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.
Because adenocarcinoma of the esophagus may be related to chronic gastroesophageal reflux disease, symptoms of GERD may also be present, including heartburn and indigestion.
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. Sometimes the bleeding can be microscopic and not seen by the naked eye. The patient may experience weakness due to low red blood cell count, and because it is due to blood loss, it is most often an iron-deficiency anemia.
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.