• Esophageal Submucosal Lesions
• Esophageal Cancer
• Barrett's Esophagus
• Celiac Disease
• Gastric Malignancies
• GERD
• Non-Cancerous Stomach Conditions

What is esophageal cancer?

The esophagus functions as a conduit for food once it is chewed and swallowed. Esophageal cancer is a malignant tumor of the esophagus. There are two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. Barrett's esophagus is a precursor condition to esophageal carcinoma -- specifically, adenocarcinoma.

What symptoms are associated with this condition?

Esophageal cancer can be associated with a variety of symptoms, including:

• Difficulty swallowing solid or liquid materials (dysphagia)
• Indigestion
• Heartburn
• Vomiting of blood
• Chest pain/discomfort
• Regurgitation of food
• Weight loss
• Anemia (low blood count)

How is esophageal cancer diagnosed?

Esophageal cancer can be diagnosed by your gastroenterologist using the following tests:

• Barium swallow - this test involves swallowing a liquid that can be seen on x-rays as it goes down the esophagus.
• Chest CT scan - this test involves a radiologist taking an image of the esophagus and chest to visualize the tumor and also look for evidence of cancer spread.
• Esophagogastroduodenoscopy (EGD) - a gastroenterologist uses a fiber optic instrument (scope) to directly visualize the inside of the esophagus and take tissue samples of any abnormal areas.
• Endoscopic ultrasound - this test is used to determine the depth of invasion of the cancer and to see if there is spread of the disease to other places in the chest (see below).
• PET scan - a radiologic study used to help stage esophageal cancer.
• Probe-based confocal endomicroscopy - Live endoscopic microscopy performed to assess the cells within the wall of the esophagus.

What other testing and treatments are available?

Endoscopic ultrasound (EUS)

Endoscopic ultrasound (EUS) is increasingly employed to help assess and stage esophageal cancer. This test is used to take a detailed look at the different layers of the esophagus and to determine how deep the cancer has penetrated. It is accomplished via an endoscope, just like routine upper endoscopy (EGD). The difference is an ultrasound probe present at the tip of the scope. The test is used to help visualize the tumor, determine its depth, and look for evidence of disease spread to the lymph nodes or invasion into surrounding organs or vessels. EUS can provide much additional information about the esophageal cancer and aid the planning of surgery, chemotherapy, and radiation treatment. If abnormal lymph nodes are seen, they can be sampled and sent to a pathologist to determine if they contain cancerous cells. (See EUS-FNA of mediastinal lymph nodes.)

Endoscopic mucosal resection (EMR)

Endoscopic mucosal resection (EMR) is a technique to remove small superficial cancers. Prior to EMR, your gastroenterologist can perform endoscopic ultrasound to be certain the cancer is superficial. These decisions are also made in conjunction with a thoracic surgeon.

Removal of the superficial cancer with the EMR technique is accomplished by placing a small rubber band around the tissue after it has been suctioned into a cap at the end of the endoscope. Once the area of concern has been banded, a "snare" is inserted and closed around the tissue. Electrocautery (heat) is then applied through the metal snare to cut the tissue out of the esophagus. The area is then allowed to heal, and in a few weeks, it is re-inspected with upper endoscopy and biopsies taken from the treated area to ensure complete removal of the abnormal tissue has been accomplished.

Cryotherapy

Our center offers cryotherapy, a new endoscopic procedure used to help treat superficial cancers that cannot be removed endoscopically and/or in patients who cannot have surgery. Cryotherapy involves the use of a super-cooled liquid or gas to freeze abnormal (dysplastic) cells found within Barrett's esophagus. Many studies remain to be done on the long-term efficacy of cryotherapy in the treatment of superficial cancers. In some cases, cryotherapy can be used to help treat bleeding from esophageal tumors.

Esophageal stenting

In some patients, the esophageal tumor can prevent the swallowing of solid and/or liquid foods. In these cases, esophageal stenting can be performed. It involves the use of an endoscope and x-rays to help place a metal stent across the esophageal tumor and helps to force the tumor up against the wall of the esophagus. The stent has a hollow center that permits the passage of pureed foods and liquids into the stomach so the patient can still eat and get nutrition. The placement of a stent does not interfere with the patient's ability to have chemotherapy or radiation treatment. In some cases, the stent can later be removed if the disease responds to therapy.

For more about these procedures, visit the Advanced Interventional Endoscopy page.

Surgical resection

Surgical removal of esophageal cancer remains a major treatment option. Depending on the stage of the cancer, chemotherapy or radiation therapy may be used prior to surgery. In these circumstances, your doctor may have you see a thoracic surgeon to consider minimally invasive surgery or more comprehensive surgery to remove a portion (or all) of the esophagus (esophagectomy). Our thoracic surgeons are highly skilled in the full range of surgical techniques.

How can I make an appointment to see an advanced endoscopist?

Our specialists are experienced in diagnosing and treating esophageal disorders. An interdisciplinary team of gastrointestinal specialists in endoscopy, radiology, and surgery work together as a team to provide each patient with coordinated, advanced, and individualized care. Please contact our Advanced Interventional Endoscopy team to discuss your case.