Esophageal cancer is a malignancy that develops in the inner lining (mucosa) of the esophagus, which is the long, muscular tube that carries food from the mouth to the stomach. The cancer can potentially spread to other layers of the esophagus, including the submucosa and muscle layer. Additionally, esophageal cancer can spread to nearby lymph nodes and travel to other parts of the body (metastasize).
Esophageal cancer can be classified not only by its extent and spread, but also based on the kind of cells involved. The two most common types are squamous cell carcinoma and adenocarcinoma. Other types, including sarcoma, small cell carcinoma and lymphoma, are relatively uncommon.
Squamous cell carcinoma
This type of esophageal cancer affects the squamous cells, which are the thin, flat cells that line the esophagus. Squamous cell carcinoma can form in any part of the esophagus, but it most often occurs in the upper-to-middle section, which is located in the neck and the upper two-thirds of the chest. While squamous cell carcinoma was previously the most common type of esophageal cancer in the United States, due to recent advances in treatment it now accounts for less than half of all diagnoses. However, it is still the most prevalent type of esophageal cancer worldwide.
Esophageal squamous cell carcinoma occurs due to genetic mutations that cause the cells of the esophagus to grow and divide uncontrollably. While the exact cause of this genetic mutation is unknown, experts believe it may be linked to heavy alcohol or tobacco consumption. While there is no definitive way to prevent this malignancy, managing risk factors such as avoiding tobacco and excessive alcohol consumption can help to reduce the chance of developing squamous cell carcinoma of the esophagus.
Adenocarcinoma is the most common type of esophageal cancer in the United States. In order for adenocarcinoma of the esophagus to develop, mucus-making gland cells must replace an area of the squamous cells that would otherwise line the esophagus. This transformation is common in individuals with Barrett’s esophagus, a complication of gastrointestinal reflux disease that causes the cells in the esophagus to mutate and become similar to the cells that line the intestine. Therefore, having Barrett’s esophagus may put an individual at a greater risk of developing esophageal cancer. However, it does not necessarily indicate that cancer will develop.
Experts believe esophageal adenocarcinoma occurs due to overexposure to stomach acid, and the malignancy most often occurs in the lower third (distal) portion of the esophagus. Often, adenocarcinoma forms at the gastroesophageal junction (GEJ), which is the area where the stomach and the esophagus connect. While these cancers affect the stomach (usually about the first two inches of the stomach known as the cardia), they are grouped with esophageal cancers because they tend to have similar characteristics and are therefore treated as such.
Similar to squamous cell carcinoma, the exact causes of esophageal adenocarcinoma are still unknown. However, certain factors, including persistent acid reflux and obesity, have been associated with an increased likelihood of developing this malignancy. To reduce the risk of developing adenocarcinoma of the esophagus, individuals should take steps to maintain their overall health, including eating a balanced, nutrient-rich diet, exercising regularly and maintaining a healthy body weight.
The ideal course of treatment for esophageal cancer can vary depending on individual factors, including the type of esophageal cancer, the cancer’s stage and the patient’s overall health and treatment preferences. Considering these and other factors, a patient’s treatment team may recommend any of the following treatments as part of an esophageal cancer treatment plan:
- Surgery – Surgery, which is the most common form of treatment for esophageal cancer, may be recommended for patients whose cancer has not spread beyond the esophagus. One of several surgical procedures may be recommended depending on the extent of the cancer, such as an esophagectomy to remove the cancerous portion of the esophagus or an esophagastrectomy to remove parts of the esophagus and stomach.
- Chemotherapy – Powerful drugs are administered either orally or intravenously to destroy cancer cells. A patient’s treatment team will determine which combination of chemotherapy medications would potentially be most effective for treating the cancer. Often, several cycles of chemotherapy, including a period of treatment followed by several days of rest, are necessary.
- Radiation therapy – High-powered beams of energy are delivered directly to a tumor, either through a machine located outside the body (external beam radiation) or through small particles placed near the cancer inside the body (brachytherapy).
In many cases, a patient’s treatment team will recommend a combination of treatment methods to more effectively destroy the cancer. For example, in some cases chemotherapy or radiation therapy may be administered before surgery to shrink a tumor, making it easier to remove. Other times, chemotherapy may be done following surgery to destroy cancer cells that remain in the body. Chemotherapy and radiation therapy are often done at the same time. However, a patient must be healthy enough to sustain the effects of the combined treatments, which tend to be more taxing than those of either treatment performed on its own.
The experts at Moffitt Cancer Center have extensive experience in treating all types of esophageal cancer. Moffitt is a high-volume cancer center, so we see more cases of even the most uncommon esophageal malignancies each year than many other physicians will see in their entire careers. Our unparalleled experience in combination with our physicians’ expertise consistently leads to the best possible outcomes and improved quality of life for our patients.
When you come to Moffitt for esophageal cancer treatment, the experts in our Gastrointestinal Oncology Program will review your case to ensure your treatment plan addresses the unique challenges of your malignancy. From there, you will receive all of the treatments you require in a single location. You may also have opportunities to benefit from groundbreaking new therapies in our clinical trials. Moffitt remains at the forefront of esophageal cancer research and treatment, and we have been named a Comprehensive Cancer Center by the National Cancer Institute for our research efforts. It is our goal to one day find a cure for all and we will not be satisfied until this is accomplished.
If you have been diagnosed with squamous cell carcinoma, adenocarcinoma or an uncommon type of esophageal cancer and would like to consult with the experts at Moffitt about your treatment options, request an appointment by calling 1-888-663-3488 or filling out a new patient registration form online. Referrals are not required to come to Moffitt.