Esophageal Cancer
(Cancer of the Esophagus)
Esophageal Cancer Linked to Heartburn
Medical Revising Editor: Jay W. Marks, MD
Esophageal cancer is the eighth most common type of cancer and
causes 12,000 deaths per year in the U.S. (2% of all cancer
deaths). One type of esophageal cancer, adenocarcinoma, accounts
for 50% of esophageal cancers and occurs primarily in Caucasian men.
The incidence of adenocarcinoma and deaths from esophageal cancer
have been increasing steadily in the U.S. and western Europe.
Gastroesophageal reflux disease(GERD), in
which acid refluxes from the stomach into the esophagus (known primarily for causing
heartburn) is a condition that afflicts 20% of the populations of the
U.S. and western Europe.
It has been
hypothesized that GERD is an important cause of adenocarcinoma of the esophagus.
Specifically, the hypothesis is that chronic reflux of acid
into the esophagus causes changes in the cells lining the lower esophagus--changes
that are referred to as Barrett's esophagus--that ultimately lead the
cells to become cancerous. It is estimated that ½ to
1% of patients with Barrett's esophagus develop adenocarcinoma each year they
are followed. (This means that during 20 years a patient
with Barrett's esophagus has a 10 to 20% risk of developing adenocarcinoma.) Therefore, it
has been recommended that patients with Barrett's esophagus
undergo regular and frequent endoscopy (every year)
and biopsy of the esophagus so that early malignant changes can
be detected and treated early before cancer spreads.
What is the esophagus?
The esophagus is in the chest. It's about 10 inches long.
This organ is part of the digestive tract. Food moves from the mouth through
the esophagus to the stomach.
The esophagus is a muscular tube. The wall of the esophagus has several
layers:
- Inner layer or lining (mucosa): The lining of the esophagus is moist so that
food can pass to the stomach.
- Submucosa: The glands in this layer make mucus. Mucus keeps the esophagus
moist.
- Muscle layer: The muscles push the food down to the stomach.
- Outer layer: The outer layer covers the esophagus.
Cancer Cells
Cancer begins in cells, the building blocks that make up tissues. Tissues
make up the organs of the body.
Normal cells grow and divide to form new cells as the body needs them. When
normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body does not
need them, and old or damaged cells do not die as they should. The buildup of
extra cells often forms a mass of tissue called a growth or tumor.
Growths in the wall of the esophagus can be benign (not cancer) or malignant
(cancer). The smooth inner wall may have an abnormal rough area, an area of tiny
bumps, or a tumor. Benign growths are not as harmful as malignant growths:
- Benign growths:
- are rarely a threat to life
- can be removed and probably won't
grow back
- don't invade the tissues around them
- don't spread to other parts of
the body
- Malignant growths:
- may be a threat to life sometimes
- can be removed but can
grow back
- can invade and damage nearby tissues and organs
- can spread to other
parts of the body
Esophageal cancer begins in cells in the inner layer of the
esophagus. Over time, the cancer may invade more deeply into the esophagus and
nearby tissues.
Cancer cells can spread by breaking away from the original tumor. They may
enter blood vessels or lymph vessels, which branch into all the tissues of the
body. The cancer cells may attach to other tissues and grow to form new tumors
that may damage those tissues. The spread of cancer cells is called metastasis.
See the Staging section for information about esophageal cancer that has spread.
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Esophageal Cancer - Prognosis
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