Getting treated for esophageal cancers — and precancerous conditions such as Barrett's esophagus — at City of Hope gives you access to unparalleled treatment options and exceptional care. It means you are the focus of a multidisciplinary team of world class scientific leaders that know the newest and best treatments for your disease.
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More than 16,000 Americans will be diagnosed with esophageal cancer in 2016, according to the American Cancer Society — and timely diagnosis and intervention can make a dramatic difference in improving your chances of survival and quality of life.
If you have been diagnosed with esophageal cancer or are looking for a second opinion consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.
As one of only a few dozen institutes to be designated a comprehensive cancer center by the National Cancer Institute, City of Hope is an acknowledged leader in esophageal cancer research and treatment. Our decades of experience, specialized therapy protocols and extensive clinical trials program mean newly diagnosed or relapsed patients can find a treatment regimen that is tailored to their individual needs and gives them the best chance for survival.
U.S. News & World Report has rated City of Hope one of the top cancer hospitals in the country for over a decade — reflecting how our multidisciplinary team takes an integrated, comprehensive approach to diagnosing and treating esophageal cancers, as well as precancerous conditions such as Barrett’s esophagus.
Highlights of our program include:
- Experience in minimally invasive, robotically assisted surgery for esophageal cancer, reducing complication risk and recovery time
- Endoscopic ultrasound to accurately locate and evaluate tumors
- Radiofrequency ablation to destroy tumor cells in the body
- Highly precise radiation therapy
City of Hope patients have access to our comprehensive team of supportive care experts, who can help manage and treat quality-of-life issues that may come up such as trouble eating, drinking or speaking following treatment.
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What is esophageal cancer?
Esophageal cancer is a disease in which cells in the tissues of the esophagus — a hollow muscular tube that moves food and liquid from the throat to the stomach — become abnormal and grow and divide uncontrollably into tumors.
The two most common types of esophageal cancer are:
- Squamous cell carcinoma: Cancer that begins in the squamous cells, which line the esophagus. This type of cancer can occur anywhere along the esophageal tract.
- Adenocarcinoma: Starts in gland cells, which produce and secrete mucus that helps food move through the esophagus. This type of cancer is more common in the lower esophagus.
Other cancers, such as lymphomas, sarcomas and melanomas, may start in the esophageal tract, but they are exceedingly rare. Each type of esophageal cancer grows and is treated in different ways. A multidisciplinary team will work together and carefully study your individual case to determine the best treatment plan.
What are the signs and symptoms of esophageal cancer?
There is no standard screening test for esophageal cancer. It is usually found as a result of symptoms caused by the cancer.
Symptoms can include:
- Trouble (or painful) swallowing
- Chest pain, particularly behind the breast bone
- Weight loss
- Persistent hoarseness and coughing
- Esophageal bleeding, which can lead to black stools
- Frequent vomiting and hiccupping
Many of these symptoms may be caused by other conditions, so it is important to rule those out before pursuing screening for esophageal cancer. If you or a loved one is experiencing any of the above symptoms, please contact a doctor for further evaluation.
What are the risk factors of esophageal cancer?
- Age: The chance of getting esophageal cancer increases with age; more than 85 percent are diagnosed in people age 55 or older.
- Alcohol: Alcohol consumption is linked with a higher risk of esophageal cancer, particularly in people who do not metabolize alcohol well due to an inherited enzyme deficiency.
- Barrett’s esophagus: Chronic reflux of stomach acid in to the esophagus can damage the inner lining of the esophageal tract. Over time, the normal squamous cells lining the esophagus are replaced with gland cells — a condition known as Barrett’s esophagus. This increases the risk of adenocarcinoma.
- Diet: A diet high in processed meat may increase esophageal cancer risk, while a diet high in fruits and vegetables may lower it. Additionally, drinking very hot liquids frequently may increase risk due to its long-term damage to esophageal lining.
- Esophageal conditions: In addition to Barrett’s esophagus and GERD, people with conditions such as achalasia (the esophagus sphincter fails to relax properly), Plummer-Vinson syndrome (which causes esophageal webs that can obstruct food’s passage into the stomach) and tylosis (an inherited disease that predisposes people to develop small esophageal growths) are at an elevated risk for developing esophageal cancer.
- Gastroesophageal reflux disease (GERD): For people with GERD, the digestive enzymes and acid in the stomach escape into the lower part of the esophagus, causing frequent heartburn or pain in the middle of the chest. People with GERD have a slightly elevated risk of getting adenocarcinoma of the esophagus. GERD also elevates the risk of developing Barrett’s esophagus, another risk factor for esophageal cancer.
- Gender: Men are three times more likely than women to get esophageal cancer.
- Overweight/obesity: People who are overweight or obese have a higher chance of developing esophageal cancer, possibly due to their higher likelihood of experiencing gastric reflux.
Tobacco: The use of cigarettes, cigars, pipes or chewing tobacco has been linked to a higher likelihood of developing esophageal cancer. The risk increases with more frequent or prolonged use of tobacco products.
Sources: American Cancer Society, National Cancer Institute
How we diagnose and stage esophageal cancer
Timely and accurate detection of esophageal cancer is essential to planning the best course of treatment. After a thorough physical examination, City of Hope doctors may also use the following tests to diagnose esophageal cancer and precancerous conditions such as Barrett’s esophagus:
- Endoscopic ultrasound: A highly sensitive detection method, using a probe in combination with sound waves to obtain detailed internal images of the esophagus. If a suspicious growth is identified, it can be biopsied for further evaluation.
- Barium swallow/upper GI series: For this test, a patient swallows a liquid that contains barium, a silver-white compound that covers the inner lining of the esophagus. X-rays are then taken and examined for suspicious growths.
- Esophagoscopy: In this procedure, a thin tubed instrument called an esophagoscope is inserted into the esophagus. It is equipped with a lighted lens used to examine the esophageal lining, along with a tool to obtain tissue samples for further evaluation.
- Biopsy: Abnormal-looking cells of the esophagus are removed and checked by a pathologist for cancerous signs. In addition to detecting esophageal cancer, this test can also spot precancerous changes in the esophagus cells.
- Other tests that may be used for diagnosis or further evaluation include chest X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) or positron emission tomography (PET) scans.
Staging Esophageal Cancer
To properly plan for treatment, esophageal cancer patients are staged according to how advanced the disorder is. This is done while taking into consideration a number of factors, including:
- Size of the tumor
- Grade of the tumor (with grade 1 being the slowest growing and grade 3 being the fastest)
- Whether the tumor have grown into or through the muscle and connective tissue layers of the esophagus
- Whether the cancer has spread to nearby lymph nodes and, if so, the number of lymph nodes affected
- If the cancer has spread to adjacent organs and tissues such as the diaphragm, lungs, spine, aorta or the membrane surrounding the heart
- If the cancer has metastasized to distant organs such as the bone, liver or kidney
Patients are staged according to their risk level, with higher risk patients typically requiring more intensive treatments.
More information on esophageal cancer staging criteria is available on the National Cancer Institute’s website.
Treatment options for esophageal cancer
Esophageal cancer is often diagnosed at an advanced stage, so treatment should be rapid and aggressive, requiring the expertise of specialists in the disease.
Because esophageal cancer rarely shows symptoms in early stages, it is often advisable to treat precancerous conditions — such as Barrett’s esophagus.
At City of Hope, a multidisciplinary team of medical experts across different fields — including thoracic surgery, radiation oncology, medical oncology and supportive care medicine — work together to plan and implement a treatment plan that is individually tailored to you so that you get the best results.
Therapies we use to treat cancer and precancer of the esophagus may include:
Surgery is often the primary treatment for esophageal cancer, as well as precancerous esophageal conditions such as Barrett’s esophagus. Surgery may also be used to alleviate esophageal cancer symptoms, including difficulty swallowing and speaking.
Chronic heartburn (gastroesophageal reflux disease) can lead to irritation of the lining of the esophagus. Over time, this irritation can cause the cells to become precancerous, a condition known as Barrett’s esophagus. Through an endoscope (small, flexible camera that enters through the mouth), experts at City of Hope can destroy (ablate) this precancerous tissue, allowing the body to lay down a new layer of more normal cells.
We can also remove very early stage cancers with the endoscope, in a technique known as endoscopic mucosal resection. These endoscopic treatments are outpatient procedures and, in most cases, do not require an overnight stay. Patients recover quickly and usually resume normal activities by the next day.
For Barrett’s esophagus and early stage esophageal tumors, these endoscopic treatments are highly effective and have cure rates equivalent to traditional surgery.
Minimally Invasive Surgery and Its Benefits
Unfortunately, most esophageal cancers are found at a more advanced stage than can be treated with endoscopic therapies. For these aggressive tumors, we recommend a radical esophagectomy, which involves removal of most of the esophagus, as well as some of the stomach.
Many patients receive a combination of treatments with chemotherapy and radiation before surgery. In most cases, City of Hope surgeons perform radical esophagectomy using minimally invasive, robotic techniques.
Compared to traditional esophagectomy which requires a large abdominal incision, a large chest incision with rib spreading, and sometimes a neck incision, minimally invasive esophagectomy has been shown to cause less pain, less blood loss, a faster recovery and fewer complications. There is no difference in the risk of cancer recurrence.
Radiation is often combined with other therapies to treat esophageal cancer. For cancers of the esophagus, radiation may be applied externally, using one or more beams focused on the tumor or internally, using radioactive seeds that are implanted into or near the tumor site (brachytherapy).
City of Hope also offers helical TomoTherapy, a technology combining radiation delivery with advanced imaging that results in more focused beams of radiation focused on the tumor, while minimizing exposure to adjacent tissues and organs, including the heart, lungs and spine.
Chemotherapy — the use of anti-cancer medicines — includes a wide range of drugs to treat primary and metastatic esophageal cancer. City of Hope provides both standard chemotherapies and access to newly developed drugs (or drug combinations) through an extensive program of clinical trials.
Chemotherapy can also enhance the effectiveness of surgery or radiation therapy, by shrinking the tumor before the procedure and making it easier to remove (neoadjuvant chemotherapy), or given after the procedure to minimize the chance of recurrence (adjuvant chemotherapy.)
As part of the treatment team, a medical oncologist will evaluate the patient’s cancer, health and other factors, so that the chemotherapy, if appropriate, can be tailored to the patient throughout the continuum of care.
City of Hope’s renowned physicians and researchers use the latest in technology and innovation to treat cancer, and couple that expertise with an enduring belief in providing compassionate care. If you have been diagnosed with esophageal cancer or are looking for a second opinion consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.
Esophageal research and clinical trials
Our clinicians and researchers frequently collaborate to develop and evaluate new therapies designed to improve survival and quality of life. City of Hope patients have access to a wide variety of clinical trials ranging from new chemotherapy and targeted therapies, novel surgical techniques and new radiation approaches — all focused on enhancing treatment, detection and prevention of esophageal cancer.
Some of our current research projects include:
- City of Hope researchers, in collaboration with the California Institute of Technology, have developed a nanoparticle formulation of the chemotherapy drug camptothecin called CRLX101. CRLX101’s small size enables it to permeate the more leaky blood vessels present in tumors, allowing the anti-cancer drug to accumulate at cancer sites and minimizing its side effects on normal tissues. The drug has already shown promise for patients with lung and pancreatic cancers, and investigators hope it will have benefits for esophageal cancer patients as well.
- Overexpression of the HER2 protein is linked to growth and progression of several cancers, including esophageal cancers, so City of Hope is participating in a phase III clinical trial to see whether adding trastuzumab (Herceptin) — a drug that targets HER2 — can enhance standard therapy’s effectiveness against adenocarcinoma of the esophagus.
- Overexpression of the HER2 protein in some esophageal cancers can also be exploited for imaging purposes, since they will take in more trastuzumab than normal tissues. Using this knowledge, researchers are investigating whether linking trastuzumab to imaging agent 64Cu-DOTA results in better visualization of tumors in a positron emission tomography (PET) scan.
- Following surgery to treat esophageal cancer, some patients may have trouble eating, drinking and maintaining a healthy body weight — all of which can lead to poorer outcomes and quality of life. To address this, City of Hope’s Division of Nursing Research is currently conducting an assessment study of patients’ dietary habits and problems following esophageal surgery. The research team will then use the results to develop a supportive care program to help patients adjust to new eating patterns after surgery.
Living with esophageal cancer
When you come to City of Hope, you automatically gain access to an unparalleled array of support services to help you and your family take each step in your cancer journey. We can help with all of these concerns, and more:
- Managing side effects
- Pain management
- Navigating the health care system
- Your emotional, social and spiritual health
- Staying healthy and active
- Healthy cooking and eating
- Healing arts
- Caregiver skills
- Dealing with family, school or work stress
- National Cancer Institute’s esophageal cancer site
- American Cancer Society’s esophageal cancer site
- ECEF | Esophageal Cancer Education Foundation
- Esophageal Cancer Awareness Association (ECAA)
- Statistics for Esophageal Cancer
- Frequently Asked Questions About Esophageal Cancer
- Questions to Ask About Treatment for Esophageal Cancer
- Nutrition for Esophageal Cancer Treatment