Esophageal Cancer

Esophageal cancer grows in tissue lining the esophagus, the 10-inch-long, muscular tube that allows food to move from your throat to your stomach. The National Cancer Institute projects about 15,560 new cases of esophageal cancer in the U.S. in 2007, and approximately 14,000 deaths from the disease.

There are two types of esophageal cancer. Squamous cell carcinoma begins in flat cells lining the esophagus, and adenocarcinoma begins in cells that make and release mucus and other fluids.

The risk factors for squamous cell esophageal cancer are:

• Being male
• Tobacco use
• Alcohol abuse
• African-Americans at higher risk than white men
• Ingesting very hot liquids

The risk factors for adenocarcinoma are:

• Obesity
• Acid reflux
• Barrett's esophagus

Diagnosis of esophageal cancer usually involves endoscopy (a tube in the throat to view changes), CT scanning, PET scanning, and endoscopic ultrasound.

Lockhart, a specialist in esophageal cancer, said treatment requires a multidisciplinary team with surgeons, radiation oncologists and medical oncologists. "Depending on the size and stage of the tumor, patients either have surgery only for small tumors, or chemotherapy and radiation first if they have larger tumors," Lockhart said. Surgery is usually the next step.

Lockhart said when looking for a doctor or facility to treat esophageal cancer, experience is the key. "Especially for the surgery," Lockhart said. "A number of studies have shown that outcomes are better when patients have surgery at a center where more surgeries for this kind of cancer are performed. For the oncologists, experience is important too, to help manage treatment complications and design a treatment regimen that fits the patient's clinical presentation."

As far as prevention, Lockhart said if you have chronic reflux you need to be followed by a gastroenterologist. If you are diagnosed with Barrett's esophagus, you need close and regular follow-up with biopsies, in order to try to diagnose cancer at the earliest stages, he said.

Warning signs to watch for:

• Trouble swallowing or a feeling of food stuck in your throat or chest
• Pain in your throat, mid-chest, or between your shoulder blades
• Hoarseness
• Chronic cough or coughing blood
• Vomiting blood

For more information about the Vanderbilt-Ingram Esophageal Cancer Program, log on to: www.vicc.org, and click on cancer types. Or call our Information Program at: 1-800-811-8480.