Description
Esophageal cancer is a malignant tumour that begins in cells lining the esophagus, the muscular tube that carries food from the throat to the stomach. Early disease may cause no obvious symptoms. As the tumour grows, patients often first have difficulty swallowing solid food and may later struggle with liquids.
The two main types are squamous cell carcinoma and adenocarcinoma. Smoking and alcohol use are associated with squamous cell carcinoma, while long-term acid reflux, Barrett’s esophagus and obesity are more closely linked to adenocarcinoma. Persistent difficulty swallowing, painful swallowing or unexplained weight loss should be assessed promptly with upper endoscopy.
Types
Esophageal Squamous Cell Carcinoma: Begins in the squamous cells lining the esophagus and more commonly develops in the upper or middle part.
Esophageal Adenocarcinoma: Usually occurs in the lower esophagus or at the gastroesophageal junction and is often associated with Barrett’s esophagus and long-term reflux.
Other Rare Types: Include small cell carcinoma, lymphoma, sarcoma and melanoma
Stages
Esophageal cancer is staged from 0 to IV using the TNM system. The stage considers depth of tumour invasion, lymph nodes, distant spread, tumour location and pathological type.
Stage 0: Abnormal cells are confined to the most superficial layer and have not invaded deeper tissue.
Stage I: The tumour is limited to the shallower layers of the esophagus, with no or limited lymph node involvement.
Stages II–III: The tumour has grown more deeply into the esophageal wall or nearby structures and may involve regional lymph nodes.
Stage IV: Cancer has spread to distant organs such as the liver, lungs or bones.
Risk Factors
The following factors may increase the risk, but having one or more risk factors does not mean that a person will develop cancer:
Smoking and long-term heavy alcohol consumption
Chronic gastroesophageal reflux disease and Barrett’s esophagus
Obesity, particularly in relation to adenocarcinoma
Frequently drinking very hot beverages
A diet low in fruit and vegetables or poor nutrition
Achalasia or long-term injury to the esophagus
Previous radiation treatment to the chest or upper abdomen
Increasing age
Symptoms
Early disease may not cause obvious symptoms. Medical evaluation is recommended when any of the following symptoms persist, recur, or gradually worsen:
Difficulty swallowing, often beginning with solid food
Painful swallowing or a sensation that food is stuck
Unexplained weight loss
Pain, burning or pressure behind the breastbone
Persistent hoarseness or cough
Worsening reflux, vomiting or indigestion
Vomiting blood or passing black stools
Persistent fatigue, which may be related to anaemia
Diagnosis
Diagnosis usually combines medical history, physical examination, imaging, laboratory tests, and pathology. The exact tests are selected by the doctor according to the individual case.
Endoscopic Examination
Upper gastrointestinal endoscopy to inspect the esophagus directly
Biopsy for pathological confirmation
Local Staging
Endoscopic ultrasound to assess invasion depth and nearby lymph nodes
Imaging
Contrast-enhanced CT and PET-CT to assess lymph nodes and distant spread
Bronchoscopy or MRI when indicated
Other Assessment
Nutritional status, heart and lung function, and overall health assessment
HER2, PD-L1 or other biomarker testing in selected cases
Facts (FAQ)
Q: Does difficulty swallowing always mean esophageal cancer?
A: No. Reflux, narrowing and motility disorders can also cause difficulty swallowing, but persistent or worsening symptoms must be investigated.
Q: Does early esophageal cancer cause symptoms?
A: It may cause no obvious symptoms, which is why some patients already have more advanced disease when swallowing problems begin.
Q: Can acid reflux become esophageal cancer?
A: Most people with reflux do not develop cancer. However, long-term reflux can lead to Barrett’s esophagus, which increases the risk of adenocarcinoma.
Q: Can endoscopy confirm esophageal cancer?
A: Endoscopy can identify a suspicious lesion, but biopsy and pathological examination are required for confirmation.
Q: Can esophageal cancer be cured?
A: Localised esophageal cancer may be treated with curative intent. The chance of cure depends on stage, location, pathological type and general health.
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*Disclaimer: The effect of treatment varies from person to person. The information on the website of Modern Cancer Hospital Guangzhou is for reference only, and cannot be used as the basis for medical diagnosis and treatment, nor can it replace the doctor's diagnosis and treatment. For more details, please review the Liability Clause.
