Esophageal cancer occurs in about 11,000 Americans per year. This accounts for less than one percent of all cancers. However, the incidence of esophageal cancer is increasing.

On this page:

• Risk Factors
• Symptoms
• Diagnosis
• Staging
• Treatment
• Clinical Trials
• Thoracic Oncology Clinical Program
• Care Team Members

Risk Factors for Esophageal Cancer

• Smoking
• Excessive alcohol use
• Age over 55
• Male gender (men get esophageal cancer about twice as often as women do)
• Chronic irritation or damage to the lining of the esophagus (usually from gastroesophageal reflux disease)

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Symptoms

• Difficulty in swallowing
• A feeling of fullness, pressure, or burning as food goes down the esophagus
• A feeling of food getting stuck behind the breastbone

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Diagnosis

Esophagram: (Also called a barium swallow), an esophagram is a series of x-rays of the esophagus. To prepare for this test, the patient drinks a barium solution. The barium, which shows up on x-rays, coats the inside of the esophagus. The doctor can use a special x-ray machine (a fluoroscope) to watch the barium move down the esophagus to the stomach as the patient swallows; radiographs are also made.

Esophagoscopy: For this procedure, the patient's throat is sprayed with a local anesthetic to reduce discomfort and gagging. The doctor then passes a thin, flexible, lighted instrument (an endoscope) through the mouth and down the throat to the esophagus. The scope lets the doctor see the lining of the esophagus and the place where the esophagus joins the stomach. If an abnormal area is found, the doctor does a biopsy (removal of a small amount of tissue through the endoscope). Also, cells can be brushed (washed) from the walls of the esophagus through the scope. A pathologist examines the samples under a microscope to see whether cancer is present. Esophagoscopy is the only way to detect the very early stages of esophageal cancer.

If cancer is found, the pathologist determines what type. Cancer in the middle or upper part of the esophagus is usually squamous cell carcinoma. Cancer at the lower end of the esophagus, near the stomach, is usually adenocarcinoma. (Carcinoma is another name for cancer in the lining of the tissues.)

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Staging

As with non-small-cell lung cancer, the doctor needs to determine the extent of the tumor in the esophagus and any possible spread to other sites in the body. The nature of the tumor is primarily evaluated by a CT scan of the chest. A CT scan reveals any invasion of the tumor into surrounding structures, such as the trachea (windpipe) and large blood vessels. It may also show lymph node enlargement, suggesting spread of the tumor to these lymph nodes.

Esophageal ultrasound is similar to esophagoscopy, but with the addition of a built-in ultrasound devise. The doctor uses the ultrasound to assess how deep the tumor extends beyond the wall of the esophagus and to determine any invasion of a nearby structure.

A CT scan of the abdomen is usually obtained to determine whether the tumor may have spread to lymph nodes in the abdomen or to the liver. Finally, PET scanning can also be used to evaluate esophageal cancer.

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Treatment

Treatment for esophageal cancer depends on a number of factors, including its exact location, size, extent, and type of cancer cells. The doctor also considers the person's age and general health to develop a treatment plan to fit each person's needs.

In general, surgical resection (removal) of the tumor is the preferred treatment. Recently, surgeons have been using minimally invasive surgical techniques to remove esophageal cancers, potentially decreasing the morbidity of what is otherwise a major surgical procedure.

Chemotherapy (use of drugs to shrink tumors or kill cancer cells) and radiation (use of high-energy rays to shrink tumors or kill cancer cells) are also frequently used, either in conjunction with surgery or independently.

Some patients with esophageal cancer who have significant problems swallowing food may need help to restore their ability to eat. Several options are available, including laser treatment, tumor stenting, or photodynamic therapy. For most patients, their ability to eat can be restored satisfactorily.

A multidisciplinary team of consisting of a gastroenterologist, surgeon, oncologist (cancer specialist), radiation oncologist, nurse, dietitian, and social worker are involved in the patient care.

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Clinical Trials

Clinical trials are human research studies that evaluate the effectiveness of new interventions for patients. Such interventions have already been tested in laboratories and showed enough promise to be pursued further.

Different types of cancer clinical trials include prevention trials, early detection trials, and treatment trials. If you take part in a clinical trial, you may benefit from a new drug, procedure, or symptom-control method while helping scientists evaluate its effectiveness.

The Thoracic Cancer Clinical Team of the University of Minnesota Cancer Center is actively engaged in both national and regional clinical trials for various thoracic cancers.

• Thoracic cancer trials available through Cancer Center
• All clinical trials available through the Masonic Cancer Center

Contact our program coordinator (Teri Kast, 612-273-5396) for more information about clinical trials.

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Thoracic Oncology Clinical Program

The University of Minnesota Cancer Center's Thoracic Oncology Program offers thoracic cancer patients a comprehensive approach to diagnosis, treatment, and after-treatment support. 

This multidisciplinary program consists of specialists in thoracic surgery, oncology, radiotherapy, and pathology. These specialists meet weekly in the multidisciplinary thoracic oncology conference. They review information about all patients currently undergoing therapy at Fairview-University Medical Center and help determine the best treatment plan for each. 

Also available are smoking cessation programs; the Hospice Program, which provides supportive services to dying patients; and social work services for emotional support and counseling. 

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Care Team Members

The links below go to physician profiles on the University of Minnesota Physicians Web site. To return to this site, either bookmark this page or use your browser's back button.

General Thoracic and Minimally Invasive Surgery

Rafael Andrade, M.D.

Jonathon D'Cunha, M.D., Ph.D.

Michael Maddaus M.D.

Medical Oncology-Thoracic

Arkadiusz Dudek, M.D., Ph.D.

Mark Klein, M.D.

Robert Kratzke, M.D.

Priya Kumar, M.D.

Nauman Moazzam, M.D.

Radiation Oncology-Thoracic

Chinsoo Cho, M.D.

Pathology

Jose Jessurun, M.D.

Thoracic Oncology Nurse Coordinators

Teri Kast, M.S., R.N., A.O.C.N.S.
tkast@umphysicians.umn.edu, 612-273-5396

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