NewYork-Presbyterian. The University Hospital of Columbia and Cornell.

Digestive Diseases

Esophageal Cancer

Back to the nypdigestive.org Home Page

About Esophageal Cancer

Esophageal cancer is cancer that develops in the esophagus, the muscular tube connecting the throat and the stomach. Each year, over 15,500 Americans are diagnosed with esophageal cancer.

Two Types of Esophageal Cancer:

• Squamous Cell Carcinoma
• Adenocarcinoma

Esophageal cancer is divided into two types: squamous cell carcinoma and adenocarcinoma. In the past, squamous cell carcinoma accounted for about 90% of all cases of esophageal cancer, but the incidence of adenocarcinoma has risen steeply in the past 20 years as squamous cell carcinoma cases have fallen, so that adenocarcinoma is now more prevalent in the United States and Western Europe. Squamous cell carcinoma is usually diagnosed in the upper and middle esophagus, whereas adenocarcinoma is most often found in the lower part of the esophagus, near the stomach.

There are a number of hypotheses for the rise in adenocarcinoma. First, the rise in rates of obesity seems to correlate with growing numbers of adenocarcinoma. Another hypothesis is that the declining prevalence of the H. pylori bacterial infection in Western countries may be linked with the rise in adenocarcinoma. The theory is that infection with helicobacter pylori bacteria (H. pylori bacteria) in the stomach may actually protect against esophageal adenocarcinoma. A third hypothesis is that esophageal sphincter-relaxing (LES) drugs are contributing to the rise of esophageal adenocarcinoma. These drugs include calcium channel blockers, tricyclic antidepressants, and certain asthma medications.

Symptoms of Esophageal Cancer

The most common signs of esophageal cancer are pain or difficulty when swallowing, a painful or sore throat, and weight loss. Hoarseness or cough, indigestion and heartburn may also be present. Some individuals may also experience pain behind the breastbone.

Risk Factors for Esophageal Cancer

Smoking, heavy and/or long-term alcohol use, malnutrition, the presence of long-standing gastroesophageal reflux disease (GERD) and/or Barrett's esophagus are major risk factors for esophageal cancer. Infection with the human papillomavirus (HPV) may also be a risk factor.

Men have a three-times higher risk of esophageal cancer than women, and black males are at higher risk for squamous cell carcinoma than white males. Obesity is thought to be a risk factor for adenocarcinoma and may in part account for the steep rise in recent decades of this type of esophageal cancer.

Diagnosis of Esophageal Cancer

To determine whether a patient has esophageal cancer, our team performs a number of tests, including a chest x-ray, a barium swallow, and an esophagoscopy. For a barium swallow, patients drink a liquid barium solution, and as it flows through the esophagus and into the stomach, x-rays are taken to check for abnormalities. In esophagoscopy, a thin, lighted tube, or esophagoscope (an endoscope) is inserted through the mouth or nose into the throat and esophagus while the patient is given a local anesthetic. Small tissue biopsies can be taken through the scope, which our pathologists analyze to determine the type and stage of cancer.

To help identify precancerous areas, or dysplasias (abnormal cells), and early-stage cancer in patients with Barrett's esophagus, our physicians are employing new diagnostic techniques in addition to upper gastrointestinal endoscopy to closely examine the esophagus. These techniques include narrow band imaging and capsule endoscopy (camera pill). In narrow band imaging, physicians use a modified blue light to examine the esophagus with a special endoscope to obtain extremely detailed views of the esophagus. In capsule endoscopy, patients swallow a "pill" that is actually a tiny camera, which takes pictures of the esophagus and upper stomach as it travels downward. It is later excreted.

Treatment for Esophageal Cancer

Our interdisciplinary team of surgeons, and radiation and medical oncologists treat a large number of patients with esophageal cancer each year. Surgical techniques pioneered here at NewYork-Presbyterian have produced some of the world's highest cure rates. We use minimally invasive techniques whenever possible, to treat patients effectively and with the fewest side-effects. Our thoracic surgeons are also spearheading the use of robotic technologies to improve minimally invasive surgical outcomes.

Esophageal cancer is usually treated with surgery, radiation, and chemotherapy.

Surgery for Esophageal Cancer

Our surgeons treat patients with very early cancer with endoscopic mucosal resection (EMR), in which the diseased part of the lining of the esophagus is removed during an endoscopic procedure.

To open up esophageal blockages or treat small, shallow tumors in patients who cannot tolerate open surgery we use photodynamic therapy (PDT). In PDT, a drug, called a photosensitizer is administered intravenously and preferentially absorbed by cancer cells over a few days. Using an endoscope, we then expose the lesion to a certain wavelength of light which causes an active form of oxygen to be produced. This directly kills the cancer cells and also acts indirectly to damage the tumor's blood vessels, further destroying the cancer while and limiting damage to surrounding healthy tissue. PDT cannot be used for large or deep tumors. Risks include light sensitivity for about six weeks after treatment, trouble swallowing after treatment, swelling, pain or scarring in healthy tissue.

Surgeons may also place a stent in the esophagus to open up any blockage and enable more comfortable swallowing.

Our surgeons generally treat lower esophageal cancer, especially when it is in the earliest stages, with laparoscopic esophagectomy rather than more traditional surgery to remove a diseased lower esophagus. This technique, developed at NewYork-Presbyterian, is minimally invasive and results in shorter recovery time, a smaller incision and scar, fewer risks associated with open surgery, and better overall results.

Radiation for Esophageal Cancer

Our radiation oncologists offer the most up-to-date, minimally invasive therapies for patients with esophageal cancer, including the placement of small catheters threaded to the site of the tumor to deliver a high, pinpointed dose of radiation. This technique, called brachytherapy, destroys cancer cells while limiting damage to the surrounding healthy tissue. We also employ radiation therapy to relieve symptoms, such as an inability to swallow solid foods.

Chemotherapy for Esophageal Cancer

Our medical oncology team may administer chemotherapy before surgery to reduce the size of the tumor and enable surgeons to remove more of the cancer. Similarly, we often combine chemotherapy with radiation therapy, to shrink the cancer before surgery.

Research for Esophageal Cancer

Our research efforts focus on the use of radiation and chemotherapy before surgery to reduce tumor size. We also focus on the causes of Barrett's esophagus, its progression to esophageal cancer, and what chemopreventive strategies may be effective in preventing this progression.