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Esophagus Cancer

What is cancer?
The body is made up of hundreds of millions of living cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair injuries. Cancer begins when cells in a part of the body start to grow out of control. There are many kinds of cancer, but they all start because of out-of-control growth of abnormal cells. Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into) other tissues, something that normal cells cannot do. Growing out of control and invading other tissues are what makes a cell a cancer cell. Cells become cancer cells because of damage to DNA. DNA is in every cell and directs all its actions. In a normal cell, when DNA gets damaged the cell either repairs the damage or the cell dies. In cancer cells, the damaged DNA is not repaired, but the cell doesn't die like it should. Instead, this cell goes on making new cells that the body does not need. These new cells will all have the same damaged DNA as the first cell does. People can inherit damaged DNA, but most DNA damage is caused by mistakes that happen while the normal cell is reproducing or by something in our environment. Sometimes the cause of the DNA damage is something obvious, like cigarette smoking. But often no clear cause is found. In most cases the cancer cells form a tumor. Some cancers, like leukemia, rarely form tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate through other tissues where they grow. Cancer cells often travel to other parts of the body, where they begin to grow and form new tumors that replace normal tissue. This process is called metastasis. It happens when the cancer cells get into the bloodstream or lymph vessels of our body.

No matter where a cancer may spread, it is always named for the place where it started. For example, breast cancer that has spread to the liver is still called breast cancer, not liver cancer. Likewise, prostate cancer that has spread to the bone is metastatic prostate cancer, not bone cancer. Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That is why people with cancer need treatment that is aimed at their particular kind of cancer. Not all tumors are cancerous. Tumors that aren't cancer are called benign. Benign tumors can cause problems – they can grow very large and press on healthy organs and tissues. But they cannot grow into (invade) other tissues. Because they can't invade, they also can't spread to other parts of the body (metastasize). These tumors are almost never life threatening.

What is cancer of the esophagus?
The esophagus
The esophagus is a hollow, muscular tube that connects the throat to the stomach. Food and liquids that are swallowed travel through the inside of this tube (called the lumen) to reach the stomach. The esophagus is usually between 10 and 13 inches long. The normal adult esophagus is roughly ¾ of an inch across at its smallest point.

The wall of the esophagus has several layers. The layer that lines the inside of the esophagus is called the mucosa. The mucosa has 2 parts: the epithelium and the lamina propria. The epithelium forms the lining of the esophagus and is made up of flat, thin cells called squamous cells. The lamina propria is a thin layer of connective tissue right under the epithelium. The next layer is the submucosa. In some parts of the esophagus, this layer contains glands that secrete mucus. The layer under the submucosa is a thick band of muscle called the muscularis propria. This layer of muscle contracts in a coordinated, rhythmic way to push food along the esophagus from the throat to the stomach. The outermost layer of the esophagus is formed by connective tissue. It is called the adventitia. The upper part of the esophagus has a special area of muscle at its beginning that relaxes to open the esophagus when it senses food or liquid coming toward it. This muscle is called the upper esophageal sphincter. The lower part of the esophagus that connects to the stomach is called the gastroesophageal junction, or GE junction. There is a special area of muscle near the GE junction called the lower esophageal sphincter. The lower esophageal sphincter controls the movement of food from the esophagus into the stomach and it keeps the stomach's acid and digestive enzymes out of the esophagus.

The stomach has strong acid and enzymes that digest food. The epithelium or lining of the stomach is made of glandular cells that release acid, enzymes, and mucus. These cells have special features that protect them from the stomach's acid and digestive enzymes. In some people, acid escapes from the stomach back into the esophagus. The medical term for this is reflux or gastroesophageal reflux disease (GERD). In many cases, reflux can cause symptoms such as heartburn or a burning feeling spreading out from the middle of the chest. But sometimes, reflux can occur without any symptoms at all. If reflux of stomach acid into the lower esophagus continues for a long time, it can damage the lining of the esophagus. This causes the squamous cells that usually line the esophagus to be replaced with glandular cells. These glandular cells usually look like the cells that line the stomach and the small intestine and are more resistant to stomach acid. The presence of glandular cells in the esophagus is known as Barrett's (or Barrett) esophagus. People with Barrett's esophagus are much more likely to develop cancer of the esophagus (about 30 to100 times normal). These people require close medical follow-up in order to find cancer early. Still, although they have a higher risk, most people with Barrett's esophagus do not go on to develop cancer of the esophagus.

Esophageal cancer
Cancer of the esophagus (also referred to as esophageal cancer ) starts in the inner layer (the mucosa) and grows outward (through the submucosa and the muscle layer). Since 2 types of cells line the esophagus, there are 2 main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. The esophagus is normally lined with squamous cells. The cancer starting in these cells is called squamous cell carcinoma. This type of cancer can occur anywhere along the length of the esophagus. At one time, squamous cell carcinoma was by far the more common type of esophageal cancer in the United States, making up to 90% of all esophageal cancers. This has changed over time, and now it makes up less than 50% of esophageal cancers in this country. Cancers that start in gland cells are called adenocarcinomas. This type of cell is not normally part of the inner lining of the esophagus. Before an adenocarcinoma can develop, glandular cells must replace an area of squamous cells, which is what happens in Barrett's esophagus. This occurs mainly in the lower esophagus, which is the site of most adenocarcinomas. Cancers that start at the area where the esophagus joins the stomach (the GE junction) or the first part of the stomach (called the cardia) used to be staged as stomach cancers. But because these cancers behave like esophagus cancers (and are treated like them, as well), they are now grouped with esophageal cancers.

510 in women) • About 14.What are the key statistics about cancer of the esophagus? The American Cancer Society's most recent estimates for esophageal cancer in the United States are for 2010: • About 16. Cancer of the esophagus is much more common in some other countries. Although many people with esophageal cancer will go on to die from this disease. the rate of adenocarcinoma of the esophagus in white men has been increasing at about 1% a year. These survival rates are 5-year relative survival rates.130 in men and 3. Squamous cell carcinoma is the most common type of cancer of the esophagus among African Americans. northern China. treatment has improved and survival rates are getting better.650 men and 2. This is a more accurate way to describe the outlook for patients with a particular type and stage of cancer. A relative survival rate compares the observed survival with what would be expected for people without the cancer.640 new esophageal cancer cases will be diagnosed (13. . 20% of white patients and 13% of African-American patients survive at least 5 years after diagnosis. A 5-year survival rate refers to the percent of patients who live at least 5 years after their cancer is diagnosed. The main type in these countries is squamous cell carcinoma. esophageal cancer rates in Iran. but 5-year rates are used to produce a standard way to discuss outlook for survival. India. Survival rates for early stage disease are higher. People may live longer than 5 years. Now. only 4% of all white patients and 1% of all African-American patients survived at least 5 years after diagnosis. and southern Africa are 10 to 100 times higher than in the United States. no matter what stage they were in at diagnosis.850 women) from esophageal cancer will occur This disease is 3 to 4 times more common among men than among women and overall is now as common in whites as it is in African Americans. This helps to correct for the deaths caused by something besides cancer and is a better way to see the effect that the cancer has on survival.500 deaths (11. These figures take into account all patients with esophageal cancer. while adenocarcinoma is more common in whites. The lifetime risk of esophageal cancer in the United States is 1 in 200. For example. During the early 1960s. The esophageal cancer rate has been unchanged in white women. In Western countries. The rate of esophageal cancer has been dropping in African-American men and women by 4 to 5% per year. This number includes people who die of other causes.

reflux doesn't cause any symptoms at all. Gender Compared with women. GERD can also cause Barrett's esophagus. and are more resistant to stomach acid. Less than 15% of cases are found in people younger than age 55. which is linked to an even higher risk (discussed below). Age The chance of getting esophageal cancer is low at younger ages and increases with age. For example. This causes the squamous cells that usually line the esophagus to be replaced with glandular cells. Scientists have found several risk factors that affect your risk of cancer of the esophagus. Most cases occur in those 65 and older." but many have no symptoms at all. This is because the gland cells in Barrett's esophagus can become more abnormal over time until . acid can escape from the stomach into the esophagus. Most people with Barrett's esophagus have had symptoms of "heartburn. In many people. This condition is known as Barrett's (or Barrett) esophagus. The longer someone has GERD. Gastroesophageal reflux disease In some people. men have a 3-fold higher rate of esophageal cancer. The risk goes up based on how long the reflux has been going on and how severe the symptoms are. Barrett's esophagus increases the risk of adenocarcinoma of the esophagus. reflux causes symptoms such as heartburn or pain that seems to come from the middle of the chest. Barrett's esophagus If reflux of stomach acid into the lower esophagus continues for a long time. The medical term for this is reflux or gastroesophageal reflux disease (GERD). About 10% of people with symptoms of gastroesophageal reflux disease (GERD) have this condition. the more likely that they have Barrett's esophagus. and smoking is a risk factor for lung cancer as well as many other types of cancer. it can damage the lining of the esophagus.What are the risk factors for cancer of the esophagus? A risk factor is anything that changes your chance of getting a disease such as cancer. People with GERD have a risk of getting adenocarcinoma of the esophagus that is 2 to 16 times normal. These glandular cells usually look like the cells that line the stomach and the small intestine. Different cancers have different risk factors. About 30% of esophageal cancer can be linked to GERD. Some are more likely to increase the risk for adenocarcinoma of the esophagus and others for squamous cell carcinoma of the esophagus. unprotected exposure to strong sunlight is a risk factor for skin cancer. In some though.

The chance of getting esophageal cancer goes up with higher intake of alcohol. the more cigarettes smoked per day and the longer a person uses tobacco. People with Barrett's esophagus are anywhere from 30 to 125 times more likely than people without this condition to develop esophageal cancer. that a diet high in processed meat may also increase the chance of developing esophageal cancer. . a pre-cancerous condition. Certain substances in the diet may increase the cancer risk. cigars. High-grade dysplasia is the most abnormal. Tobacco and alcohol The use of tobacco products. and chewing tobacco. with more than half of all cases linked to smoking. Dysplasia is graded by how abnormal the cells look under the microscope. Combining smoking and drinking alcohol raises the risk of esophageal cancer much more than using either alone. the higher the cancer risk. The risk of esophageal cancer goes down if tobacco use stops. increases the risk of the adenocarcinoma of the esophagus. including cigarettes. The risk of cancer is higher if dysplasia is present. The exact risk of developing cancer in people with Barrett's esophagus is not known. Fruits and vegetables provide a number of vitamins and minerals that may help prevent cancer. The link to squamous cell esophageal cancer is even stronger. but researchers estimate it to be only 1 in 200 per year. Alcohol affects the risk of the squamous cell type more than the risk of adenocarcinoma. many people with Barrett's esophagus do not get esophageal cancer. which leads to obesity (being extremely overweight). This is in part explained by the link between obesity and esophageal reflux.they become dysplasia. Overeating. pipes. Someone who smokes at least a pack a day has twice the chance of getting adenocarcinoma of the esophagus than a nonsmoker. There have been suggestions. Drinking alcohol also increases the risk of esophageal cancer. Eating these foods raw has the best effect on risk. The risk goes up with increased use. Diet A diet high in fruits and vegetables is linked to a lower risk of esophageal cancer. is a major risk factor for esophageal cancer. Obesity People who are overweight or obese have a higher chance of getting adenocarcinoma of the esophagus. Still. Drinking very hot liquids frequently may increase the risk for the squamous cell type of esophageal cancer. as yet unproven. About 15% of esophageal cancer can be linked to a diet low in fruits and vegetables. This may explain the high rate of this cancer in certain parts of the world.

Esophageal webs A web is an abnormal bulge of tissue that causes an area of narrowing in the esophagus. Achalasia In this disease. People with these strictures have an increased rate of the squamous cell type of esophageal cancer as adults. Another name for this is PatersonKelly syndrome. . As the injury heals. Injury to the esophagus Lye is a chemical found in strong industrial and household cleaners such as drain cleaners. The esophagus above this muscle becomes larger (dilated). People with achalasia have a risk of esophageal cancer that is at least 15 times normal. The cancers occur on average about 40 years after the lye was swallowed. Dry cleaning workers have a higher rate of esophageal cancer. Lye is a corrosive agent. Food and liquid that are swallowed have trouble passing into the stomach and tend to collect in the esophagus. This can lead to a feeling like food gets stuck when it is swallowed. About 6% (1 in 20) of all achalasia patients develop squamous cell cancer of the esophagus. On average. This disorder is linked to a gene on an area of chromosome 17 called TOC. brittle fingernails. the muscle at the lower end of the esophagus (the lower esophageal sphincter) does not relax properly.Workplace exposures Exposure to the solvents used for dry cleaning may lead to a greater risk of esophageal cancer. People with tylosis are watched closely to try to find esophageal cancer early. Tylosis This is a rare. the scar tissue can cause an area of the esophagus to become very narrow (called a stricture). Often this involves regular monitoring with an upper endoscopy (scope with camera placed to view the esophagus). The lye causes a severe chemical burn in the esophagus. meaning it can burn and destroy cells. About 1 in 10 patients with this syndrome eventually develop squamous cell cancer of the esophagus. tongue irritation (glossitis). Exposure to other chemical fumes also may lead to an increased risk of esophageal cancer. When an esophageal web is found along with anemia. inherited disease that causes excess growth of the top layer of skin on the palms of the hands and soles of the feet. People with this condition develop abnormal areas in the lining of the mouth. They also have a very high risk of getting squamous cell cancer of the esophagus. Sometimes small children find a lye-based cleaner and drink from the bottle. and a large spleen it is called Plummer-Vinson syndrome. the cancers are found about 17 years after the achalasia is diagnosed.

pylori infection can cause the stomach to make less acid. Long-term irritation of the lining of the esophagus. as happens in GERD. or scarring from swallowing lye. Scientists believe that some risk factors. Other cancers People who have had certain other cancers. there are certain risk factors that make getting esophageal cancer more likely (see the section. cause esophageal cancer by damaging the DNA of cells that line the inside of the esophagus. In the United States. esophageal webs.Stomach bacteria A certain bacteria called Helicobacter pylori (or H. such as lung cancer. such as use of tobacco or alcohol abuse. including ulcers and even some types of stomach cancer. The infection causes many problems in the stomach. pylori) can cause many stomach problems. there have been no special changes described that are typical of this cancer. achalasia. Do we know what causes cancer of the esophagus? We do not yet know exactly what causes most esophageal cancers. However. the most important lifestyle risk factors for cancer of the esophagus are the use of tobacco and alcohol. but the risk of developing this disease can be greatly reduced by avoiding certain risk factors. If this same person smokes at least 1 to 2 packs of cigarettes a day. The lower levels of acid mean that the stomach contents are less harmful to the esophagus (in people with reflux). "What are the risk factors for cancer of the esophagus?"). Infection with this bacteria can be treated with antibiotics plus a drug to stop stomach acid. Avoiding these 2 factors is the best way to reduce the risk of esophageal cancer. The risk of esophageal cancer increases by 18 times in people who drink more than about 13 ounces of alcohol a day over a period of years. and throat cancer have a high risk of getting squamous cell carcinoma of the esophagus as well. The DNA of esophageal cancer cells often shows many abnormalities. Some risk factors (like age and sex) cannot be changed but others can. however. mouth cancer. but it may actually protect the esophagus. the risk of esophageal cancer increases 44 times. It seems that H. . This may be because these cancers are all caused by smoking. People who have had treatment to rid the stomach of H pylori get adenocarcinoma of the esophagus more often than expected. Can cancer of the esophagus be prevented? Not all cases of esophageal cancer can be prevented. Barrett's esophagus. can promote formation of cancers.

persons at increased risk for esophageal cancer. In the United States. using these drugs every day can lead to problems. If dysplasia (a pre-cancerous condition) is found. Can cancer of the esophagus be found early? Looking for a disease in someone without symptoms is called screening. are often monitored closely (with endoscopy and biopsy) to look for signs that could mean that the cells lining the esophagus have become more abnormal. If you are thinking of using an NSAID regularly.) This procedure is also used to look for signs of esophageal injury in many people who have chronic esophageal reflux. The goal of screening is to find a disease like cancer in an early. lansoprazole (Prevacid®). However. Also. are often followed closely with endoscopy to look for early cancers and pre-cancers. Surgery is also an option for treating reflux. you first should discuss the potential benefits and risks with your doctor. treatment with a high dose of a PPI may lower the risk of developing cell changes that can turn into cancer (dysplasia). there are no tests used to screen for esophageal cancer in the general population. such as kidney damage and bleeding in the stomach. also called NSAIDs. and esomeprazole (Nexium®). However. Treatment can improve symptoms and may prevent future problems. Examples of these drugs include omeprazole (Prilosec®). particularly the adenocarcinoma type. (Endoscopy is a test that allows the doctor to look at the inside of the esophagus through a flexible lighted tube called an endoscope. For this reason. Often. such as those with Barrett's esophagus. is thought to help protect against esophageal cancer. in order to help people live longer.Diet and exercise are also important. NSAIDs are not widely used to prevent cancer. such as ibuprofen. In addition. physical activity and maintaining a healthy weight can reduce the risk of this disease. For those who already have Barrett's esophagus. Some studies have found that the risk of cancer of the esophagus is reduced in people who take aspirin or other nonsteroidal anti-inflammatory drugs. people who have a high risk of esophageal cancer. you should tell your doctor. A diet rich in fruits and vegetables. more curable stage. especially if eaten raw. such as those with Barrett's esophagus. healthier lives. reflux is treated using drugs called proton pump inhibitors (PPIs). the doctor may recommend treatments to keep it from progressing to esophageal cancer. since obesity has been associated with esophageal cancer. Treating people with reflux may be able to prevent Barrett's esophagus and esophageal cancer. If you have chronic heartburn (or GERD). .

If an abnormal area is seen. If treated with surgery. cancers of the esophagus are discovered because of the symptoms they cause. Doctors are not certain how often the test should be repeated. Surgery is more often recommended when the area of Barrett's is long and/or there are many different spots of high-grade dysplasia. They take smaller bites and chew their food more carefully and slowly. Diagnosis in people without symptoms is rare and usually accidental (because of tests done to check other medical problems). surgery is not an option because they are in poor health and aren't able to withstand the operation. when a cure is less likely. Dysphagia is commonly a late symptom caused by a large cancer. This is often mild when it starts. Unfortunately. In these cases. How is cancer of the esophagus diagnosed? Signs and symptoms of esophageal cancer In most cases. the problem gets worse. surgery is advised because of the high risk that an adenocarcinoma is either already present (but was not found) or will develop within a few years. Other treatment options for high-grade dysplasia include endoscopic mucosal resection (EMR). and then gets worse over time. These are discussed in more detail later in this document. but most recommend testing more often if abnormal cells are found (the presence of abnormal cells is called dysplasia). with the feeling like the food is stuck in the throat or chest. photodynamic therapy (PDT). If a biopsy shows high-grade dysplasia. The opening of the esophagus is often narrowed to about half of its normal width. the doctor may recommend surgery to remove the area of Barrett's esophagus. most esophageal cancers do not cause symptoms until they have reached an advanced stage. This testing is repeated even more often if there is high-grade dysplasia (the cells appear very abnormal). a small sample of tissue should be removed from that area and checked to see if it contains cancer cells. This is called dysphagia. people often change their diet and eating habits without realizing it. Doctors recommend that people with Barrett's esophagus have an upper endoscopy and biopsy done.Testing for people at high risk Many experts recommend that people with a high risk of esophageal cancer have upper endoscopy regularly. When swallowing becomes difficult. For some patients. Dysphagia The most common symptom of esophageal cancer is a problem swallowing. This monitoring and intervention strategy may be able to help prevent cancer from developing and detect cancers early when they are more likely to respond to treatment. People then may start eating . As the cancer grows larger. and radiofrequency ablation. the outlook for these patients is relatively good.

The physical exam will provide information about signs of esophageal cancer and other health problems. stools may turn black. Other factors include a decreased appetite and an increase in metabolism from the cancer. such as heartburn. people complain of pain or discomfort in the middle part of their chest. To help pass food through the esophagus. Other symptoms Hoarseness. If your doctor suspects you may have esophageal cancer. please see a doctor right away: • Dysphagia (a feeling of food getting stuck in your throat or chest) • Significant weight loss without dieting • Avoidance of solid food because of pain when you swallow • Hiccups and dysphagia together Medical history and physical exam The doctor will take a complete medical history (medical interview) to check for risk factors and symptoms. the body makes more saliva. and so they are rarely seen as a signal that cancer is present. you will need farther tests to find out what is causing your problems. and high blood calcium levels are usually signs of more advanced cancer of the esophagus. Pain Sometimes. pneumonia.softer foods that can pass through the esophagus more easily. This can also occur with other cancers and with some benign (non-cancerous) diseases. It does not always mean that cancer is present. . This happens because their swallowing problems keep them from eating enough to maintain their weight. If you have any of the following symptoms. If there is enough blood. since these foods typically get stuck. Sometimes the cancer will bleed. They may avoid bread and meat. Some people describe a feeling of pressure or burning in the chest. hiccups. If the cancer keeps growing. Swallowing may be painful when the cancer is large enough to block the esophagus. as food or liquid reaches the tumor and cannot get past it. Weight loss About half of patients with esophageal cancer lose weight (without trying to). at some point even liquids will not be able to pass. This causes some people to complain of bringing up lots of thick mucus or saliva. Pain may be felt a few seconds after swallowing. These symptoms are more often caused by problems other than cancer. The swallowing problem may even get bad enough that some people stop eating solid food completely and switch to a liquid diet.

This leads to frequent coughing and gagging. A barium swallow test can also be used to diagnose one of the more serious complications of esophageal cancer called a tracheoesophageal fistula. early cancer can be seen using this test. This helps better outline structures in your body. This helps outline the esophagus and intestines so that certain areas are not mistaken for tumors. or as a part of a series of x-rays that includes the stomach and part of the intestine. but they can help see how far it has spread. A barium swallow test cannot be used to determine how far a cancer may have spread outside of the esophagus. A barium swallow test is often the first test done to see what is causing a problem with swallowing. A barium swallow test can show any irregularities in the normally smooth surface of the esophageal wall. you need to tell your doctor before the scan. Advanced cancers look like large irregular areas and cause a narrowing of the width of the esophagus. a CT scanner takes many pictures of the part of your body being studied as it rotates around you. If you are having any trouble swallowing.Imaging studies Barium swallow In this test. Tumors grow out from the lining of the esophagus. CT scans are not usually used to make the initial diagnosis of esophageal cancer. This test can be done by itself. . They cause the barium to coat that area of the esophagus unevenly. called an upper gastrointestinal (GI) series. With this connection. early cancers can look like small round bumps. Computed tomography (CAT or CT) scan The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. as well as distant areas of cancer spread. This problem can be helped with surgery or an endoscopy procedure. Instead of taking one picture. In the barium x-ray. A computer then combines these pictures into an image of a slice of your body. the barium outlines the esophagus clearly. anything that is swallowed can pass from the esophagus into the windpipe and lungs. CT scans often can show where the cancer is in the esophagus. You may also receive an IV (intravenous) line through which a different kind of contrast dye (IV contrast) is injected. The CT scan can help to determine whether surgery is a good treatment option. a liquid called barium is swallowed. These masses stick out into the lumen (the open area of the tube). This occurs when the tumor destroys the tissue between the esophagus and the trachea (windpipe) and creates a hole connecting them. These scans can also show the nearby organs and lymph nodes (bean-sized collections of immune cells that help fight infections and cancers). They also can appear as a flat. raised area called a plaque. Before any pictures are taken. like a conventional x-ray does. you may be asked to drink 1 to 2 pints of a liquid called oral contrast. Even small. When x-rays are taken. It coats the walls of the esophagus.

An open MRI does not have an enclosed tube. relaxing mental images has also been shown to be helpful in making the time pass quickly. but you should feel free to discuss any concerns you have with your health care team. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. try keeping your eyes closed. The patient lies on the CT scanning table while a radiologist advances a biopsy needle toward the location of the mass. Your doctor may give you a medicine for anxiety to take before the scan. these scans are getting faster and the stay might be pleasantly short. The MRI machine also makes a thumping noise like a washing machine that you may find annoying. Also. A fine-needle biopsy sample (tiny fragment of tissue) or a core needle biopsy sample (a thin cylinder of tissue about one-half inch long and less than 1/8-inch in diameter) is removed and examined under a microscope. Still. If that is not enough. . MRI scans are also very helpful in looking at the brain and spinal cord. A few people are allergic to the dye and get hives. it can also produce slices that are parallel with the length of your body. they often take up to an hour. Although these scanners are less available than regular MRI machines. Some places provide headphones with music to block this noise out. Not only does this produce cross-sectional slices of the body like a CT scanner. CT scans are more inconvenient than regular x-rays because they take longer and require you to lie still on a table while they are being done. Most people have little difficulty with their MRI experience. Thinking of pleasant. Be sure to tell your doctor if you have ever had a reaction to any contrast material used for x-rays. They are not often needed to assess spread of esophageal cancer. This procedure is called a CT-guided needle biopsy. CT scans are repeated until the doctors can see that the needle is in the mass. more serious reactions like trouble breathing and low blood pressure can occur. MRI scans are a little more uncomfortable than CT scans. While you are in the MRI machine you will be able to talk to the technician during the whole procedure. You can be given medicine to prevent and treat allergic reactions. People with a fear of enclosed spaces (claustrophobia) have a very hard time getting an MRI. A contrast material might be injected just as with CT scans but is used less often. you have to be placed inside tube-like equipment. To stay calm. Rarely.The injection can cause some flushing (redness and warm feeling that may last hours to days). many cities have a center with an open MRI. some people feel a bit confined by the ring they have to lie in when the pictures are being taken. If you have a problem with tight spaces. First. talk to your doctor about it. your doctor may be able to have the scan done using an open MRI. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. CT scans can also be used to guide a biopsy needle precisely into a suspected area of cancer spread. which is confining and makes many people uneasy. Also. Magnetic resonance imaging (MRI) scan MRI scans use radio waves and strong magnets instead of x-rays.

Some machines combine a PET scan with a CT scan. During an upper endoscopy procedure. A scanner is used to spot the radioactive deposits. the radioactivity will tend to concentrate in the cancer. The camera is connected to a television set. Endoscopy is an important test for diagnosing esophageal cancer. These samples are sent to the laboratory so that a doctor can look at them under a microscope to see if cancer is present. then certain instruments can be used to help enlarge the opening to help food and liquid pass. The endoscope with the small ultrasound probe is placed in the esophagus. Studies are also looking to see whether changes in the brightness on a PET scan can be used to see whether treatment. Upper endoscopy can give the surgeon information for follow-up surgery. such as chemotherapy. This test is useful for finding areas of cancer spread. radioactive glucose (sugar) is injected into the vein. is working. allowing the doctor to see abnormalities in the wall of the esophagus clearly. This type of scan may be used to look for areas of cancer spread if nothing is found on other imaging tests. If the esophageal cancer is blocking the opening (called the lumen) of the esophagus. This allows the probe to get very close to the cancer. The sound waves bounce off normal tissue and any cancer that is present. including the size and spread of the tumor and whether the tumor can be completely removed. For an endoscopic ultrasound. The doctor can see the cancer through the scope and remove a tissue sample (biopsy).Positron emission tomography (PET) scan In this test. the patient is sedated (made sleepy) and then the endoscope is placed through the mouth and into the esophagus and stomach. This test is very useful in finding the size of an esophageal cancer and how far it has grown into nearby tissues. Endoscopic ultrasound Ultrasound tests use sound waves to take pictures of parts of the body. Studies are being done to see if the degree of uptake or brightness can be used as to tell how fast the tumor is growing. This allows any abnormal areas seen on the PET scan to be precisely located on the CT scan. The probe sends out very sensitive sound waves that penetrate deep into tissues. They are picked up by the probe and a computer turns the pattern of sound waves into a . The uptake of the radioactive glucose ("brightness") may be measured. the probe that gives off the sound waves is at the end of an endoscope. Because cancers use sugar much faster than normal tissues. Endoscopy Upper endoscopy An endoscope is a flexible. It can help find small collections of cancer cells that may not be seen on other tests. very narrow tube with a video camera and light on the end. A tissue sample can also be removed from any other area that doesn't look normal (through the endoscope).

For a biopsy. T refers to the size of the primary tumor and how far it has spread within the esophagus and to nearby organs. The surgeon can operate instruments through the tube and remove lymph node samples and take biopsies to see if the cancer has spread. Endoscopic ultrasound can help determine how much of the tissue next to the esophagus (including nearby lymph nodes) is affected by the cancer. Now staging also takes into account the . the doctor removes a small piece of tissue (usually from an area that looks abnormal). How is cancer of the esophagus staged? Staging is the process of finding out how far a cancer has spread. A doctor called a pathologist then looks at the tissue under the microscope to see if any cancer cells are present.picture. N refers to cancer spread to nearby lymph nodes. the staging system for esophageal cancer changed. Thoracoscopy and laparoscopy These procedures allow the doctor to see lymph nodes and other organs near the esophagus inside the chest (by thoracoscopy) or the abdomen (by laparoscopy) through a hollow lighted tube. This information is often important in deciding whether or not a person is likely to benefit from surgery. If there is cancer. The treatment and outlook for people with esophageal cancer depend. The picture shows how deeply the tumor has invaded into the esophagus. In 2010. It can detect small abnormal changes very well. on the cancer's stage. This lets the doctor see whether the cancer has grown into these structures. see the next section "How is cancer of the esophagus staged?" It takes at least a couple of days to get the results of a biopsy. The patient is sedated for this procedure. The most common system used to stage esophageal cancer is the TNM system of the American Joint Committee on Cancer (AJCC). This helps surgeons decide which tumors can be surgically removed and which cannot. For details about grading. This test uses no radiation and is very safe. Bronchoscopy This procedure uses an endoscope to look into the windpipe (trachea) and tubes leading from the trachea into the lung (bronchi). to a great extent. the pathologist will determine what type it is (adenocarcinoma or squamous cell) and what grade it is. but the only way to know for sure is to do a biopsy. Esophageal cancer is staged with the imaging tests described in “How is cancer of the esophagus diagnosed?” combined with endoscopy and biopsy. M indicates whether the cancer has metastasized (spread to distant organs). Biopsy An area may look like cancer. The TNM system describes 3 key pieces of information. These procedures are done in an operating room and under general anesthesia (the patient is in a deep sleep).

the aorta (the large blood vessel coming from the heart). M1: The cancer has spread to distant lymph nodes and/or other organs. the pericardium (the tissue covering the heart). N stages N0: The cancer has not spread (metastasized) to nearby lymph nodes. or the diaphragm (the muscle powering the lungs). N1: The cancer has spread to 1 or 2 nearby lymph nodes. Grade The grade of a cancer is based on how normal (or differentiated) the cells appear when they are looked at under the microscope. as well as the grade of the cancer. Higher grade tumors tend to grow and spread faster than lower grade tumors. . muscularis mucosa. In the past it was called carcinoma in situ. or other crucial structures. The higher the number. It has not started growing into the deeper layers. The cancer can be removed with surgery. T4b: The cancer cannot be removed with surgery because it has grown into the trachea (windpipe). T1: The cancer is growing into the tissue under the epithelium. T stages Tis: The cancer is only in the epithelium (the top layer of cells lining the esophagus). This stage is also known as high-grade dysplasia. T4: The cancer is growing into nearby structures. such as the lamina propria. M stages M0: The cancer has not spread (metastasized) to distant organs or lymph nodes.cell type of the cancer (squamous cell carcinoma or adenocarcinoma). N3: The cancer has spread to 7 or more nearby lymph nodes. the more abnormal the cells look. T3: The cancer is growing into the outer layer of tissue covering the esophagus (the adventitia). For squamous cell cancers. the spine. or submucosa. T4a: The cancer is growing into the pleura (the tissue covering the lungs). N2: The cancer has spread to 3 to 6 nearby lymph nodes. the location of the tumor can also be a factor in staging. T2: The cancer is growing into the muscle layer (muscularis propria).

G2: The cells are moderately differentiated G3: The cells are poorly differentiated G4: The cells are undifferentiated (these cells are so abnormal that doctors can't tell if they are adenocarcinoma or squamous cell carcinoma). The cancer cells are found only in the epithelium (the layer of cells lining the esophagus). but it has not grown any deeper (T1). Stage IA: T1. M0. Squamous cell carcinoma Stage 0: Tis. The stages are described using the number 0 and Roman numerals from I to IV. GX) and can be anywhere in the esophagus. It may also have grown through that tissue into the layer below (the submucosa). GX or G1. M0. The location is assigned as either upper. The cancer has not grown into the connective tissue beneath these cells (Tis). G4 cancers are grouped with G3 squamous cell cancers.GX: The grade cannot be assessed (treated in stage grouping as G1). Location Some staging of early squamous cell carcinoma also takes into account where the tumor is located in the esophagus. G2 or G3. and any cancer spread is then combined to assign the stage of disease. any location: The cancer has grown from the epithelium into the connective tissue underneath (the lamina propria). N0. The tumor is a grade 1 (or grade information is not available. but it has not grown any deeper (T1). any location: This is the earliest stage of esophageal cancer. This stage is also called high-grade dysplasia or carcinoma in situ. This process is called stage grouping. For staging. lymph nodes. G1: The cells are well-differentiated. It has . It can be anywhere in the esophagus. The tumor is a grade 1 (or grade information is not available. grade X). middle. N0. It may also have grown through that tissue into the layer below (the submucosa). any location: The cancer has grown from the epithelium into the connective tissue underneath (the lamina propria). The stage groupings for adenocarcinoma and squamous cell carcinomas are different. M0. N0. Stage IB: Either of the following: T1. It has not spread to lymph nodes (N0) or to distant sites (M0). The cancer has not spread to lymph nodes (N0) or other organs (M0). Stage grouping Information about the tumor. GX or G1. or lower based on where the upper edge of the tumor is.

the connective tissue covering the outside of the esophagus (T3). location lower: The cancer has grown into the muscle layer called the muscularis propria (T2). The cancer has not spread to lymph nodes (N0) or to distant sites (M0). location lower: The cancer has grown into the muscle layer called the muscularis propria (T2). or it is in the lower part of the esophagus and is a grade 2 or grade 3. any location: The cancer has grown into the lamina propria (T1). It may also have grown into the submucosa (T1) and the muscularis propria (T2).The cancer is either in the upper or middle part of the esophagus and is grade 1 (or grade information is not available. grade X). The cancer has not spread to lymph nodes (N0) or to distant sites (M0). It may also have grown through the muscle layer into the adventitia. OR . OR T1 or T2. ).not spread to lymph nodes (N0) or to distant sites (M0). location upper or middle. N1. It is in the upper or middle part of the esophagus and is grade 2 or grade 3. any G. It has not grown through to the outer layer of tissue covering the esophagus. It has not grown through to the outer layer of tissue covering the esophagus. Stage IIIA: Either of the following: T1 or T2. GX or G1. Stage IIB: Either of the following: T2 or T3. M0. It is grade 1 (or grade information is not available. The cancer has not spread to lymph nodes (N0) or to distant sites (M0). or G2 or G3. N0. GX or G1. It may also have grown through the muscle layer into the adventitia. It may also have grown into layers below: the submucosa (T1) and the muscularis propria (T2). It has spread to 1 or 2 lymph nodes near the esophagus (N1) but has not spread to lymph nodes further away from the esophagus or to distant sites (M0). M0. M0. G2 or G3. M0. OR T2 or T3. the connective tissue covering the outside of the esophagus (T3). It can be any grade and can be located anywhere. any G. It can be any grade and can be located anywhere. N2. Stage IIA: T2 or T3. M0. N0. grade X) and is in the lower part of the esophagus. N0. location upper or middle: The cancer has grown into the muscle layer called the muscularis propria (T2). It is a grade 2 or grade 3. It may also have grown through the muscle layer into the adventitia. the connective tissue covering the outside of the esophagus (T3). any location: The cancer has grown into the lamina propria (T1). The tumor can be anywhere in the esophagus. It has spread to 3 to 6 lymph nodes near the esophagus (N2) but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0).

It has not spread to nearby lymph nodes (N0) or to distant sites (M0). M0. any location: The cancer has grown all the way through the esophagus and into nearby organs or tissues (T4a) but still can be removed. but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). OR T4a. M0. any N. the aorta (the large blood vessel coming from the heart).T3. N0. This stage is also called high-grade dysplasia. any location: The cancer has grown through the wall of the esophagus to its outer layer. any location: The cancer has grown through the wall of the esophagus to its outer layer. the spine. N1. It can be any grade and can be located anywhere. M1. any N. but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It has spread to 1 or 2 lymph nodes near the esophagus (N1). It has spread to 1 to 6 lymph nodes near the esophagus (N1 or N2). Stage IIIC: Either of the following: T4a. M0. any G. It may have spread to nearby lymph nodes (any N). It can be any grade and can be located anywhere. It can be any grade and can be located anywhere. any G. M0. M0. It can be any grade and can be located anywhere. Adenocarcinoma Stage 0: Tis. any G. The cancer cells are only found in the . N3. any G. OR T4b. any G. M0. It can be any grade and can be located anywhere. It can be any grade and can be located anywhere. Stage IIIB: T3. N2. or other crucial structures (T4b). Stage IV: Any T. but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). GX or G1: This is the earliest stage of esophageal cancer. but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade and can be located anywhere. any G. any location: The cancer cannot be removed with surgery because it has grown into the trachea (windpipe). It has spread to 3 to 6 lymph nodes near the esophagus (N2). any location: The cancer has spread to distant lymph nodes or other sites (M1). any location: The cancer has grown all the way through the esophagus and into nearby organs or tissues (T4a) but still can be removed. OR Any T. but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). any location: The cancer has spread to 7 or more nearby lymph nodes (N3). N1 or N2. the adventitia (T3). any G. the adventitia (T3). M0. N0.

but it has not grown any deeper (T1). any G: The cancer has grown into the lamina propria (T1). OR T2. N0. M0. It has not spread to lymph nodes (N0) or to distant sites (M0). It can be any grade. It has not grown through to the outer layer of tissue covering the esophagus.epithelium (the layer of cells lining of the esophagus). It is a grade 3. It has not spread to lymph nodes (N0) or to distant sites (M0). grade X). any G: The cancer has grown into the lamina propria (T1). G3: The cancer has grown from the epithelium into the connective tissue underneath (the lamina propria). Stage IA: T1. The cancer has not spread to lymph nodes or other organs. It may also have grown into the submucosa (T1) and the muscularis propria (T2). M0. It has not spread to lymph nodes (N0) or to distant sites (M0). N0. N2. It can be any grade. the adventitia (T3). Stage IB: Either of the following: T1. M0. It is a grade 1 or grade 2 (or grade information is not available. It may also have grown through that tissue into the layer below (the submucosa). It may also have grown through that tissue into the layer below (the submucosa). It has not spread to lymph nodes (N0) or to distant sites (M0). It is a grade 1 or grade 2 (or grade information is not available. M0. M0. It has not spread to lymph nodes (N0) or to distant sites (M0). It is grade 1 (or grade information is not available. It is a grade 3. It has spread to 1 or 2 lymph nodes near the esophagus (N1). but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). Stage IIIA: Either of the following: T1 or T2. It has spread . M0. G1. N0. M0. or G2: The cancer has grown into the muscle layer called the muscularis propria (T2). Stage IIB: Either of the following: T3. grade X). but it has not grown any deeper (T1). It may also have grown into layers below: the submucosa (T1) and the muscularis propria (T2). The cancer has not grown into the connective tissue beneath these cells. GX. G1. N0. grade X). GX. G3: The cancer has grown into the muscle layer called the muscularis propria (T2). N0. N1. It has not grown through to the outer layer of tissue covering the esophagus. Stage IIA: T2. any G: The cancer has grown through the wall of the esophagus to its outer layer. or G2: The cancer has grown from the epithelium into the connective tissue underneath (the lamina propria). OR T1 or T2.

M0. but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). M0. N1 or N2. any G: The cancer has spread to 7 or more nearby lymph nodes (N3). M0. any G: The cancer has grown all the way through the esophagus and into nearby organs or tissues (T4a) but still can be removed. OR Any T. M0. M0. It can be any grade. It has spread to 1 or 2 lymph nodes near the esophagus (N1). N1. the adventitia (T3). any G: The cancer has grown through the wall of the esophagus to its outer layer. any N. but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade. It can be any grade. It can be any grade. any G: The cancer cannot be removed with surgery because it has grown into the trachea (windpipe). the adventitia (T3). It has spread to 1 to 6 lymph nodes near the esophagus (N1 or N2). M1. any G: The cancer has spread to distant lymph nodes or other sites (M1). It may have spread to nearby lymph nodes (any N). Stage IIIB: T3. the aorta (the large blood vessel coming from the heart). any N. It has spread to 3 to 6 lymph nodes near the esophagus (N2). OR T3. It can be any grade. It has not spread to nearby lymph nodes or to distant sites (M0). M0. but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). or other crucial structures (T4b). N2. . the spine. It can be any grade. N0.to 3 to 6 lymph nodes near the esophagus (N2) but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). any G: The cancer has grown through the wall of the esophagus to its outer layer. OR T4a. OR T4b. Stage IIIC: Either of the following: T4a. Stage IV: Any T. but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). N3. any G: The cancer has grown all the way through the esophagus and into nearby organs or tissues (T4a) but still can be removed. but has not spread to lymph nodes farther away from the esophagus or to distant sites (M0). It can be any grade. It can be any grade.

improvements in treatment since then mean that the survival rates for people now being diagnosed with these cancers may be higher. or T3. Five-year relative survival rates (such as the numbers below) take into account the fact that some patients with cancer will die from other causes. and distant. Stage 0 cancers are not included in these statistics. It includes AJCC stage I and some stage II tumors (such as those that are T1. can also affect outlook. Although they are among the most current numbers we have available. Epidemiology. A number of other factors. This includes T4 tumors and cancers with lymph node spread (N1. There are some important points to note about these numbers: • The 5-year survival rate refers to the percentage of patients who live at least 5 years after being diagnosed with cancer. such as all M1 cancers. they may not accurately represent any one person's outlook. or N3). M0). and are based on patients who were diagnosed with esophageal cancer between 1999 and 2007. including other tumor characteristics and a person's age and general health. Many of these patients live much longer than 5 years after diagnosis. Distant means that the cancer has spread to organs or lymph nodes away from the tumor. They are considered to be a more accurate way to describe the outlook for patients with a particular type and stage of cancer. Your doctor can tell you how these statistics may apply to you. Stage localized regional distant 5-Year Relative Survival Rate 37% 19% 3% . • The SEER database does not divide survival rates by AJCC stage. Localized means that the cancer is only growing in the esophagus. N2. N0. • These numbers are based on patients treated several years ago. this database divides cancers into the summary stages: localized. Instead. as he or she is familiar with the aspects of your particular situation. and End Results (SEER) database. • Although survival statistics can sometimes be useful as a general guide.Survival rates by stage The survival statistics come from the National Cancer Institute's Surveillance. regional. Regional means that the cancer has spread to nearby lymph nodes or tissues. T2.

the cancer care team will discuss a treatment plan or treatment options with you. how . Surgery can also be combined with other treatments. It is important to discuss all treatment options as well as their possible side effects with the doctor to help make the decision that best fits your needs. A second opinion can provide more information and help you feel confident about the chosen treatment plan. depending on the stage of esophageal cancer.How is cancer of the esophagus treated? This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. Don't hesitate to ask him or her questions about your treatment options. as well as their own professional experience. Part of the stomach is pulled up into the chest or neck to become the new esophagus. The upper part of the esophagus is then connected to the remaining part of the stomach. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. such as chemotherapy and/or radiation therapy. together with your doctor. Other treatments. Surgery Surgery may be used to remove the cancer and some of the surrounding tissue. Esophagectomy Surgery to remove all or part of the esophagus is called an esophagectomy. Some of these treatments can also be used as palliative treatment when all the cancer cannot be removed. Some insurance companies require a second opinion before they will agree to pay for treatments. different treatment options may be used alone or in combination. such as endoscopic mucosal resection. chemotherapy. and photodynamic therapy. may be used for early cancers and pre-cancers of the esophagus. and radiation therapy. These views are based on their interpretation of studies published in medical journals. For this procedure. Depending on the stage of the cancer and your general medical condition. radiofrequency ablation. It is intended to help you and your family make informed decisions. The options for treatment of cancer of the esophagus include surgery. the 2 main factors to consider are your overall physical health and the stage of the cancer. In selecting a treatment plan. lymph nodes near the esophagus are also removed. When the esophagus is removed as treatment for cancer. It is important that you take time to think about all of the choices. Palliative treatment is meant to relieve symptoms. The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. General treatment information After the cancer is found and staged. It is often a good idea to seek a second opinion. Often a small part of the stomach is removed as well. such as pain and trouble swallowing but is not expected to cure the cancer.

Lymph node removal In addition to removing some or all of the esophagus. No matter what approach is used. This is called a transthoracic esophagectomy. it is called a tranhiatal esophagectomy. Unfortunately. Surgery often helps with trouble swallowing. the part of the esophagus containing the cancer. Then the stomach is connected to what is left of the esophagus either high in the chest or in the neck. These are then checked to see of they contain cancer cells. If a cancer is located in the distal part of the esophagus (near the stomach) or at the place where the esophagus and stomach meet (the gastroesophageal junction or GE junction). most of the esophagus will need to be removed to be sure to get enough tissue above the cancer. The stomach will then be brought up and connected to the esophagus in the neck. You and your surgeon should discuss in detail the operation planned for you and what you can expect. If the cancer has spread to lymph nodes. If the main incisions are in the abdomen and neck. If the tumor is in the upper or middle part of the esophagus. and about 8 to10 cm (3 to 4 inches) of normal esophagus. . and abdomen. Some techniques involve incisions in the neck. This allows the surgeon to see everything during the operation. The surgeon may use pictures to describe how the operation will be done. If the stomach cannot be used to replace the esophagus. Open esophagectomy: Many different techniques and approaches are used in operating on esophageal cancer. Then the surgical instruments go in through some smaller incisions. the surgeon will remove part of the stomach. removing the esophagus may be able to cure the cancer. and the tissue will die. Minimally invasive esophagectomy: The esophagus can also be removed through several small incisions instead of 1 or 2 large incisions. In patients who can't be cured with surgery. A successful minimally invasive esophagectomy allows the patient to leave the hospital sooner and recover faster. In order to do this type of procedure well. The surgeon puts a scope (like a tiny telescope) through one of the incisions. This approach is used most often for early (small) cancers. chest. and the doctor may recommend other treatments (like chemotherapy and/or radiation) after surgery. an operation may still be done to help reduce symptoms. The esophagus can be removed with the main incisions (cuts) in the abdomen and then the chest. making it easier for patients to eat and maintain good nutrition. When a piece of intestine is used. this is not a simple operation and it may require a long hospital stay. This is called a minimally invasive esophagectomy. If the vessels are damaged.much of the esophagus that is removed depends upon the stage of the tumor and where it's located. If the cancer has not yet spread beyond the esophagus. the surgeon needs to be highly skilled and have a great deal of experience removing the esophagus this way. nearby lymph nodes are removed as well. it must be moved without damaging its blood vessels. most esophageal cancers are not found early enough for doctors to cure them with surgery. the outlook is not as good. not enough blood will get to that piece of intestine. the surgeon may use a piece of the intestine instead.

how many times they have done this procedure. The hospital where the surgery is done is also important. leading to a longer hospital stay. some doctors think radiation therapy can be as effective as surgery when it is combined with chemotherapy. This can cause symptoms such as heartburn. surgery of the esophagus has some risks. in a few cases. Internal radiation therapy. Radiation therapy Radiation therapy is the use of high-energy radiation to kill cancer cells. This is known as adjuvant therapy. External-beam radiation therapy focuses radiation from outside the body on the cancer. Radiation therapy can be used as the primary (main) treatment of esophageal cancer in some patients. Radiation therapy combined with chemotherapy might be curative for some people and provide good relief of symptoms and extend survival for others. A heart attack or a blood clot in the lungs or the brain can occur during or after the operation. the best outcomes are achieved with surgeons and hospitals that have the most experience. It is used more often for people who can't have surgery due to poor health. This type of radiation therapy is most often used to treat esophageal cancer. radiation therapy is combined with surgery and/or chemotherapy. This is why patients should not hesitate to ask the surgeon about his or her experience: how often they operate on the esophagus. In general. bile and stomach contents can enter the esophagus because the lower esophageal sphincter is often removed or changed by the surgery. When radiation is used to ease the symptoms of esophageal cancer such as pain.Risks and side effects of surgery Like most serious operations. Strictures (narrowing) can form where the esophagus is surgically connected to the stomach and cause difficulty swallowing in about 10% to 15% of patients. also known as brachytherapy. or difficulty swallowing it may be called palliative therapy. To relieve this symptom. Radiation therapy may be given after surgery. and any hospital that you consider should be willing to show you survival statistics. lead to frequent nausea and vomiting. After the operation. This complication is not as common as it used to be because of improvements in surgical techniques. and what percentage of their patients have died after this surgery. and sometimes even death. This can. these strictures can be expanded during an upper endoscopy procedure. . bleeding. Lung complications are common. Infection is a risk with any surgery. Sometimes antacids or motility drugs can help relieve these symptoms. After surgery. The risk of dying from this operation is related to the hospital and doctor's experience with these procedures. Some of these complications may be fatal. Most often. the stomach may empty too slowly because the nerves that control its contractions can be affected by surgery. to kill any tiny deposits of cancer cells that may have been left behind but are too small to see. There may be a leak at the place where the stomach is connected to the esophagus. places radioactive material directly into or near the cancer. Pneumonia may develop. In fact.

. Often it is combined with radiation therapy and/or surgery. This combination (called chemoradiation or chemoradiotherapy) can be useful for large tumors that couldn't be removed otherwise. radiation to the chest can cause lung damage. Talk with your doctor before and during treatment about what side effects you can expect and any ways that they could be reduced.The form of radiation therapy known as brachytherapy is useful in shrinking tumors so a patient can swallow more easily. making this treatment useful for cancer that has spread. which may lead to problems breathing and shortness of breath. During treatment of the esophagus. radioactive seeds are placed into the tumor through an endoscope. Depending on the type and stage of esophageal cancer. For example. but some rare serious side effects can be permanent. This is called palliative treatment. • Alone or with radiation to help control symptoms like pain or trouble swallowing when the cancer can't be cured. Chemotherapy by itself rarely cures esophageal cancer. so it is better used as a way to relieve symptoms (and not to cure the cancer). Side effects of radiation therapy may include: • Skin changes ranging from sunburn-like to blistering and open sores • Nausea and vomiting • Diarrhea • Fatigue • Painful sores in the mouth and throat These side effects are often worse if chemotherapy is given at the same time as radiation. • After the cancer has been removed completely at surgery (called adjuvant treatment). In this procedure. This technique cannot be used to treat a very large area. Most side effects of radiation are temporary. This improves after treatment. These drugs enter the bloodstream and reach all areas of the body. Chemotherapy Chemotherapy (chemo) uses drugs that are given through a vein or by mouth to treat cancer. leading to painful swallowing. This treatment is meant to kill any tiny deposits of tumor cells too small to see that may have been left behind. chemotherapy may be given: • As the main (primary) treatment • Before surgery to shrink the cancer and make it easier to remove (called neoadjuvant treatment. It can shrink the tumor enough for surgery to be an option. Chemo is often given together with radiation therapy. the radiation kills the normal cells in the lining.

Some studies have shown that chemoradiation may be as effective as the main treatment as surgery. This is not seen on most tumors. In order for it to work. and 5-FU • 5-FU or capecitibine (Xeloda®) (often combined with radiation) • DCF: docetaxel (Taxotere®). Using chemoradiation and surgery may help people live longer than using just surgery. Often combinations of 2 or more drugs are used together. Many different chemotherapy drugs can be used to treat esophageal cancer. vinorelbine (Navelbine®). bleomycin. CPT-11). oxaliplatin. This approach also seems to help people live longer than surgery alone. This may also be an option for patients who could have surgery. methotrexate. leading to some side effects.Chemoradiation is also often used before surgery for smaller tumors. and irinotecan (Camptosar®. chemoradiation may be used as the only treatment. This can result in: • An increased chance of infection (because of a shortage of white blood cells) • Problems with bleeding or bruising (due to a shortage of blood platelets) • Fatigue or shortness of breath (due to low red blood cell counts) . In some cases. cisplatin. paclitaxel (Taxol®). Common side effects of chemo include: • Nausea and vomiting • Loss of appetite • Loss of hair • Mouth sores. and the length of treatment. mitomycin. topotecan. their dose. the cancer cells must have too much of a protein called Her-2 on their surface. cisplatin. The drug trastuzumab (Herceptin®). This may be a good choice for patients who cannot have surgery because they have other major health problems. Chemoradiation can also be given after surgery. such as: • Cisplatin and 5-fluorouracil (5-FU) (often combined with radiation) • ECF: epirubicin (Ellence®). and 5-FU • Cisplatin with capecitibine (Xeloda®) Other chemo drugs that have been used to treat cancer of the esophagus include carboplatin. Side effects depend on the specific drugs used. may be helpful in some cases of esophagus cancer. Chemotherapy drugs kill cancer cells but can also damage some normal cells. which is more often used to treat breast cancer. doxorubicin (Adriamycin®). • Low blood counts Low blood counts result from the effect of chemo on the blood-producing cells of the bone marrow.

Endoscopic treatments Endoscopic mucosal resection Endoscopic mucosal resection (EMR) is a technique where the inner lining of the esophagus is removed with instruments attached to the endoscope. and chemoradiation can cause painful sores in the mouth and throat. These can make it hard to eat well enough to get good nutrition. Cisplatin can cause nerve and kidney damage. 5-FU often causes diarrhea. Treatment to suppress acid (with a proton pump inhibitor) continues after the abnormal tissue is removed. it can only kill cancer cells near the inner surface of the esophagus -. Treatment such as chemo. This can make treatment easier to tolerate. many good drugs are available to prevent and treat nausea and vomiting. so they can be treated. This allows liquid nutrition to be put directly into the intestine to prevent further weight loss and improve nutrition. This can help keep the disease from returning. PDT begins with the injection of a non-toxic chemical into the blood. A special type of laser light is then focused on the cancer through an endoscope. making weight loss worse. some can last a long time or even be permanent. Although most side effects improve once treatment is stopped. Feeding tubes can easily be removed when they are no longer needed. Photodynamic therapy Photodynamic therapy (PDT) is a method that can be used to treat esophageal pre-cancer (dysplasia) and early esophageal cancer. This chemical is allowed to collect in the tumor for a few days. This light cannot reach cancers that have spread deeper into the esophagus or to other organs. small tumors) cancers of the esophagus. These side effects can last for up to 6 weeks after therapy and. The advantage of PDT is that it can kill cancer cells with very little harm to normal cells. Let your health care team know if you have side effects. radiation. Doxorubicin and epirubicin both can cause heart damage if enough of the drug is given. If your doctor plans treatment with chemo you should be sure to discuss the drugs that will be used and the possible side effects. PDT can also be used to help with symptoms when a cancer has come back after other treatment. Side effects of PDT include redness or discoloration of the skin and sensitivity to the sun or to other light sources. People with esophageal cancer often had problems with weight loss before the cancer was found. These may be found when Barrett's esophagus is biopsied. For example. There are ways to prevent and treat many of the side effects of chemotherapy. For example. But because the chemical must be activated by light. Some people with esophageal cancer need to have a feeding tube placed before treatment.those that can be reached by the light. in . EMR can be used for dysplasia (pre-cancer) and some very early focal (single. The light changes the non-toxic chemical into a new chemical that can kill cancer cells. This light causes changes in the chemical that has collected inside the cancer cells.Certain drugs have their own specific side effects.

so it can be hard to be certain that the cancer has not spread into deeper layers of the esophagus. PDT is not meant to destroy all of the cancer. PDT is also often used to treat large cancers that are blocking the esophagus. Radiofrequency ablation (RFA) In this procedure. Strictures (areas of extreme narrowing) also occur in about one third of patients.some cases. Argon plasma coagulation This technique is similar to laser ablation. The patient needs to stay on drugs to block acid production after the procedure. It is used to open up the esophagus when it is blocked. They also need to stay on medication to stop acid production (a proton pump inhibitor). Then high-power energy is used to kill the cells in the lining. Laser ablation This technique uses a laser called a neodymium: yttrium-aluminum-garnet (Nd:yag) laser that is aimed through the endoscope to kill cancer cells. When PDT is used to treat dysplasia (pre-cancer) in Barrett's esophagus. It can be used to treat dysplasia in areas of Barrett's esophagus. This treatment can cure some very early esophageal cancers that have not spread to deeper tissues. PDT is being used to treat Barrett's esophagus and very early esophageal cancers found in Barrett's esophagus. This treatment may lower the chance of cancer developing in that area. RFA rarely causes strictures (scar tissue that narrows the esophagus). Endoscopy (with biopsies) then is done periodically to watch for any further changes in the lining of the esophagus. and grow into a new tumor. cells of deeper cancers could be left behind. it cuts the chance of a cancer developing in half. may be severe. But this procedure destroys the tissue. People getting this treatment need to have follow-up endoscopies to make sure the cancer hasn't grown back. Normal cells grow in to replace the Barrett's cells. Because of this. a balloon is passed into an area of Barrett's esophagus. . It is also used to unblock the esophagus when the patient has trouble swallowing. In this situation. Since the light used in PDT may only reach those cancer cells near the surface of the esophagus. Right now. These often need to be treated by with dilation. These studies compare the results of PDT with other treatments such as surgery or use of lasers to vaporize the cancer. but to kill enough of the cancer to improve the patient's ability to swallow. This can help improve problems swallowing. Current studies are looking at the exact role of PDT in treating esophageal cancer. patients should stay indoors for about 6 weeks after treatment. Researchers are also working to improve PDT by developing new photosensitizing drugs and evaluating new ways to deliver the proper amount of light to the cancer. It is inflated so that the surface of the balloon is in contact with the inner lining.

or other methods such as acupuncture or massage. this treatment can help relieve esophageal blockage. In some cases. If you do qualify for a clinical trial. These methods can include vitamins.cancer. Clinical trials You may have had to make a lot of decisions since you've been told you have cancer. We use complementary to refer to treatments that are used along with your regular medical care. Or maybe someone on your health care team has mentioned a clinical trial to you. Complementary and alternative therapies When you have cancer you are likely to hear about ways to treat your cancer or relieve symptoms that your doctor hasn't mentioned.cancer. herbs. They are the only way for doctors to learn better methods to treat cancer. Clinical trials are carefully controlled research studies that are done with patients who volunteer for them. You can reach this service at 1-800-303-5691 or on our Web site at www. There are requirements you must meet to take part in any clinical trial. and they are used to refer to many different methods. You can read it on our Web site or call our toll-free number (1-800-227-2345) and have it sent to you. They are done to get a closer look at promising new treatments or procedures.gov/clinicaltrials. to name a few. they are not right for everyone. it is up to you whether or not to enter (enroll in) it. You may have heard about clinical trials being done for your type of cancer. Everyone from friends and family to Internet groups and Web sites may offer ideas for what might help you. Clinical trials are one way to get state-of-the art cancer treatment. One of the most important decisions you will make is choosing which treatment is best for you. You can get a lot more information on clinical trials in our document called Clinical Trials: What You Need to Know. If you would like to take part in a clinical trial. Still. you should start by asking your doctor if your clinic or hospital conducts clinical trials. . so it can be confusing.org/clinicaltrials. What exactly are complementary and alternative therapies? Not everyone uses these terms the same way. You can also get a list of current clinical trials by calling the National Cancer Institute's Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) or by visiting the NCI clinical trials Web site at www.Electrocoagulation This method involves burning the tumor off with electric current. Alternative treatments are used instead of a doctor's medical treatment. and special diets. You can also call our clinical trials matching service for a list of clinical trials that meet your medical needs.

you may be able to safely use the methods that can help you while avoiding those that could be harmful. These treatments have not been proven safe and effective in clinical trials. Treating esophageal cancer by stage Stage 0 A stage 0 tumor is not true cancer. If you want to use a non-standard treatment. Some complementary methods are known to help. but they are . or have life-threatening side effects. or peppermint tea to relieve nausea. It contains abnormal cells called high-grade dysplasia and is really a type of pre-cancer. they are used to help you feel better. But the biggest danger in most cases is that you may lose the chance to be helped by standard medical treatment. here are 3 important steps you can take: • Look for "red flags" that suggest fraud. • Contact us at 1-800-227-2345 to learn more about complementary and alternative methods in general and to find out about the specific methods you are looking at. Some of these methods may pose danger. The choice is yours Decisions about how to treat or manage your cancer are always yours to make. learn all you can about the method and talk to your doctor about it. Some methods that are used along with regular treatment are meditation to reduce stress. You want to do all you can to fight the cancer. Does the method promise to cure all or most cancers? Are you told not to have regular medical treatments? Is the treatment a "secret" that requires you to visit certain providers or travel to another country? • Talk to your doctor or nurse about any method you are thinking about using. while others have not been tested. Alternative treatments: Alternative treatments may be offered as cancer cures.Complementary methods: Most complementary treatment methods are not offered as cures for cancer. Finding out more It is easy to see why people with cancer think about alternative methods. As you consider your options. But the truth is that most of these alternative methods have not been tested and proven to work in treating cancer. Delays or interruptions in your medical treatments might give the cancer more time to grow and make it less likely that treatment will help. Some have been proven not be helpful. or they may no longer be working. With good information and the support of your health care team. and a few have even been found harmful. and the idea of a treatment with no side effects sounds great. acupuncture to help relieve pain. Sometimes medical treatments like chemotherapy can be hard to take. Mainly. The abnormal cells look like cancer cells.

or both together. . Unfortunately. Still. or endoscopic mucosal resection (EMR). Patients who have received chemotherapy and radiation therapy may be cured and not need surgery at all. or chemoradiation followed by surgery. Some very early stage I cancers that involve a small area of the mucosa and haven't grown into the submucosa may be treated with EMR. In some instances. surgery to remove the esophagus remains the standard treatment. Stage I In this stage the cancer has grown into some of the deeper layers of the esophagus (past the innermost layer of cells). chemotherapy followed by surgery. This stage is often diagnosed when a routine biopsy is done in someone with Barrett's esophagus. Patients with adenocarcinoma at the place where the stomach and esophagus meet (the gastroesophageal junction) are often treated with chemotherapy followed by surgery. Treatment options for people with this stage of esophageal cancer include surgery. radiofrequency ablation. They have not grown into the connective tissue below (the lamina propria). the surgery might not be needed after chemoradiation therapy. photodynamic therapy and radiofrequency ablation are not options. This approach may be more helpful for cancers that have grown into the muscle layer or through that layer into the outer covering of the esophagus. follow-up is very important. Patients who cannot have surgery because they have other serious health problems may be treated with chemotherapy. Because cancer cells have grown into the deeper layers of the esophagus. even when cancer cannot be seen. Skipping surgery is only an option when no cancer can be seen on endoscopy. Stage III Cancers in this stage include those that have grown through the wall of the esophagus to the outer layer and have spread to nearby lymph nodes. Stage III also includes cancers that have grown through all the layers of esophagus and into nearby organs or tissues (T4). Therefore.only found in the inner layer of cells lining of the esophagus (the epithelium). Most patients with this stage of esophageal cancer have their cancer (and their esophagus) removed with surgery. Some doctors may recommend treatment with chemotherapy and/or radiation in addition to surgery. This stage also includes cancers that have spread to nearby lymph nodes (N1). Options include endoscopic treatments such as photodynamic therapy. it can still be present below the inner lining of the esophagus. Stage II Stage II includes cancers that have grown into the muscle layer of the esophagus and cancers that have grown through the muscle layer into the connective tissue on the outside of the esophagus. radiation therapy.

Treatment of a recurrence of esophageal cancer depends on where the cancer grows back. If the first cancer was treated endoscopically (with endoscopic mucosal resection or photodynamic therapy). but the benefit of giving chemo is not clear. Some people prefer not to have treatments that have serious side effects and choose to receive only those treatments that will keep them comfortable and add to their quality of life. it is called a local recurrence. radiation. it is usually still possible to give more chemotherapy. radiation and/or chemotherapy may be used. If the cancer comes back in or near the same area it started. more radiation is rarely an option. as well as how it was treated the first time.This stage is treated much like stage II disease. or both. no treatment can cure stage IV esophageal cancer. Radiation therapy may be used to help with pain or trouble swallowing. chemo. If radiation were given before. Another option is to give chemoradiation first. If that is the case. then surgery may be an option. treatment is only used to help relieve symptoms. and surgery may be avoided. it most often comes back in the esophagus. may be offered after surgery. often with radiation. If the cancer comes back in distant organs or tissues (such as the liver). surgery can be done. This treatment is given more often for adenocarcinomas than for squamous cell carcinomas of the esophagus. Recurrent esophageal cancer When a cancer comes back after treatment. However. Some stage IVA cancers can be completely removed with surgery. there is no test to definitely prove this. it is called recurrent or relapsed. If cancer is found in nearby lymph nodes when they are removed at surgery. the cancer may go away completely after chemoradiation therapy. If the doctor thinks that removing all of the cancer is possible. Stage IV Stage IVA esophageal cancer has spread to distant lymph nodes. Chemotherapy may also be given to try to help patients feel better and live longer. chemoradiation followed by surgery. while in stage IVB the cancer has spread to other organs or tissues. This type of recurrence is often treated by removing the esophagus. When chemotherapy was given before. it is called a distant recurrence. . Palliative treatments (see next section) are used as needed. or surgery alone. If cancer recurs locally after surgery. Treatment may include chemotherapy followed by surgery. If the patient is unable to have surgery due to other health problems. Sometimes the same drugs that were used before are given again. if the cancer shrinks enough to be able to be removed. the cancer may be treated with chemotherapy. Then. Esophageal cancer that recurs in other organs or tissues is treated like a stage IV cancer. but often other drugs are used. Often. In some cases.

"Endoscopic treatments. Stents will relieve trouble swallowing in most patients that are treated. Electrocoagulation This method involves burning the tumor off with electric current. . dilatation is often followed by other treatments to keep the esophagus open. Esophageal stents A stent is a device made of mesh material. In some cases. Laser endoscopy In this treatment. The goal is to open up the blocked area and allow better swallowing. They may be used after dilatation to keep the esophagus open. A surgical incision is not needed. Using endoscopy. palliative therapy is given along with other treatments that are intended to cure the disease. the esophagus stays open only about 2 weeks. palliative treatments are given when a cure is not possible. The laser used is called a neodymium: yttrium-aluminum-garnet (Nd:yag) laser. It is not meant as a cure for the disease (cancer). The success of these stents depends on the type of stent that is used and where it is placed. In other cases. this type of laser therapy is done before an esophageal stent is placed. In some cases. However. laser beams are aimed at the cancer through an endoscope. they are placed into the esophagus across the length of the tumor. About 70% to 80% of patients will benefit from laser endoscopy. a device shaped like a cylinder is pushed through an area of the esophagus that is blocked. Most often stents are made out of metal. Esophageal dilatation In this procedure. Once in place. The laser opens up the esophagus by vaporizing and coagulating cancerous tissue. therefore. they self-expand (open up) to become a tube that helps hold the esophagus open. There is a small risk of tearing a hole in the esophagus (called perforation). but they can also be made out of plastic. This procedure can be repeated. this treatment can help relieve esophageal blockage." It can be used to remove superficial layers of tumor tissue and help relieve esophageal blockage. the cancer grows back. After this procedure. The main purpose of this type of treatment is to improve the patient's comfort and quality of life.Palliative therapy Palliative therapy is treatment aimed at relieving symptoms. so the procedure may need to be repeated every month or two. In some cases. Photodynamic therapy This treatment is discussed in more detail in the section.

Pain management Pain control is an important concern for people with cancer. Information for patients as well as more detailed information intended for use by cancer care professionals is also available on www. no matter how trivial they might seem to the patient.cancer. The cancer care team wants to answer all of these questions.the National Comprehensive Cancer Network (NCCN) and the National Cancer Institute (NCI) are good sources of information.Radiation therapy External-beam radiation can help relieve some of the symptoms from advanced esophageal cancer. made up of experts from many of the nation's leading cancer centers. it may not be able to be treated that way again. The NCI provides treatment information via telephone (1-800-4-CANCER) and its Web site (www. Radiation is often used for cancer that has spread to the brain or spine. If an area had been treated with external beam radiation therapy earlier.org).gov). but it is also useful in treating problems with swallowing from a blocked esophagus.cancer.nccn. people with esophageal cancer can consider these questions: • What kind of esophageal cancer do I have? • Has my cancer spread beyond the primary site? • What is the stage of my cancer and what does that mean in my case? • What treatment choices do I have? . The NCCN. open discussions with their cancer care team. In that case. What should you ask your doctor about cancer of the esophagus? It is important for people with cancer and their families to have honest. People with cancer should let their cancer care team know immediately if they are in pain. Brachytherapy is especially useful in helping to relieve a blocked esophagus. Those are available on the NCCN Web site (www.including some that may not be addressed in this document -. develops cancer treatment guidelines for doctors to use when treating patients. there are many ways to treat cancer pain. More treatment information For more details on treatment options -. brachytherapy may be an option. including pain and problems swallowing. However. The cancer care team can provide medicines and other palliative treatments to relieve pain and other symptoms.gov. For instance.

but others can be permanent. physically examine you. This is the time for you to ask your health care team any questions you need answered and to discuss any concerns you might have. During these visits. barium swallows. Living With Uncertainty: The Fear of Cancer Recurrence. What happens after treatment for cancer of the esophagus? Completing treatment can be both stressful and exciting. Be sure to write down your questions so that you remember to ask them during each visit with your cancer care team. your doctors will ask about symptoms. it is very important to keep all follow-up appointments. Follow-up care After your treatment is over. You can learn more about what to look for and how to learn to live with the possibility of cancer coming back in our document. Also keep in mind that doctors are not the only ones who can provide you with information. Other health care professionals. such as nurses and social workers. But it may take a while before your confidence in your own recovery begins to feel real and your fears are somewhat relieved. This is a very common concern among those who have had cancer. Some may last for a few weeks to several months. what is my prognosis? • What possible risks or side effects are there to the treatments you suggest? • What are the chances of recurrence of my cancer with these treatment plans? • What should I do to be ready for treatment? • Will I have special nutritional needs due to the esophageal cancer? • Where can I find more information and support? You will no doubt have other questions about your personal situation. or upper endoscopy.• What treatment(s) do you recommend and why? • Based on what you've learned about my cancer. Don't hesitate to tell your cancer care team about any symptoms or side effects that bother you so they can help you manage them. as well as for possible side effects of certain treatments. available at 1-800-227-2345. Almost any cancer treatment can have side effects. . and other imaging studies (such as CT scans). Follow-up is needed to check for cancer recurrence or spread. may have the answers you seek. and order blood tests or imaging studies such as upper gastrointestinal (GI) x-rays.

A team of doctors and a nutritionist can work together with you to provide nutritional supplements and information about your individual nutritional needs. so they can give you prompt and effective pain management. Quitting helps improve appetite and overall health and can reduce the chance of developing a new cancer. please tell your cancer care team right away. a copy of the discharge summary that doctors prepare when patients are sent home from the hospital • If you were treated with radiation. It is important that you be able to give your new doctor the exact details of your diagnosis and treatment. If you want to quit smoking and need help. call the American Cancer Society at 1-800-227-2345. Seeing a new doctor At some point after your cancer diagnosis and treatment. especially if they include trouble swallowing or chest pain. Smoking If you smoke. Your original doctor may have moved or retired. Nutrition Cancer of the esophagus often causes trouble swallowing. If you experience pain. Pain control There are many ways to control pain caused by cancer of the esophagus. it is very important to quit. Make sure you have the following information handy: • A copy of your pathology report from any biopsy or surgery • If you had surgery. Early treatment can relieve many symptoms and improve your quality of life.New symptoms It is important that you report any new symptoms to the doctor right away. a copy of your operative report • If you were hospitalized. or you may have moved or changed doctors for some reason. our document. weight loss and weakness due to poor nutrition are common problems. you may find yourself in the office of a new doctor. Should your cancer return. This can be valuable in helping you maintain your weight and nutritional intake. a copy of your radiation treatment summary . You can get this document by calling 1-800-227-2345. When Your Cancer Comes Back: Cancer Recurrence gives you information on how to manage and cope with this phase of your treatment. For this reason.

too. drug doses. maybe you kept your feelings bottled up. when you can. an expert in nutrition who can give you ideas on how to fight some of the side effects of your treatment. it is always a possibility. On the other hand. For instance. Lifestyle changes to consider during and after treatment Having cancer and dealing with treatment can be time-consuming and emotionally draining. Maybe you are thinking about how to improve your health over the long term. Get help with those that are harder for you. If it happens. Were there things you did that might have made you less healthy? Maybe you drank too much alcohol. but it can also be a time to look at your life in new ways. Make healthier choices Think about your life before you learned you had cancer. . Not only will you feel better but you will also be healthier. This can be frustrating. You may lose your appetite for a while and lose weight when you don't want to. or smoked. For instance. do the best you can. You may also find it helps to eat small portions every 2 to 3 hours until you feel better and can go back to a more normal schedule.• Finally. but it can get even tougher during and after cancer treatment. or ate more than you needed. Diet and nutrition Eating right can be a challenge for anyone. However. or maybe you let stressful situations go on too long. call the American Cancer Society at 1-800-227-2345. Try to keep in mind that these problems usually improve over time. Now is not the time to feel guilty or to blame yourself. some people gain weight even without eating more. Nausea can be a problem. During treatment If you are losing weight or have taste problems during treatment. you can start making changes today that can have positive effects for the rest of your life. Eat whatever appeals to you. Even though no one wants to think about their cancer returning. if you are thinking about quitting smoking and need help. and when you took them It is also important to keep medical insurance. Now is not the time to restrict your diet. treatment often may change your sense of taste. You may want to ask your cancer team for a referral to a dietitian. a list of your drugs (especially chemotherapy drugs). Some people even begin this process during cancer treatment. Emotionally. since some drugs can have long-term side effects. Eat what you can. What better time than now to take advantage of the motivation you have as a result of going through a life-changing experience like having cancer? You can start by working on those things that you feel most concerned about. the last thing you want is to have to worry about paying for treatment. or didn't exercise very often.

you may need to eat smaller amounts of food more often.After treatment If your esophagus has been removed. One of the best things you can do after treatment is to put healthy eating habits into place. Any program of physical activity should fit your own situation. If you drink alcohol. which can help fight fatigue and the sense of depression that sometimes comes with feeling so tired. bologna. This is called the dumping syndrome. like increasing the variety of healthy foods you eat. this fatigue lasts a long time after treatment and can discourage them from physical activity. and exercise Fatigue is a very common symptom in people being treated for cancer. Try to eat 5 or more servings of vegetables and fruits each day. endurance. The food that is swallowed quickly passes into the intestine. you will need to balance activity with rest. you may want to think about taking short walks. The combination of a good diet and regular exercise will help you maintain a healthy weight and keep you feeling more energetic. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis 3 times a week. Choose whole grain foods instead of white flour and sugars. it can't hold food for digestion like it did before. Talk with your health care team before starting. Cut back on processed meats like hot dogs. Studies have shown that patients who follow an exercise program tailored to their personal needs feel physically and emotionally improved and can cope better. fatigue. Rest. Physical therapy can help you maintain strength and range of motion in your muscles. Then try to get an exercise buddy so that you're not doing it alone. If you are ill and need to be on bed rest during treatment. Many patients have trouble with reflux after treatment. You will be surprised at the long-term benefits of some simple changes. And don't forget to get some type of regular exercise. It is okay to rest when you need to. If you haven't exercised in a few years but can still get around. exercise can actually help you reduce fatigue. and bacon. sweating. When the stomach is used to replace the esophagus. This is often not an ordinary type of tiredness but a "bone-weary" exhaustion that doesn't get better with rest. For some. If you are very tired. leading to these symptoms after eating. and muscle strength to decline some. Try to limit meats that are high in fat. though. and get their opinion about your exercise plans. it is normal to expect your fitness. It is really hard for some people to allow themselves to do that when . Your health care team can help you adjust your diet if you are having problems eating. Having family or friends involved when starting a new exercise program can give you that extra boost of support to keep you going when the push just isn't there. limit yourself to 1 or 2 drinks a day at the most. Some patients have problems with diarrhea. However. and flushing after eating. work. Get rid of them altogether if you can. You should also stay upright for several hours after eating.

or the effect of your cancer on your family. recommends that adults take part in at least 1 physical activity for 30 minutes or more on 5 days or more of the week. How about your emotional health? Once your treatment ends. Fatigue in People With Cancer. please see our publication. cancer support groups. Whatever your source of strength or comfort. Some people feel safe in peer-support groups or education groups. You may have been going through so much during treatment that you could only focus on getting through your treatment. • It improves your cardiovascular (heart and circulation) fitness. This is an ideal time to seek out emotional and social support. • It reduces fatigue. friends. You may also begin to re-evaluate your relationship with your spouse or partner. You need people you can turn to for strength and comfort. Let them in and let in anyone else who you feel may help. (For more information about fatigue. online support communities. Support can come in many forms: family. Almost everyone who has been through cancer can benefit from getting some type of support. Now you may find that you think about the potential of your own death. as you become healthier and have fewer doctor visits. This happens to a lot of people.) Exercise can improve your physical and emotional health. you will see your health care team less often. • It strengthens your muscles. And your friends and family may feel shut out if you decide not to include them. If you aren't sure who . you may find yourself overwhelmed by emotions. Children and teens are encouraged to try for at least 60 minutes a day of energetic physical activity on at least 5 days a week. such as church. or individual counselors. That can be a source of anxiety for some.they are used to working all day or taking care of a household. make sure you have a place to go with your concerns. For instance. Others would rather talk in an informal setting. Unexpected issues may also cause concern. The American Cancer Society. • It makes you feel generally happier. • It lowers anxiety and depression. we know that exercise plays a role in preventing some cancers. friends. in its guidelines on physical activity for cancer prevention. And long term. What's best for you depends on your situation and personality. Others may feel more at ease talking one-on-one with a trusted friend or counselor. • It helps you feel better about yourself. It is not necessary or realistic to go it all by yourself. The cancer journey can feel very lonely. church or spiritual groups. and career.

can help. Everyone has his or her own way of looking at this. you need to think about and understand your reasons for choosing this plan. Although your doctor may offer you new treatment. Its main purpose is to improve your quality of life. such as pain. Some people are tempted to try more chemotherapy or radiation. This is likely to be the most difficult time in your battle with cancer -. over time the cancer tends to become resistant to all treatment. it is often possible to try another treatment plan that might still cure the cancer. or if it returns. What you can change is how you live the rest of your life: making healthy choices and feeling as well as possible. You should know that receiving hospice care doesn't mean you can't have treatment for the problems caused by your cancer or other health . even when their doctors say that the odds of benefit are less than 1%. If you want to continue treatment to fight your cancer as long as you can. call your American Cancer Society at 1-800-227-2345 and we can put you in touch with an appropriate group or resource. you still need to consider the odds of more treatment having any benefit. At this time it's important to weigh the possible limited benefit of a new treatment against the possible downsides. Some people may want to focus on remaining comfortable during their limited time left.when you have tried everything medically within reason and it's just not working anymore. But this is not the same as receiving treatment to try to cure the cancer. radiation therapy might be given to help relieve bone pain from bone metastasis. this is given at home. In many cases. Your cancer may be causing symptoms or problems that need attention. At some point. For example. continuing treatment is not likely to improve your health or change your prognosis or survival. or at least shrink the tumors enough to help you live longer and feel better. your doctor can estimate the response rate for the treatment you are considering. when a person has received several different medical treatments and the cancer has not been cured. the treatments you get to control your symptoms are similar to the treatments used to treat cancer. it is important that you be as comfortable as possible. On the other hand. Or chemotherapy might be given to help shrink a tumor and keep it from causing a bowel obstruction. Palliative treatment helps relieve these symptoms. and hospice focuses on your comfort. Most of the time. you need to consider that at some point. you may benefit from hospice care. but it is not expected to cure the disease. What happens if treatment is no longer working? If the cancer continues to grow after one kind of treatment. No matter what you decide to do. In this situation. You can't change the fact that you have had cancer. physically and emotionally. Make sure you are asking for and getting treatment for any symptoms you might have. including continued doctor visits and treatment side effects. This type of treatment is called palliative treatment. for example. Sometimes.

For example. university hospitals. Remember also that maintaining hope is important. In people with Barrett's esophagus. In a way. It just means that the focus of your care is on living life as fully as possible and feeling as well as you can at this difficult stage of your cancer.times that are filled with happiness and meaning. They are also studying new ways to destroy Barrett's mucosa and . efforts are being made to reduce obesity. Immunotherapy Experimental treatments that boost the patient's immune reaction to fight esophageal cancer more effectively are being tested in clinical trials. Understanding these changes will lead to new targeted therapies that overcome the effects of these abnormal genes. Drug treatment Several clinical trials are in progress to test new ways to combine drugs already known to be active against esophageal cancer in order to improve their effectiveness. a major risk factor for this form of cancer (and several types as well). Genetics Researchers have found many of the changes in certain genes that appear to be responsible for causing normal cells of the esophagus to develop into esophageal cancer. more curable stage. and eventually to gene therapies that repair the abnormal DNA changes in esophageal cancer cells. What's new in esophageal cancer research and treatment? Research on the treatment and prevention of esophageal cancer is now being done at many medical centers. researchers are investigating tests to determine which patients will go on to develop cancer. Other studies are testing the best ways to combine chemotherapy with radiation therapy. They expect that additional progress will lead to new tests for finding esophageal cancer at an earlier. Your hope for a cure may not be as bright. but there is still hope for good times with family and friends -. pausing at this time in your cancer treatment is an opportunity to refocus on the most important things in your life. It is now being tested in esophageal cancer. This is the time to do some things you've always wanted to do and to stop doing the things you no longer want to do. New drugs that target certain substances in the cancer cell are becoming available. Screening and prevention As the rate of adenocarcinoma rises. and other institutions across the nation. This is known as targeted therapy and it has been successful in some other cancers. drugs are being tested that interfere with the molecules within esophageal cancer cells that control their growth and spread.conditions.

After Diagnosis: A Guide for Patients and Families (also available in Spanish) Caring for the Patient With Cancer at Home: A Guide for Patients and Families (also available in Spanish) Pain Control: A Guide for Those With Cancer and Their Loved Ones (also available in Spanish) Surgery (also available in Spanish) Understanding Chemotherapy: A Guide for Patients and Families (also available in Spanish) Understanding Radiation Therapy: A Guide for Patients and Families (also available in Spanish) The following books are available from The American Cancer Society. These materials may be viewed on our Web site or ordered from our toll-free number (1-800-227-2345). Additional resources More information from your American Cancer Society We have some related information that may also be helpful to you.promote its replacement by normal mucosa.gov National Coalition for Cancer Survivorship Toll-free number: 1-888-650-9127 1-877-NCCS-YES (622-7937) for some publications and Cancer Survivor Toolbox® . Cancer in the Family: Helping Children Cope With a Parent's Illness Caregiving: A Step-By-Step Resource for Caring for the Person With Cancer at Home What Helped Me Get Through: Cancer Patients Share Wisdom and Hope What To Eat During Cancer Treatment National organizations and Web sites* In addition to the American Cancer Society. other sources of patient information and support include:* National Cancer Institute Toll-free number: 1-800-4-CANCER (1-800-422-6237) TYY: 1-800-332-8615 Web site: www. Research also continues to find ways to stop Barrett's cells from turning into pre-cancer or cancer.cancer. Call us at 1-800227-2345 to ask about costs or to place your order.

Mayer RJ. 2008:993–1043. Philadelphia. Kosary CL.org on April 20. JAMA. et al. Call us at 1-800-227-2345 or visit www. PA: Lippincott-Williams & Wilkins. Radiofrequency ablation in Barrett's esophagus with dysplasia. 2008:1399–1429. Contact us anytime. Niederhuber JE.9:137–146 and 147–159. McKenna WG. Kastan MB. Kleinberg LR. SEER Cancer Statistics Review. Spechler SJ. Burmeister BH. Sharma P. Rosenberg SA. National Cancer Institute. No matter who you are. eds.org *Inclusion on this list does not imply endorsement by the American Cancer Society. Lichter AS. Cancer of the Esophagus. Enzinger PC. Shaheen NJ. eds. 2002. 2010. Philadelphia. Cancer Facts and Figures 2010. Overholt BF. Ga: American Cancer Society. Koshy M. Krapcho M. PA:Elsevier. American Joint Committee on Cancer. Lancet Oncology.6:659–668. NCCN Clinical Practice Guidelines in Oncology. Landry JC. 19752007. Esophageal cancer. Cancer of the Esophagus. 7th ed. et al. In: DeVita VT. Armitage JO. and esophageal cancer: scientific review. 2010:103–111. . N Engl J Med. V. day or night.org. Accessed at www. 2003. et al. for information and support.1.canceradvocacy. Hellman S. Esophageal Cancer. Jagannath SB.cancer.orders Web site: www. posted to the SEER web site. Shaheen N. 2010 Posner MC. Minsky B. The Oncologist. Ransohoff DF. Clinical Oncology. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. American Cancer Society.55:334–351. Multiple management modalities in esophageal cancer. Barrett's esophagus. AJCC Cancer Staging Manual.cancer. Gebski V. 2004.349:2241–2252. based on November 2009 SEER data submission. 2005. 2009 May 28. New Engl J Med. MD. Concepts in the prevention of adenocarcinoma of the distal esophagus and proximal stomach. NY: Springer. Atlanta. Cancer: Principles and Practice of Oncology. 287:1972–1981. et al (eds).360(22):2277-88. Bethesda.gov/csr/1975_2007/. CA Cancer J Clin. Esiashvilli N. 2010. New York. 2005. Forastiere AA. In: Abeloff MD.2010. we can help. References Altekruse SF. Ilson DH. Souza RF. Smithers BM. Brock MV.nccn. Gastroesophageal reflux. http://seer.

Komaki RK. Weichselbaum RR. eds. Frei E. Bast RC. Pollock RE. Ajani JA.Swisher SG. Neoplasms of the Esophagus. 6th ed. Hamilton. Cancer Medicine. In: Kufe DW. 2003:1499–1514. Ont: BC Decker. Ferguson MK. Holland JF. Gansler TS. Last Medical Review: 6/4/2010 Last Revised: 8/20/2010 2010 Copyright American Cancer Society .