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Esophagus Cancer

Cancer of the esophagus, otherwise called esophageal cancer, is an aggressive disease that most often requires a combination of different forms of therapy. The esophagus is a hollow, muscular tube that begins in the throat and ends at the stomach. Food and liquid that are swallowed travel through the inside of the esophagus to reach the stomach. Esophageal cancer arises from the cells that line the inside of the esophagus. Esophageal cancer can occur anywhere along the entire length of the esophagus, however the commonest area of occurrence in the United States is in the lower esophagus. The two most common types of esophageal cancer are adenocarcinoma and squamous cell carcinoma. Rarely, sarcomas or gastrointestinal stromal tumors (GIST) arise in the esophagus.

Diagnosis

Signs and symptoms of esophageal cancer include but are not limited to:

  • Difficulty swallowing liquids or solids
  • Losing weight without trying
  • Fatigue

Risk Factors

Risk factors for esophageal cancer include but are not limited to:

  • Barrett's esophagus - A precancerous condition that increases your risk of esophageal cancer, which is associated with severe or long-standing Gastroesophageal reflux disease (GERD).
  • Heavy alcohol consumption
  • Smoking
  • Obesity
  • Achalasia - A rare disease in which the nerve cells within the esophageal wall do not function properly. As a result, the lower end of the esophagus does not relax and the remainder of the organ becomes massively dilated, allowing contents to collect for abnormally long periods of time. 
  • Esophageal injury - Those with a history of lye or chemical injury to the esophagus are at increased risk for esophageal cancer. Cancer may develop many years after the injury.

Treatment

As esophageal cancer is an aggressive type of tumor, we often recommend multimodality therapy or a combination of therapies including surgery, chemotherapy, and/or radiation therapy. Surgery is often recommended alone or in combination with other treatments if the tumor is confined to the superficial layers of your esophagus and hasn't spread to other areas of your body. The operation performed to remove a portion or all of the esophagus is call an esophagectomy, which we perform with minimally invasive techniques when appropriate.

Your surgical oncologist removes the portion of the esophagus with or without the stomach, along with surrounding lymph nodes. A reconstruction is then performed. Your staging evaluation prior to surgery, which often includes CT scans and endoscopic procedures, will guide your cancer team in determining the most appropriate course or treatment.

Our gastroenterologists have expertise in performing endoscopic ultrasonography (EUS), which allows us to determine the degree to which the tumor has penetrated the stomach wall. The recommendation to use surgery in combination with chemotherapy and/or radiation will be made after discussion of your case in a conference attended by surgeons, medical oncologists, and radiation oncologists.