Cancer, Esophagus

Risk: Cancer of the esophagus is found more often in men then women, with blacks having a rate 2 times that of non-Hispanic white men ("Overview"). Cancer of the esophagus has been linked with prolonged tobacco and alcohol use; the likelihood of this disease increases with age with most of those afflicted being over 60 (Patti). Barrett's esophagus, chemicals used in the dry cleaning industry (especially perchloroethylene), and ingestion of lye are all risk factors for esophageal cancer.

Incidence and Prevalence: In the U.S in 2004 there were 14,250 new cases of esophagus cancer ("Detailed Guide").

History: Squamous cell carcinoma is found most often in tobacco users (smokers or users of smokeless tobacco), heavy drinkers, or from a caustic substance swallowed into the esophagus; while adenocarcinoma results from repeated reflux of stomach contents into the esophagus. The individual may complain of difficulty in swallowing (dysphagia) or pain during swallowing. Swallowing difficulty usually occurs with solid foods, but as the disease progresses, this problem may occur with swallowing liquids as well. There is usually rapid and progressive weight loss, poor appetite, pain with swallowing, fatigue, gastrointestinal bleeding, chronic cough, vomiting, chest pain, black stools, and often hoarseness.

Physical exam: The exam is rarely helpful in diagnosing esophageal cancer. Enlarged lymph nodes in the neck or fluid collection in the chest or abdomen may be found late in the disease. Direct observation of the upper gastrointestinal tract using a flexible optical instrument (endoscope) may reveal a growth on the walls of the esophagus.

Tests: A complete blood count (CBC) may be done to determine if the individual has low amounts of hemoglobin in the blood (anemia). Liver function tests (SGOT, alkaline phosphatase, and bilirubin) may be performed to determine if the cancer has metastasized to the liver. The esophagus may be visualized by x-ray after swallowing an opaque dye (barium swallow x-ray) or by using an endoscope (endoscopy). Both of these tests may discern the location of the tumor and the degree of obstruction within the esophagus. Also, during endoscopy, a biopsy of the tumor can be performed followed by microscopic examination of the tissue to determine if it is cancerous. An endoscopic examination of the upper respiratory tract (bronchoscopy) may determine if the tumor has spread into the upper airways. High-frequency sound waves (endoscopic ultrasound) may be used in the early stages of the disease to determine how deep the tumor has spread into the esophageal tissue. The degree of metastasis can also be determined using harmless, low-energy radio waves (MRI) or computer analysis of x-ray data (CT).