WFUBMC Home

>

Comprehensive Cancer Center

>

Types of Cancer

>

Esophageal Cancer

>

index

The Wake Forest Baptist Approach Abdominal Cancer (Including Esophageal, Stomach, Colon, Rectal, and Pancreatic Cancers) Management of abdominal cancers focuses on preventive measures, early detection and treatment through numerous clinical trials developed locally, regionally and nationally. New drug and radiation therapies, and combined modality treatments, are being explored through these trials. Our surgical oncologists are pioneering a number of innovative treatments including: Head and Neck Cancer With the incidence of head and neck tumors at twice the national average in our region, the Head and Neck Cancer Program is of prime importance.  A multidisciplinary physician team meets regularly to evaluate cases. Each new patient is evaluated by the appropriate clinicians (surgeons, medical and radiation oncologists), and a treatment plan is recommended to the patient and referring physician.  This multidisciplinary coordination allows for better patient convenience and timing of appointments, as well as closer and more effective physician consultative planning and disease management decisions. Active research is being conducted in the areas of tumor biology and Positron Emission Tomography (PET) scanning of head and neck tumors.  Clinical trials in the areas of cancer prevention, cancer treatment and symptom management are offered to our patients with head and neck cancer. 3D Conformal and Intensity Modulated Radiation Therapy Among the newer treatment options for cancer of the prostate, brain, lung, and head and neck are two methods of focusing radiation on the tumor and surrounding at-risk tissues while optimally sparing nearby normal tissues, 3-dimensional (3D) conformal radiation therapy, and intensity modulated radiation therapy (IMRT).  This approach uses anatomic computed tomogrphic and/or magnetic resonance images of the patient, computer-generated radiation dose calculations, and a computer-controlled linear accelerator to conform or “paint” the radiation dose very precisely to match the shape of the tumor to be treated, avoiding critical structures that may be only millimeters away. When the linear accelerator radiation beam intensity is varied, or modulated, over space and time during the patient’s treatment, hence the term “Intensity Modulated” radiation therapy. In combination with advanced imaging techniques like magnetic resonance spectroscopy and positron emission tomography that image both tumor anatomy and biology, IMRT holds great promise for improving local tumor control and survival, even in the most resistant and aggressive human cancers.   Esophageal cancer Digestive system Heartburn prevention Definition: Esophageal cancer is a malignant (cancerous) tumor of the esophagus, the muscular tube that moves food from the mouth to the stomach. See also: Barrett's esophagus Alternative Names: Cancer - esophagus Causes, incidence, and risk factors: Esophageal cancer is relatively uncommon in the United States, and occurs most often in men over 50 years old. It affects less than 5 in 100,000 people. There are two main types of esophageal cancer --squamous cell carcinoma and adenocarcinoma. These two types look different from each other under the microscope. Squamous cell esophageal cancer is associated with smoking and alcohol consumption. The rate of this disease in the United States has remained mostly the same, while the rate of adenocarcinoma of the esophagus has risen dramatically. Barrett's esophagus, a complication of gastroesophageal reflux disease (GERD), is a risk factor for the development of adenocarcinoma of the esophagus. Risk factors for adenocarcinoma of the esophagus include male gender, obesity, poor nutrition, and smoking. Symptoms: Backwards movement of food through the esophagus and possibly mouth (regurgitation) Chest pain unrelated to eating Difficulty swallowing solids or liquids Heartburn Vomiting blood Weight loss Signs and tests: Tests used to help diagnose esophageal cancer may include: Barium swallow Esophagogastroduodenoscopy (EGD) and biopsy Chest MRI or thoracic CT (usually used for helping to determine the stage of the disease) PET scan (sometimes useful for determining the stage of disease, and whether surgery is possible) Stool sample testing may show signs of hidden (occult) blood in the stool. Treatment: When esophageal cancer is only in the esophagus and has not spread elsewhere, surgery is the treatment of choice. The goal of surgery is to remove the cancer. Sometimes chemotherapy, radiation, or a combination of the two may be used instead of surgery, or to make surgery easier to perform. If the patient cannot tolerate surgery or the cancer has spread to other organs, chemotherapy or radiation may be used to help reduce symptoms. This is called palliative therapy. In such circumstances, however, the disease is usually not curable. Other treatments that may be used to improve a patient's ability to swallow include endoscopic dilation of the esophagus (sometimes with placement of a stent), or photodynamic therapy. In photodynamic therapy, a special drug is injected into the tumor, which is then exposed to light. The light activates the medicine that attacks the tumor. Support Groups: The stress of illness can often be eased by joining a support group of people who share common experiences and problems. See cancer - support group. Expectations (prognosis): Esophageal cancer is a very difficult disease to treat. When the cancer has not spread outside the esophagus, surgery may improve chances of survival. Radiation therapy is used instead of surgery in some cases where the cancer has not spread outside the esophagus. For patients whose cancer has spread, cure is generally not possible and treatment is directed toward relief of symptoms. Complications: Difficulty swallowing Pneumonia Severe weight loss resulting from not eating enough Spread of the tumor to other areas of the body Calling your health care provider: Call your health care provider if you have difficulty swallowing with no known cause and it does not get better, or if you have other symptoms of esophageal cancer. Prevention: The following may help reduce your risk of squamous cell cancer of the esophagus: Avoid smoking Limit or eliminate alcoholic drinks People with symptoms of severe reflux should seek medical attention. Screening with EGD and biopsy in people with Barrett's esophagus may lead to early detection and improved survival. People diagnosed with Barrett's esophagus should see a gastroenterologist (digestive system specialist) at least every year. References: Kleinberg LR, Forastier AA, Heitmiller RF. Cancer of the esophagus. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004; chap 77. Esophageal Cancer. NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network, Inc. 2008. Accessed July 22, 2008.

Review Date:7/22/2008 Reviewed By:A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz. Previously reviewed by Mark Levin, MD, Hematologist and Oncologist, Newark, NJ. Review provided by VeriMed Healthcare Network (4/8/2008).