Esophageal Cancer

Esophageal cancer occurs when the cells of the tissues forming the esophagus (the tube connecting the throat to the stomach) begin to grow uncontrollably. The excess cells accumulate as tumors anywhere in the esophagus, although they are most frequently found in the inner lining.

Based on their characteristics and location, esophageal cancers can be classified into two types:

• Squamous cell carcinoma: the most common type. It originates in the thin, flat cells of the inner esophageal lining, usually in the upper or middle esophagus, and is more frequently associated with tobacco and alcohol consumption.
• Adenocarcinoma: develops in glandular cells responsible for secreting mucus to lubricate food, facilitate swallowing, and protect the esophagus from stomach acids. It typically occurs in the lower part of the esophagus near the junction with the stomach and is closely associated with chronic gastroesophageal reflux and Barrett’s esophagus.

Esophageal cancer is relatively uncommon in Spain and in Western countries overall, though it ranks seventh in global incidence due to higher prevalence in Asia and Africa. It significantly reduces life expectancy, with an estimated five-year survival rate of 22%. However, early-stage localized detection can increase this rate up to 48%.

Symptoms

Esophageal cancer is often asymptomatic in its early stages, making early detection challenging. When symptoms appear in more advanced stages, the most notable include:

• Regurgitation: food rises from the stomach to the pharynx without nausea or effort.
• Dysphagia: difficulty swallowing.
• Unexplained weight loss.
• Hoarseness: due to nerve involvement.
• Cough.
• Chest pain.
• Heartburn.
• Indigestion.
• Esophageal obstruction.
• Vomiting.

Causes

Esophageal cancer arises from changes in the DNA of esophageal cells. These alterations cause cells to multiply excessively and survive longer than normal healthy cells. The resulting accumulation of malignant cells forms tumors.

Risk Factors

The risk of developing esophageal cancer is higher in individuals with the following factors:

• Tobacco use.
• Excessive alcohol consumption.
• Consumption of very hot liquids.
• Gastroesophageal reflux: the lower esophageal sphincter does not function properly, allowing stomach acids to return to the esophagus.
• Chronic hiatal hernia: part of the stomach protrudes into the chest through the diaphragm.
• Barrett’s esophagus: the esophageal lining is damaged due to chronic reflux. Squamous cells acquire columnar cell characteristics similar to those of other organs, such as the intestine.
• Plummer-Vinson syndrome: tissue webs form in the upper esophagus, potentially obstructing the tube and increasing susceptibility to malignancy.
• Achalasia: esophageal muscle fibers fail to relax, impeding swallowing.
• Low intake of fruits and vegetables.
• Obesity.

Complications

The most frequent complication of esophageal cancer is metastasis, meaning the spread of tumors to other parts of the body. Common sites include nearby lymph nodes, pleura, lungs, or liver.

Patients with esophageal cancer may also present:

• Esophageal obstruction, preventing the ingestion of food or liquids.
• Bleeding, which may be gradual or, occasionally, sudden.
• Aspiration pneumonia: improperly swallowed food may enter the lungs, causing infection.

Prevention

Although esophageal cancer cannot always be prevented, the following measures may reduce risk:

• Avoid smoking.
• Limit alcohol consumption.
• Maintain a healthy weight.
• Engage in regular physical activity.
• Consume a diet rich in fruits and vegetables.
• Attend regular health check-ups, especially with a family history of cancer.

Which Specialist Treats Esophageal Cancer?

Medical Oncology and Radiation Oncology primarily diagnose and treat esophageal cancer. Gastroenterology and general and digestive system surgery also participate in patient management.