Esophageal Cancer (Cancer of the Esophagus)

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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What are the symptoms and signs of esophageal cancer?

Esophageal cancer tends not to be associated with symptoms until it grows large enough to narrow the esophagus and make it difficult for food to pass. This also means there is time and opportunity for the cancer to grow beyond the esophagus and spread (metastasize) either to surrounding tissues or to distant parts of the body before it is discovered.

Esophageal Cancer Symptoms

The first symptom of esophageal cancer is almost always dysphagia (dys=abnormal + phagia=swallowing). Initially there may be difficulty swallowing solid foods, but symptoms worsen so there may also problems swallowing liquids.

Patients with esophageal cancer also can present with unexplained weight loss which occurs in more than half of patients. Esophageal cancers bleed and may cause vomiting of blood or black, tarry stools. Pain from esophageal cancer can be felt in the lower chest or upper abdomen. If the cancer has spread there may be pain in other places around the chest or back.

Patients may experience voice hoarseness due to vocal cord damage caused by reflux of stomach acid into the throat. As the tumor grows, it may cause nerve damage. The cancer can affect the recurrent laryngeal nerve that helps control the vocal cords. The nerve runs close to the esophagus, so if cancer spreads to the nerve, it means the cancer has grown beyond the esophagus wall.

Esophageal Cancer Signs

Physical examination may not be helpful in making the diagnosis; the esophagus is hidden within the chest cavity and not easily evaluated by physical examination. That is the reason why patient history is so important in making the diagnosis and all complaints of difficulty swallowing should be taken seriously.

If the cancer has metastasized beyond the esophagus, there may be abnormal lymph nodes palpable in the neck below the jaw or above the clavicles (collarbones). If cancer has spread to the liver, the liver may become enlarged and may be palpated on examination of the abdomen.

How is esophageal cancer diagnosed?

The diagnosis of esophageal cancer is made by endoscopy and biopsy.

When symptoms of difficulty swallowing (dysphagia) occur, a gastroenterologist can do a procedure called an endoscopy where the patient swallows a flexible tube with an attached camera and the doctor can look at the full length of the esophagus, the stomach, and the first part of the intestine (duodenum). If a mass or tumor is seen in the esophagus, the gastroenterologist has the ability to take a sample of tissue (biopsy) through the same tube. The patient is usually sedated for endoscopy.

The tissue biopsy is examined by a pathologist using a microscope and the clinical diagnosis is then confirmed.

Medically Reviewed by a Doctor on 11/6/2015

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