Esophageal cancer

Overview

Esophageal cancer is a malignant tumor of the muscular tube that connects the throat with the stomach. It has two main types:

• Squamous cell carcinoma — linked especially to smoking and alcohol.
• Adenocarcinoma — linked to chronic reflux, Barrett's esophagus and overweight.

The two types have different risk factors and behavior, so treatment is not always the same.

Symptoms

• difficulty swallowing (dysphagia) that gets worse over time — first for solid foods, then for soft ones as well
• a sensation that food gets stuck behind the breastbone
• unexplained weight loss
• pain on swallowing, regurgitation, chest pain, hoarseness or anemia

These signs do not necessarily mean cancer, but they should not be treated as reflux alone without being assessed.

Risk factors

Smoking, alcohol, chronic reflux, Barrett's esophagus, overweight and frequent consumption of very hot drinks. The presence of a risk factor does not mean the person has cancer.

When to see a doctor

Difficulty swallowing that lasts or gets worse needs a visit as soon as possible — do not delay it. An outpatient consultation can start the diagnostic process right away.

Diagnosis

• Gastroscopy with biopsy is the main exam. Histopathological examination of the biopsy determines whether there is a tumor and which type it is.
• Staging — how deeply the tumor has grown, whether it has reached lymph nodes or other organs — may require CT, PET-CT or endoscopic ultrasound, depending on the case.

Treatment

The decision is made by a multidisciplinary team (gastroenterologist, surgeon, oncologist, radiation oncologist) according to the stage, the type of tumor, biomarkers, nutritional status and the patient's general condition. Options include:

• endoscopic removal in very early lesions
• surgery
• chemotherapy and radiotherapy
• immunotherapy or targeted therapies

When the disease cannot be cured, there are treatments to control it and to ease swallowing and other symptoms. Nutritional support matters at every stage.