A National Cancer Institute-designated Comprehensive Cancer Center

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Esophageal Cancer

Esophageal Cancer
At City of Hope, novel therapies, advanced technologies and an aggressive, multidisciplinary approach to treatment combine to give patients with esophageal cancer the best hope possible.

Through our active clinical trials research program – one of the most extensive in the nation – we can often provide patients with access to promising new anticancer drugs and technologies not available elsewhere.
 
About Esophageal Cancer
 
Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus.
 
The esophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach. The wall of the esophagus is made up of several layers of tissue, including mucous membrane, muscle, and connective tissue. Esophageal cancer starts at the inside lining of the esophagus and spreads outward through the other layers as it grows.
 
The two most common forms of esophageal cancer are named for the type of cells that become malignant (cancerous):
 
  • Squamous cell carcinoma: Cancer that forms in squamous cells, the thin, flat cells lining the esophagus. This cancer is most often found in the upper and middle part of the esophagus, but can occur anywhere along the esophagus. This is also called epidermoid carcinoma.
  • Adenocarcinoma: Cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the esophagus produce and release fluids such as mucus. Adenocarcinomas usually form in the lower part of the esophagus, near the stomach.

Recurrent Esophageal Cancer
Recurrent esophageal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the esophagus or in other parts of the body.
 
Esophageal Cancer Risk Factors and Symptoms
 
Risk Factors

Certain factors increase a person’s risk of developing cancer of the esophagus. According to the American Cancer Society, some of these factors include:
 
  • Older age
  • Male gender
  • African-American background
  • Tobacco use
  • Heavy alcohol use
  • Gastroesophageal reflux disease (GERD)
  • Barrett’s esophagus (often associated with GERD)
  • Occupational exposure to solvents and other chemicals

Symptoms
 
  • Early esophageal cancer usually does not cause symptoms. However, as the cancer grows, symptoms may include:
  • Difficult or painful swallowing
  • Severe weight loss
  • Pain in the throat or back, behind the breastbone or between the shoulder blades
  • Hoarseness or chronic cough
  • Vomiting
  • Coughing up blood

How We Diagnose Esophageal Cancer

Diagnostic tests are needed to determine whether symptoms are, in fact, esophageal cancer. If cancer is found, additional tests may be used to assess the stage of the disease, specifically, how advanced the cancer is, and whether it has metastasized (spread outside the esophagus).

City of Hope diagnostic and staging tests include:
 
  • Chest X-ray:  Rays of energy that can pass through organs and bones inside the chest are used to expose film, making an image of areas within the body.
 
  • Barium swallow/Upper GI series: A series of X-rays is taken after the patient drinks a liquid to improve the visualization of the inside of the upper gastrointestinal tract.
 
  • Esophagoscopy: Doctors examine the esophagus directly using an esophagoscope (a thin, lighted tube). Sometimes, tissue samples are taken for a biopsy.
 
  • Bronchoscopy: A thin, lighted tube called a bronchoscope is inserted through the nose or mouth into the trachea and lungs. Tissue samples may be taken for a biopsy.
 
  • Laryngoscopy: The larynx (voice box) is examined using a mirror or a thin, lighted tube called a laryngoscope.
 
  • Endoscopic ultrasound: A thin, lighted tube called an endoscope is guided into the esophagus. The device emits ultrasound waves that create images of structures inside the esophagus.
 
  • Thoracoscopy: This procedure is used in staging. An incision is made between two ribs, and a thin, lighted tube called a thoracoscope is inserted into the chest. Tissue samples and lymph nodes may be removed for biopsy.
 
  • Laparoscopy: This surgical staging procedure is used to examine internal organs. An incision is made in the abdominal wall and a thin, lighted tube called laparoscope is inserted into the abdomen. Tissue samples and lymph nodes may be removed for biopsy.
 
  • CT or CAT (computerized axial tomography) scan: This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.
 
  • PET (positron emission tomography) scan: PET is used to identify malignant cells. First, a small amount of radionuclide glucose (sugar) is injected into a vein, and then the scan begins. Cancer cells take up more glucose than normal cells and appear brighter in the scan.
 

Esophageal Cancer Treatment Approaches

Esophageal cancer is often in an advanced stage when it is diagnosed, requiring rapid intervention by a group of specialists experienced in treating the disease.

The multidisciplinary team at City of Hope includes medical experts from the departments of Thoracic Surgery , Surgical Oncology , Medical Oncology , Radiation Oncology , and Plastic Surgery , as well as occupational therapists, speech pathologists, nutritionists, dentists, nurses and social workers.

Working together, our team has developed a treatment approach tailored to the patient that is achieving outstanding results.
 

Surgery to remove affected tissue is often part of a patient’s treatment plan. At City of Hope, specialty trained surgeons in chest surgery, ear, nose and throat, surgical oncology, and plastic and reconstructive surgery are experienced in procedures that offer patients excellent long-term survival rates.

Many different surgical procedures are used in treating esophageal cancer. A surgeon will discuss the best options. Sometimes, surgery is needed to relieve difficulty in swallowing. Certain patients may require an esophagectomy, the surgical removal of all or part of the esophagus, as well as part of the stomach, and reconnecting them.

Chemotherapy

Chemotherapy – the use of anticancer medicines – includes a wide range of drugs and treatment strategies to treat primary and metastatic esophageal cancer. City of Hope provides both standard chemotherapies as well as access to newly developed drugs through an extensive program of clinical trials.

As part of the treatment team, a medical oncologist will evaluate the best options, so that a course of chemotherapy, if appropriate, can be tailored to the patient.

Currently, researchers at City of Hope are testing new “neoadjuvant” strategies in which drugs are given prior to surgery to shrink esophageal cancers.

Radiation therapy uses energy beams to kill cancer cells. Specialists in the Department of Radiation Oncology have developed highly accurate new treatments that maximize the delivery of radiation to malignant cells while minimizing unnecessary exposure of healthy tissues. Therapeutic procedures include:
 
 
 
 

Resources

All of our patients have access to the Sheri & Les Biller Patient and Family Resource Center which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
 
Additional Resources
800-ACS-2345
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
 
The National Comprehensive Cancer Network, an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.
 
National Cancer Institute (NCI)
800-4-CANCER
The National cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
 
301-496-4000
301-402-9612 for TYY
The National Institutes of Health (NIH) is one of the world's foremost medical research centers, and the federal focal point for medical research in the United States. The NIH, comprising 27 separate institutes and centers, is one of eight health agencies of the Public Health Service, which, in turn, is part of the U.S. Department of Health & Human Services.

Esophageal Cancer Research/Clinical Trials

City of Hope has long been a leader in cancer research. As an organization specializing in treating cancer patients, our doctors, nurses and other medical professionals have the in-depth experience that makes a difference in cancer diagnosis and care. We also work to bring the latest scientific findings into clinical practice as quickly as possible. With our extensive program of clinical trials, patients at City of Hope have access to new treatments that are not yet available elsewhere.
 
To learn more about our clinical trials program and specifically for clinical trials for esophageal cancer, click here.
 

Esophageal Cancer Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Joe Komsky
Senior Director
Phone: 213-241-7293
Email: jkomsky@coh.org

 
 
All About Esophageal Cancer
Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus. Download brochure >>
Treatments and Clinics
A national leader in cancer treatment and prevention, City of Hope is steadfast in its drive to offer more positive outcomes to patients everywhere. Our research innovations become advances in patient care without delay, because people fighting cancer need better options – now.

To make an appointment for yourself, a family member or a friend, please complete and submit our Become a Patient Request Form, or call City of Hope at
800-826-HOPE (4673).
The Sheri & Les Biller Patient and Family Resource Center embodies the heart and soul of City of Hope’s mission to care for the whole person.
Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials.
 
Situated just northeast of Los Angeles, City of Hope combines the best science and the most innovative and highly compassionate patient care. Stretched across more than 100 acres in the City of Duarte, lushly landscaped gardens surround state-of-the-art facilities.
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