Esophageal cancer develops in the esophagus, the tube connecting the throat to the stomach. There are two main types: squamous cell carcinoma and adenocarcinoma. Risk factors include smoking, heavy alcohol use, gastroesophageal reflux disease, and Barrett's esophagus. Diagnosis involves endoscopy, biopsy, and imaging tests. Treatment depends on cancer stage and health but may include surgery, radiation, chemotherapy, targeted therapy, or palliative care. Prognosis ranges from 47% 5-year survival for localized cancer to 5% for distant stage cancer.

1. D R . S A Y E D M U D D A S I R S H A H
Esophageal cancers

3.  Esophageal cancer occurs when cancer cells develop
in the esophagus, a tube-like structure that runs
from your throat to your stomach. Food goes from
the mouth to the stomach through the esophagus.
The cancer starts at the inner layer of the esophagus
and can spread throughout the other layers of the
esophagus and to other parts of the body
(metastasis).

4.  There are two main types of esophageal cancer. One
type is squamous cell carcinoma. Squamous cells line
the inner esophagus, and cancer developing from
squamous cells can occur along the entire esophagus.
The other type is called adenocarcinoma. This
is cancer that develops from gland cells. To develop
adenocarcinoma of the esophagus, squamous cells
that normally line the esophagus are replaced by
gland cells. This typically occurs in the lower
esophagus near the stomach and is believed to be
largely related to acid exposure to the lower
esophagus.

5. Clinical presentation
 Early on there may be no symptoms. In more
advanced cancers, symptoms of esophageal cancer
include:
 Difficulty or pain when swallowing
 Weight loss
 Pain in the chest, behind the breastbone
 Coughing
 Hoarseness
 Indigestion and heartburn

6. Causes /Risk factors
 There are a number of factors which increase a person's risk of
developing esophageal cancer. They include:
 Smoking or other use of tobacco
 Heavy alcohol use
 Gastroesophageal reflux disease (GERD), in which contents
and acid from the stomach back up into the esophagus
 Barrett's esophagus, a condition that affects the lower part of
the esophagus and can lead to esophageal cancer; Barrett's
esophagus may be caused by GERD. Over time, stomach acid
in the esophagus can cause changes in the cells that increase
risk for adenocarcinoma.
 .

7. Risk factors
 In addition, certain groups -- men, the elderly, and
people who are obese -- are at greater risk for
esophageal cancer. Risk of adenocarcinoma of the
esophagus is higher in white men, but squamous cell
carcinoma of the esophagus is more common in
Asian men and men of color

8. diagnosis
 To diagnose esophageal cancer, your doctor will review
your symptoms, medical history, and examine you. In
addition, they may order certain blood tests and X-rays.
 Tests for esophageal cancer may include:
 Barium swallow X-ray, in which you drink a liquid
that coats your esophagus. This makes the esophagus
stand out on the X-ray so that your doctor can identify
certain problems.
 Endoscopy: the doctor passes an endoscope, a thin,
lighted tube, down your throat into your esophagus to
examine it. Endoscopic ultrasound uses sound waves to
provide more information about the extent of tumor
involvement in nearby tissues.

9. Diagnosis
 Biopsy: during an endoscopy, the doctor can take
cells or tissue from your esophagus. The cells are
examined under a microscope for the presence of
cancer.
 Other tests, including computed tomography (CT)
scans, positron emission tomography (PET) scan,
thoracoscopy, and laparoscopy, may be performed to
determine if the cancer has spread, or metastasized,
outside of the esophagus. This process is called
"staging." The doctor needs this information in order
to plan your treatment.

10. Staging
 The stages of esophageal cancer are given a number (I through IV); the
higher the number, the more advanced the cancer. The stages are:
 Stage 0. Abnormal cells (not yet cancer) are found only in the layer of cells
that line the esophagus.
 Stage I. Cancer cells are found only in the layer of cells that line the
esophagus.
 Stage II. The cancer has reached the muscle layer or the outer wall of the
esophagus. In addition, the cancer may have spread to 1 to 2 nearby lymph
nodes (small glands that are part of the immune system).
 Stage III. The cancer has reached deeper into the inner muscle layer or the
connective tissue wall. It may have spread beyond the esophagus into
surrounding organs and/or has spread to more lymph nodes near the
esophagus.
 Stage IV. This is the most advanced stage. The cancer has spread to other
organs in the body and/or to lymph nodes far from the esophagus.

11. How to stage the disease
 T here are several tests to determine the stage of esophageal cancer, including:
 Chest X-ray.
 Bronchoscopy. The trachea (windpipe) and airways are examined with a
bronchoscope, a thin, lighted tube that is inserted through the nose or mouth. This
test is used to check for cancer involvement in the trachea or branching airways.
 CT scan. A procedure that creates sharp pictures of the inside of the body.
 Endoscopic ultrasound, or endosonography. Used during endoscopy, sound
waves bounce off organs in the body to create pictures called sonograms. This test
can provide more information on the size and extent of the tumor.
 Thoracoscopy. An endoscope is placed into the chest through an incision to
examine the inside of the chest to look for lymph nodes and other chest organs that
may have cancer spread. Biopsies can be done during this procedure.
 Laparoscopy. The lighted tube is inserted through an incision in the abdomen to
examine the abdominal organs and take tissue samples to check for cancer spread.

12. Treatment
 As with many cancers, esophageal cancer
treatment has a greater chance of success if the
cancer is caught early. Unfortunately, by the time
esophageal cancer is diagnosed for many people, it is
often already in an advanced stage (has spread
throughout the esophagus and beyond).
 Treatment of esophageal cancer depends on many
factors, including the stage of the cancer and the
overall health of the patient.

13. Treatment
 Surgery. Part or all of the esophagus may be removed.
 Radiation therapy. Kills cancer cells with radiation.
 Chemotherapy. Powerful drugs that attack cancer cells
throughout the body; typically used in combination
with radiation therapy and/or surgery.
 Targeted therapy. Newer treatments that target specific
aspects of a cancer to curb cancer growth and spread.
 Immunotherapy. Helps the immune system to attack cancer
cells.
 Photodynamic therapy. Targets cancer cells with a special
laser light.
 Electrocoagulation. Uses electric current to destroy cancer
cells.
 Cryotherapy. Freezes cancer cells to help shrink a tumor.

14. Treatment
 Endoscopic mucosal resection may be done to treat
precancers or very small early cancers by removing
the inner lining of the esophagus. Radiofrequency
ablation treatment using a device that targets cancer
cells with radiofrequency energy is sometimes used
for early cancers.

15. Treatment on the basis of stage
 Treatment options for esophageal cancer by stage may
involve the following:
 Stage 0 . Options include surgery, photodynamic
therapy, radiofrequency ablation, or endoscopic mucosal
resection.
 Stage I, II, and III . Surgery, chemotherapy, radiation
 Stage IV . Chemotherapy, radiation, targeted therapy,
immunotherapy; treatment for this stage focuses on
"palliative" therapy. Palliative therapy is meant to relieve
the pain and difficulty swallowing caused by cancer.

16. Pognosis
 According to the American Cancer Society, the
percentages of people who live for at least five years
after being diagnosed with esophageal cancer (taking
into account that some people with esophageal
cancer will have other causes of death) is 47% for
localized cancer to the esophagus, 25% for cancer
that has spread regionally, and 5% with distant
cancer spread