and bean-shaped structures called lymph nodes.

Cancer that moves from one tissue to other body parts is known as metastatic cancer. For instance, an esophageal tumor may grow through the esophagus’s outer layer and nearby tissues over time.

Cancers in the body are given names, depending on where the cancer started. Cancer that begins in the esophagus will always be called esophageal cancer, even if it spreads to other places. 

Risk Factors

It is usually impossible to specify the cause of cancer in an individual patient. However, we do know what causes cancer in general. Doctors also know factors that can increase the chances of getting cancer.

These are known as “risk factors”. Smokers are more likely than non-smokers to develop esophageal cancer. Also, drinking more than 3 alcoholic drinks a day increases your risk. Having a diet low in fruits and vegetables may increase the risk of esophageal cancer.

Obesity increases the risk for esophageal cancer. Age is a risk factor for esophageal cancer is age. People between 45 and 70 years of age are at the highest risk. Also, men are more likely than women to develop esophageal cancer.

Acid reflux increases your risk. Acid reflux is a very common condition that can damage the tissue in the esophagus. Acid reflux is the abnormal backward flow of stomach acid into the esophagus. Having Barrett esophagus can increase your risk of esophageal cancer. Barrett esophagus is when cells in the lower part of the esophagus have changed or been replaced with abnormal cells.

It can be caused by acid reflux. Not everybody who has risk factors for esophageal cancer develops esophageal cancer. Some people who have no risk factors for esophageal cancer can still develop the cancer. 

Symptoms

Common symptoms of esophageal cancer are:

    • Food getting stuck in the esophagus, and food may come back up
    • Pain when swallowing
    • Pain in the chest or back

Symptoms of esophageal cancer also include:

    • Weight loss
    • Heartburn
    • A hoarse voice or cough that doesn’t go away within 2 weeks

These symptoms may not be caused by esophageal cancer. Make sure to see a doctor to find out what is causing your symptoms.

Diagnosis

The best way to treat esophageal cancer is by finding it very early. It is sometimes possible to find this type of cancer even before it causes any symptoms.

If you have symptoms of esophageal cancer, your doctor will try to find out if esophageal cancer is the cause of your symptoms or if there is another cause. Your doctor will ask you about your family medical history in addition to your own.

You may also have blood tests or other lab tests to rule out other causes of your symptoms. A physical exam may be performed. A barium swallow, also known as an upper GI, may be done. After you drink a barium solution, you have x-rays taken of your esophagus and stomach.

The barium solution makes your esophagus show up more clearly on the x-rays. An endoscopy may also be done. First your doctor will numb your throat with an anesthetic spray.

You may also be given medicine to help you relax. During an endoscopy, a thin, lighted tube called an endoscope is used to look into your esophagus. The tube is passed through your mouth to the esophagus.

A biopsy may be performed during an endoscopy. A biopsy is a removal of cells or tissue for examination by a pathologist. A pathologist will examine the tissue under a microscope to look for cancer cells. A biopsy is the only sure way to know if cancer cells are present. 

Staging

If you have esophageal cancer, your doctor will determine the stage of the cancer. Staging is an attempt to find out if the cancer has spread and, if so, to which parts of the body. Stages are usually described using the numbers 1 - 4; a lower number indicates an earlier stage.

Staging is helpful in deciding the best course of treatment. When staging esophageal cancer, doctors want to find out:

    • How deeply the cancer invades the wall of the esophagus
    • Whether the cancer invades nearby tissues
    • Whether the cancer has spread, and if so, to what parts of the body

If esophageal cancer has spread to nearby lymph nodes, it can spread to other areas of the body. Esophageal cancer can spread to other lymph nodes, the bones, liver, and lungs. An endoscopic ultrasound may be performed.

Your doctor will pass a thin, lighted tube down your throat. Sound waves are used to create pictures that show the organs and tissues in the body. Tumors can show up on a CT scan. A CT scan is an x-ray machine linked to a computer.

A CT scan takes a series of detailed pictures of your organs. You may be given contrast material by mouth or injection to make abnormal areas easier to see. An MRI is also used to make detailed pictures of areas inside your body.

It uses strong magnets to create images of the inside of the body. You may receive contrast material by injection to make abnormal areas easier to see. A PET scan can show if the esophageal cancer has spread elsewhere in the body. For this test, you are injected with a small and safe amount of radioactive sugar.

The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter because they use sugar faster than normal cells.

A bone scan can show if esophageal cancer has spread to the bones. For this test, you are injected with a small amount of a safe radioactive substance. It travels through the bloodstream and collects in the bones.

A machine scans and makes pictures of the bones. Laparoscopic surgery may also be used for staging esophageal cancer. During a laparoscopy, a surgeon makes small incisions in your abdomen.

A thin, lighted tube called a laparoscope is inserted into the abdomen. The surgeon may remove lymph nodes or take tissue samples for biopsy. Sometimes staging is not complete until after surgery to remove the tumor and nearby lymph nodes.

 esophageal-cancer

Treatment and Supportive Care

The type of treatment used depends on the size and location of the tumor, the stage of the disease, and the health of the patient. Treatment for esophageal cancer may involve surgery, radiation therapy, chemotherapy, or some combination of these treatments.

Surgery for esophageal cancer depends on where the cancer is located in your esophagus. The surgeon may remove part of the esophageal or the whole esophageal. Surrounding tissue may also be removed. Chemotherapy is the use of drugs to kill cancer cells.

Chemotherapy is usually given in the blood stream through an IV. Radiation therapy uses high-energy rays to kill cancer cells and stop them from growing and spreading. The radiation that treats the cells comes from a machine that aims the rays at a specific area of the body. Internal radiation is another type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters are placed directly into or near a tumor.

Chemotherapy and radiation therapy may sometimes be done together. These treatments may be used on their own, before surgery or after surgery. There may be clinical trials available for people with esophageal cancer. Clinical trials test new medical approaches and treatments. Esophageal cancer and its treatment can lead to other health problems.

It is important to have supportive care before, during, and after cancer treatment. Supportive care is treatment to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with emotions.

People with advanced esophageal cancer may have trouble swallowing. Not being able to swallow makes it hard or impossible to eat. It also increases your risk of food getting in your airways which can lead to pneumonia.

Your doctor may suggest treatment options to help with this. A stent may be used to hold open a blocked esophagus. A stent is a tube made out of metal mesh or plastic. The doctor uses an endoscope to place a stent. Laser therapy may be used to destroy cancer cells that block the esophagus.

A laser is a concentrated beam of intense light that kills tissue with heat. Photodynamic therapy may be used to kill cancer cells that block the esophagus.

A drug is injected that collects in the esophageal cancer cells.

A special light is shinned on the cancer. The drug becomes active when exposed to light and kills the cancer cells. Radiation therapy may help shrink a tumor that is blocking the esophagus. Internal or external radiation may help make swallowing easier. Balloon dilation may be used.

The doctor inserts a tube through the blocked part of the esophagus. A balloon helps widen the opening. Other ways to get nutrition may include a change in the portion size and meal times, liquid meals, a feeding tube, or intravenous nutrition.

A dietitian can help you plan a diet that will meet your nutrition needs.

Supportive care also deals with the pain associated with cancer and its treatments. Your healthcare provider or a pain control specialist can suggest ways to relieve or reduce pain. Radiation therapy and pain medicine may help.

Proton Therapy for Esophageal Cancer Treatment

"Proton therapy potentially represents the best of both worlds – delivering a high dose of radiation to tumors, while at the same time limiting side effects to patients."

Proton therapy is a non–invasive, incredibly precise cancer treatment that uses a beam of protons moving at very high speeds to destroy the DNA of cancer cells, killing them and preventing them from multiplying.

The Benefits of Proton Therapy

Unlike conventional radiation that can affect surrounding healthy tissue as it enters the body and targets the tumor, proton therapy's precise, high dose of radiation is extremely targeted. This targeted precision causes less damage to healthy, surrounding tissue.

When aimed at cancer tumors, protons pack impressive power. Protons release their energy completely once they enter a tumor, limiting the radiation dose beyond the tumor, causing less damage to the healthy surrounding tissues and resulting in fewer side effects.

Even if you've already had a course of conventional radiation and are unable to receive more, you may still be able to receive proton therapy.

More facts about proton therapy:

    • Proton therapy offers fewer reported side effects and complications
    • Normal, healthy, surrounding tissues receive 50% to 70% less radiation
    • Proton therapy offers an increased safe dose delivered to tumors
    • Cure rates may be increased with proton therapy
    • Proton therapy can re–treat tumors after recurrences

Increased Precision Close to Critical Organs

Thanks to its marvelous precision, proton therapy is perhaps the most advanced treatment for cancer tumors located close to critical organs and highly sensitive areas, such as the spinal cord, heart and brain.

Proton therapy, alone or in combination with other treatments, is a great choice for many specific types of cancers and benign conditions.

Proton therapy is also an important treatment option for cancers that cannot be completely removed by surgery.

What to expect

Each patient’s therapy is precisely tailored to their needs. Patients and clinicians collaborate closely to create a personalized treatment plan. The number and length of treatments will vary, based on the cancer. How patients respond depends on many factors, including the types of breast cancer treatments they are receiving. Many people tolerate proton therapy well and continue to perform normal activities. However, individual responses vary.

Benefits of proton prostate cancer treatment

Proton therapy improves the quality of life for prostate cancer patients and survivors by offering a number of compelling benefits:

    • It is non-invasive and therefore painless
    • It is more accurate than other kinds of radiation
    • Full or higher doses of radiation can be used for treatment without damaging healthy tissues and organs
    • Treatment is provided in an outpatient setting
    • Proton radiation therapy does not require recovery time
    • The treatment has little to no impact on a patient’s energy level
    • Proton therapy poses minimal risk of impotency
    • The treatment has lower risk of side effects compared with conventional treatment.