The Esophagus

The esophagus, the organ that connects the mouth to the stomach and is also called gullet, is a hollow tube that carries food and liquids from the throat to the stomach. When a person swallows, the muscular walls of the esophagus contract to push food down into the stomach. Glands in the lining of the esophagus produce mucus, which keeps the passageway moist and makes swallowing easier. The esophagus is located just behind the trachea (windpipe). In an adult, the esophagus is about 10 inches long.

Understanding the Cancer Process

Cancer is a disease that affects cells, the body’s basic unit of life. To understand any type of cancer, it is helpful to know about normal cells and what happens when they become cancerous.

The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells when they are needed. This process keeps the body healthy and functioning properly. Sometimes, however, cells keep dividing when new cells are not needed. The mass of extra cells forms a growth or tumor. Tumors can be benign or malignant.

• Benign tumors are not cancer. They usually can be removed and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life.
• Malignant tumors are cancer. Cells in malignant tumors are abnormal and divide without control or order. These cancer cells can invade and destroy the tissue around them. Cancer cells can also break away from a malignant tumor and enter the bloodstream or lymphatic system (the tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases). This process, called metastasis, is how cancer spreads from the original (primary) tumor to form new (secondary) tumors in other parts of the body.

Cancer that begins in the esophagus, also called esophageal cancer, is divided into two major types, squamous cell carcinoma and adenocarcinoma, depending on the type of cells that are malignant. Squamous cell carcinomas arise in squamous cells that line the esophagus. These cancers usually occur in the upper and middle part of the esophagus. Adenocarcinomas usually develop in the glandular tissue in the lower part of the esophagus. The treatment is similar for both types of esophageal cancer.

If the cancer spreads outside the esophagus, it often goes to the lymph nodes first. Lymph nodes are small, bean shaped structures that are part of the body’s immune system. Esophageal cancer can also spread to almost any other part of the body, including the liver, lungs, brain, and bones.

Diagnosing Esophageal Cancer

To help find the cause of symptoms, the doctor evaluates a person’s medical history and performs a physical exam. The doctor usually orders a chest x-ray and other diagnostic tests. These tests may include the following:

• Barium Swallow
  Barium swallow is also called an esophagram, is a series of x-rays of the esophagus. The patient drinks a liquid containing barium, which coats the inside of the esophagus. The barium makes any changes in the shape of the esophagus show up on the x-rays.
• Esophagoscopy
  Esophagoscopy is also called endoscopy, is an examination of the inside of the esophagus using a thin lighted tube called an endoscope. An anesthetic (substance that causes loss of feeling or awareness) is usually used during this procedure. If an abnormal area is found, the doctor can collect cells and tissue through the endoscope for examination under a microscope. This is called a biopsy. A biopsy can show cancer, tissue changes that may lead to cancer, or other conditions.

Staging Esophageal Cancer

If the diagnosis is esophageal cancer, the doctor needs to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to what parts of the body. Knowing the stage of the disease helps the doctor plan treatment. Listed below are descriptions of the four stages of esophageal cancer.

• Stage I
  The cancer is found only in the top layers of cells lining the esophagus.
• Stage II
  The cancer involves deeper layers of the lining of the esophagus, or it has spread to nearby lymph nodes. The cancer has not spread to other parts of the body.
• Stage III
  The cancer has invaded more deeply into the wall of the esophagus or has spread to tissues or lymph nodes near the esophagus. It has not spread to other parts of the body.
• Stage IV
  The cancer has spread to other parts of the body. Esophageal cancer can spread almost anywhere in the body, including the liver, lungs, brain, and bones.

Some tests used to determine whether the cancer has spread include:

• CAT (or CT) Scan (computed tomography)
  A computer linked to an x-ray machine creates a series of detailed pictures of areas inside the body.
• Bone Scan
  This technique, which creates images of bones on a computer screen or on film, can show whether cancer has spread to the bones. A small amount of radioactive substance is injected into a vein; it travels through the bloodstream, and collects in the bones, especially in areas of abnormal bone growth. An instrument called a scanner measures the radioactivity levels in these areas.
• Bronchoscopy
  The doctor puts a bronchoscope (a thin, lighted tube) into the mouth or nose and down through the windpipe to look into the breathing passages.

Nutrition for Cancer Patients

Eating well during cancer treatment means getting enough calories and protein to control weight loss and maintain strength. Eating well often helps people with cancer feel better and have more energy.

However, many people with esophageal cancer find it hard to eat well because they have difficulty swallowing. Patients may not feel like eating if they are uncomfortable or tired. Also, the common side effects of treatment, such as poor appetite, nausea, vomiting, dry mouth, or mouth sores, can make eating difficult. Foods may taste different.

After surgery, patients may receive nutrients directly into a vein. (This way of getting nourishment into the body is called an IV.) Some may need a feeding tube (a flexible plastic tube that is passed through the nose to the stomach or through the mouth to the stomach) until they are able to eat on their own.

Patients with esophageal cancer are usually encouraged to eat several small meals and snacks throughout the day, rather than try to eat three large meals. When swallowing is difficult, many patients can still manage soft, bland foods moistened with sauces or gravies. Puddings, ice cream, and soups are nourishing and are usually easy to swallow. It may be helpful to use a blender to process solid foods. The doctor, dietitian, nutritionist, or other health care provider can advise patients about these and other ways to maintain a healthy diet.

The Importance of Followup Care

Followup care after treatment for esophageal cancer is important to ensure that any changes in health are found. If the cancer returns or progresses or if a new cancer develops, it can be treated as soon as possible.

Checkups may include:

• Physical exams
• X-rays
• Lab tests

Between scheduled appointments, patients should report any health problems to their doctor as soon as they appear.

Questions for Your Doctor

This is designed to help you get information you need from your doctor so that you can make informed decisions about your health care. In addition, asking your doctor the following questions will help you further understand your condition. To help you remember what the doctor says, you may take notes or ask whether you may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor to take part in the discussion, to take notes, or just to listen.

Diagnosis

• What tests can diagnose esophageal cancer? Are they painful?
• How soon after the tests will I learn the results?

Treatment

• What treatments are recommended for me?
• What clinical trials are appropriate for my type of cancer?
• Will I need to be in the hospital to receive my treatment? For how long?
• How might my normal activities change during my treatment?

Side Effects

• What side effects should I expect? How long will they last?
• Whom should I call if I am concerned about a side effect?
• What will be done if I have pain?

Followup

• After treatment, how often do I need to be checked? What type of followup care should I have?
• What type of nutritional support will I need? Where can I get it?
• Will I eventually be able to resume my normal activities?

The Health Care Team

• Who will be involved with my treatment and rehabilitation?
• What is the role of each member of the health care team in my care?
• What has been your experience in caring for patients with esophageal cancer?

Resources

• Are there support groups in the area with people I can talk to?
• Are there organizations where I can get more information about cancer, specifically esophageal cancer?
• Are there Web sites I can visit that have accurate information about cancer, especially esophageal cancer?

Resources

Clinical trials (research studies) to evaluate new ways to treat cancer are an important option for many patients with esophageal cancer. In some studies, all patients receive the new treatment. In others, doctors compare different therapies by giving the new treatment to one group of patients and the usual (standard) therapy to another group. Through research, doctors learn new, more effective ways to treat cancer.

More information about research studies can be found in the National Cancer Institute (NCI) publication Taking Part in Clinical Trials: What Cancer Patients Need To Know at:
www.cancer.gov/cancertopics/wyntk/overview/page4

NCI’s Web site has a section on clinical trials at:
cancer.gov/clinical_trials
This section provides general information about clinical trials and detailed information about specific ongoing studies. This information is also available from the Cancer Information Service at:
1-800-4-CANCER (1-800-422-6237). For deaf and hard of hearing callers with TTY equipment, the number is 1-800-332-8615.

Radiation Therapy and You at:
www.cancer.gov/cancerinfo/radiation-therapy-and-you

Chemotherapy and You at:
www.cancer.gov/cancerinfo/chemotherapy-and-you

Pain Control: A Guide for People with Cancer and Their Families at:
www.cancer.gov/cancerinfo/paincontrol
Useful NCI booklets that suggest ways for patients to cope with the side effects they experience during and after cancer treatment.

Patients and their families may want to read the National Cancer Institute booklet Eating Hints for Cancer Patients at:
www.cancer.gov/cancerinfo/eatinghints
Contains many useful suggestions and recipes.

Providing Emotional Support
Living with a serious disease is challenging. Apart from having to cope with the physical and medical challenges, people with cancer face many worries, feelings, and concerns that can make life difficult. They may find they need help coping with the emotional as well as the practical aspects of their disease. In fact, attention to the emotional burden of having cancer is often a part of a patient’s treatment plan. The support of the health care team (doctors, nurses, social workers), support groups, and patient to patient networks can help people feel less isolated and distressed, and improve the quality of their lives. Cancer support groups provide a setting in which cancer patients can talk about living with cancer with others who may be having similar experiences. Patients may want to speak to a member of their health care team about finding a support group.

Many also find useful information in NCI fact sheets and booklets, including Taking Time at:
www.cancer.gov/cancer_information/doc_img.aspx?viewid=21a46445-a5c8-4fee-95a3-d9d0d665077a

Facing Forward at:
www.cancer.gov/cancerinfo/life-after-treatment

National Cancer Institute Information Resources
You may want more information for yourself, your family, and your doctor. The following National Cancer Institute (NCI) services are available to help you.

Telephone
Cancer Information Service (CIS) at:
cis.nci.nih.gov/
Provides accurate, up to date information on cancer to patients and their families, health professionals, and the general public. Information specialists translate the latest scientific information into understandable language and respond in English, Spanish, or on TTY equipment.

Toll free: 1-800-4-CANCER (1-800-422-6237)
TTY (for deaf and hard of hearing callers): 1-800-332-8615

Internet
cancer.gov
NCI’s Web site contains comprehensive information about cancer causes and prevention, screening and diagnosis, treatment and survivorship; clinical trials; statistics; funding, training, and employment opportunities; and the Institute and its programs.

See the complete index of What You Need To Know About Cancer publications at www.cancer.gov.

Source: www.cancer.gov