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Esophageal Cancer
Understanding your diagnosis
Esophageal Cancer
What is cancer?
Understanding your diagnosis
Cancer is a disease that starts in our cells.
Our bodies are made up of millions of cells,
grouped together to form tissues and organs
such as muscles and bones, the lungs and the
liver. Genes inside each cell order it to grow,
work, reproduce and die. Normally, our cells
obey these orders and we remain healthy.
When you first hear that you have cancer,
you may feel alone and afraid. You may be
overwhelmed by the large amount of
information you have to take in and the
decisions you need to make.
All I could hear was ‘cancer.’ I heard my
doctor say something like, ‘We’re going
to try and get the surgery done as soon
as possible.’ I didn’t hear one word
after that.
The introductory information in this brochure
can help you and your family take the first
steps in learning about esophageal cancer.
A better understanding may give you a sense
of control and help you work with your
healthcare team to choose the best care for you.
For more information
The information in this brochure gives an introduction
to esophageal cancer. More in-depth information is
available on cancer.ca. You can also call our Cancer
Information Service at 1-888-939-3333 to learn more
about cancer, diagnosis, treatment, support and the
services we offer.
But sometimes the instructions in some
cells get mixed up, causing them to behave
abnormally. These cells grow and divide
uncontrollably. After a while, groups of
abnormal cells form lumps, or tumours.
Tumours can be either benign (non-cancerous)
or malignant (cancerous). Benign tumour
cells stay in one place in the body and are not
usually life-threatening. Malignant tumour
cells are able to invade nearby tissues and
spread to other parts of the body. It’s important
to find and treat malignant tumours as early as
possible. In most cases, finding cancer early
increases the chances of successful treatment.
Cancer cells that spread to other parts of the
body are called metastases. The first sign that
a malignant tumour has spread (metastasized)
is often swelling of nearby lymph nodes,
but cancer can spread to almost any part of
the body.
Cancers are named after the part of the body
where they start. For example, cancer that
starts in the esophagus but spreads to the
liver is called esophageal cancer with liver
metastases.
Cover photograph: © Getty Images
Licensed material is for illustrative purposes only; persons depicted are models.
1
What is esophageal cancer?
Esophageal cancer starts in the cells of the
esophagus. The esophagus is a hollow, muscular
tube that carries food and drink from the
back of your mouth down to your stomach.
It’s located behind your windpipe and in front
of your spine. When you swallow, the muscles
of the esophagus tighten to push food down
to your stomach. The esophagus joins the
stomach at an area called the gastroesophageal
(GE) junction. The muscle at this junction
opens to let food into the stomach. This
muscle normally stops the stomach acid from
flowing back up into the esophagus and
causing heartburn.
Having gastric reflux for years can cause
Barrett’s esophagus. Gastric reflux is when
stomach acid flows up into the esophagus
and causes heartburn. Most people with
chronic gastric reflux don’t develop Barrett’s
esophagus. But a person diagnosed with
Barrett’s esophagus has a very high risk of
cancer if it isn’t treated.
Cancer of the esophagus can start anywhere
along the length of the esophagus. There are
two main types of esophageal cancer. Each one
starts in a different kind of cell.
Squamous cell carcinoma starts in the
squamous cells that line the esophagus.
These cancers usually develop in the upper
and middle part of the esophagus.
Adenocarcinoma starts in the glandular
cells in the lower part of the esophagus.
Treatment is similar for both types of
esophageal cancer.
Diagnosing esophageal cancer
Your doctor may suspect you have esophageal
cancer after taking your medical history and
doing a physical examination. To confirm the
diagnosis, your doctor will arrange special
tests. These tests may also be used to “stage”
the cancer and to help plan treatment.
Symptoms of esophageal cancer: Cancer of the
Before esophageal cancer develops, the cells
of the esophagus start to change and become
abnormal. These abnormal cells are
precancerous – this means they aren’t cancer.
Having these precancerous cells in the
esophagus is called Barrett’s esophagus.
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Esophageal Cancer: Understanding your diagnosis
esophagus often doesn’t cause any signs or
symptoms in its early stages. Most people
don’t have symptoms until the tumour blocks
the esophagus, making it hard to swallow.
© Canadian Cancer Society 2012
3
The most common signs and symptoms of
esophageal cancer include:
•
difficult or painful swallowing
•
weight loss
•
pain in the throat, chest (behind the
breastbone) or back
•
heartburn or indigestion
•
feeling very tired
•
loss of appetite
•
nausea or vomiting
•
hoarseness or coughing
Other health problems can cause some of
the same symptoms. Your doctor will do
one or more of the following tests to make
a diagnosis.
Imaging studies: Imaging studies allow tissues,
organs and bones to be looked at in more detail.
Using x-rays, ultrasounds, CT scans, MRIs or
bone scans, your healthcare team can get a
picture of the size of the tumour and see if it
has spread. These tests are usually painless,
and you don’t need an anesthetic (freezing).
You may have a series of x-rays of the esophagus
and stomach called an upper gastrointestinal
(GI) series, or a barium swallow. You will
drink a thick, chalky liquid called barium.
The barium coats the inside of the esophagus,
stomach and small intestine and helps them
show on the x-ray. The doctor looks for any
changes in the esophagus on the x-ray. If
there are signs of cancer, the doctor also
looks to see if it has spread to the stomach.
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Esophageal Cancer: Understanding your diagnosis
Esophageal endoscopy: Esophageal endoscopy
uses a thin, flexible tube with a light at the end
(called an endoscope). The tube goes into
your mouth and down your throat to look
inside the esophagus. Before an endoscopy,
a mild anesthetic (freezing) may be sprayed
on your throat. You may also get a mild sedative
to help you relax. After the endoscopy, your
throat will be sore – this is normal and lasts
only a couple of days.
Biopsy: A biopsy is usually needed to make a
definite diagnosis of cancer. Cells are taken
from the body and checked under a microscope.
If the cells are cancerous, they are studied to
see how fast they are growing.
An endoscopic biopsy is commonly used to
diagnose esophageal cancer. If an abnormal
area is found during the endoscopy, the doctor
takes samples of tissue through the endoscope.
Blood tests: Blood is taken and studied to see
if the different types of blood cells are normal
in number and appearance. The results show
how well your organs are working and may
suggest whether you have cancer and if it
has spread.
Further testing: Your doctor may order more
tests to find out if the cancer has spread and
to help plan your treatment.
© Canadian Cancer Society 2012
5
Will I be okay?
Staging
Most people with cancer want to know what to expect.
Can they be cured?
Once a defi nite diagnosis of cancer has
been made, the cancer is given a stage. This
information helps you and your healthcare
team choose the best treatment for you.
A prognosis is your doctor’s best estimate of how cancer
will affect you and how it will respond to treatment.
A prognosis looks at many factors, including:
• the type, stage and grade of cancer
• the location of the tumour and whether it has spread
• your age, sex and overall health
Even with all this information, it can still be very
hard for your doctor to say exactly what will happen.
Each person’s situation is different.
The cancer stage describes the tumour size
and tells whether it has spread.
For esophageal cancer, there are five stages.*
Stage
Your doctor is the only person who can give a
prognosis. Ask your doctor about the factors that
affect your prognosis and what they mean for you.
*
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Esophageal Cancer: Understanding your diagnosis
Description
0
Cancer cells are only in the innermost layer
of the lining of the esophagus. Stage 0 is
also called carcinoma in situ.
1
Cancer has spread beyond the innermost
layer of cells to the next layer of tissue in
the wall of the esophagus.
2
Cancer has spread to deeper layers of the
esophagus or to nearby lymph nodes. It has
not spread to other parts of the body.
3
Cancer has spread more deeply into the wall
of the esophagus or to tissue or lymph nodes
near the esophagus. It has not spread to distant
parts of the body.
4
Cancer has spread within the esophagus. It has
also spread to lymph nodes or to other parts
of the body (such as the liver, lungs, brain
or bones), or to both.
This table summarizes the stages of esophageal cancer according to
the TNM system used by the American Joint Committee on Cancer
(AJCC) and the Union for International Cancer Control (UICC). For more
in-depth information, please visit cancer.ca.
© Canadian Cancer Society 2012
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Treatments for esophageal cancer
Your healthcare team considers your general
health and the type and stage of the cancer
to recommend the best treatments for you.
You’ll work together with your healthcare
team to make the final treatment choices.
Talk to them if you have questions or concerns.
Some treatments for esophageal cancer may
make your mouth sensitive and may increase
your risk of infection. It’s important to see
your dentist and get dental work done before
starting treatment.
For esophageal cancer, you might receive one
or more of the following treatments.
be removed too. If only the upper part of the
stomach is removed, the surgeon will pull
up the stomach and connect it to the healthy
part of the esophagus. If that’s not possible,
some of the intestine will be used to make a
new esophagus.
If the tumour cannot be removed and is
blocking the esophagus, a hollow tube
(called a stent) may be put in the esophagus
to keep it open. This makes eating and
swallowing easier.
During the recovery period after surgery,
you may need help with:
•
Breathing: You may need a ventilator
(respirator) for a short time to help you
breathe. Your healthcare team can teach
you special breathing exercises to help you
keep your lungs clear of fluid.
•
Drainage: Drainage tubes may be inserted
into your chest to remove fluids that collect
around the lungs. These are removed a few
days after surgery.
•
Eating: After surgery, you may have an
intravenous (IV) drip into a vein or a feeding
tube in your nose or abdomen to give you
liquids and nutrients. Swallowing tests are
done to make sure the area where the
esophagus now joins the stomach is healing.
After a few days of healing, you may be
able to start drinking and eating soft foods
on your own.
Surgery: Surgery is the most common treatment
for esophageal cancer. Surgery may be advised
depending on the size and location of the
tumour as well as your general health. Surgery is
done under general anesthetic (you will be
unconscious). You may stay in the hospital for
a week or longer after the surgery.
There are different types of surgery for cancer
of the esophagus. An operation to remove
all or part of the esophagus is called an
esophagectomy. How much of the esophagus
is removed depends on the stage of the cancer,
the location of the tumour and whether or not
it has spread.
The surgeon will remove the tumour and some
healthy tissue around it as well as nearby
lymph nodes. Part or all of the stomach may
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Esophageal Cancer: Understanding your diagnosis
© Canadian Cancer Society 2012
9
Chemotherapy: Chemotherapy uses drugs to
treat cancer. Chemotherapy drugs may be
given as pills or by injection. They interfere
with the ability of cancer cells to grow and
spread, but they also damage healthy cells.
Although healthy cells can recover over time,
you may experience side effects from your
treatment including nausea, vomiting,
diarrhea, hair loss, fatigue and loss of appetite.
Most side effects go away after treatment is
finished, but some may last a long time or
be permanent.
tired than usual or notice changes to the skin
(it may be red or tender) where the treatment
was given.
Radiation may be given with or without
chemotherapy and may be used before or
after surgery.
Endoscopy: While endoscopy is used to diagnose
esophageal cancer, it is also sometimes used
to treat it. During surgery, an endoscopy
can help remove or destroy tissue. With
photodynamic therapy (PDT), an endoscope
delivers low-intensity laser light to activate
drugs that destroy the cancer cells. When
treating advanced cancer, an endoscope may
be used to open up the esophagus.
Chemotherapy may be given with radiation
therapy (chemoradiation) when treating
esophageal cancer, or it may be given on its
own. Side effects may be more severe when
radiation and chemotherapy are combined.
Chemotherapy may also be used before or
after surgery.
For more information on treatment, you may want
to read our booklets Chemotherapy and Other Drug
Therapies and Radiation Therapy.
Radiation therapy: Radiation therapy for
Clinical treatment trials: Clinical treatment
esophageal cancer may include two types
of treatments. In external beam radiation
therapy, a large machine is used to carefully
aim a beam of radiation at the tumour. The
radiation damages the cells in the path of the
beam – normal cells as well as cancer cells.
In brachytherapy, or internal radiation therapy,
radioactive material is placed directly into or
near the tumour.
trials investigate new approaches to treating
cancer. They provide information about the
safety and effectiveness of new drugs, types
of treatment or new combinations of existing
treatments. Clinical treatment trials are closely
monitored to make sure that they are safe for
the participants. Ask your doctor if any clinical
trials are available as a suitable treatment option
for you. It’s up to you to participate – you may
benefit and so may future cancer patients.
Radiation side effects depend on the part of
the body that receives the radiation and the
dose. You may have a dry or sore mouth and
throat, have trouble swallowing, feel more
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Esophageal Cancer: Understanding your diagnosis
For more information on clinical trials, including
information on how to find one, you may want to
read our booklet Clinical Trials.
© Canadian Cancer Society 2012
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Complementary therapies: Complementary
therapies – for example, massage therapy
or acupuncture – are used together with
conventional cancer treatments, often to
help ease tension and stress, as well as other
side effects of treatment. They don’t treat
the cancer itself. More research is needed to
understand if these therapies are effective
and how they work.
Alternative therapies are used instead of
conventional treatments. Alternative therapies
haven’t really been tested enough for safety
or effectiveness. Using alternative treatments
alone for cancer may have serious health effects.
If you’re thinking about using a complementary
or alternative therapy, find out as much as
you can about the therapy and talk to your
healthcare team. It’s possible that the
therapy might interfere with test results or
regular treatments.
For more information on complementary
therapies, you may want to read our booklet
Complementary Therapies.
Side effects of treatment: Some cancer treatments
cause side effects, such as fatigue, hair loss or
nausea. Because treatments affect everyone
differently, it’s hard to predict which side
effects – if any – you may have.
Side effects can often be well managed and
even prevented. If you’re worried about side
effects, tell your healthcare team about your
concerns and ask questions. They can tell you
which side effects you should report right
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Esophageal Cancer: Understanding your diagnosis
away and which ones can wait until your
next appointment.
If you notice any side effects or symptoms that
you didn’t expect, talk to a member of your
healthcare team as soon as possible. They’ll
help you get the care and information you need.
After treatment
Follow-up care helps you and your healthcare
team monitor your progress and your recovery
from treatment. At first, your follow-up care
may be managed by one of the specialists
from your healthcare team. Later on, it may
be managed by your family doctor.
The schedule of follow-up visits is different
for each person. You might see your doctor
more often in the first year after treatment
and less often after that. After treatment has
ended, you should report new symptoms that
don’t go away to your doctor without waiting
for your next scheduled appointment.
Maintaining a healthy diet: After treatment for
esophageal cancer, you may need to make
changes to your diet and your eating habits.
You’ll need to eat several small meals and
snacks throughout the day, rather than eating
three large meals. It’s important to eat well
so that you get enough calories and protein
to control weight loss and maintain your
strength. This can be very hard if you’re
having trouble swallowing or have problems
with digestion.
Ask your healthcare team for more information
on how to maintain a healthy diet.
© Canadian Cancer Society 2012
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Self-image and sexuality: It’s natural to be
concerned about the effects of esophageal
cancer and its treatment on your sexuality.
You may be concerned about how your body
looks and how it works after treatment.
And you may worry about having sex with a
partner or that you may be rejected. It may
help to talk about these feelings with someone
you trust. Your doctor can also refer you to
specialists and counsellors who can help you
with the emotional side effects of esophageal
cancer treatment.
For more information on sexuality, you may want
to read our booklet Sexuality and Cancer.
The end of cancer treatment may bring mixed
emotions. You may be glad the treatments
are over and look forward to returning to
your normal activities. But you might feel
anxious as well. If you’re worried about the
end of your treatment, talk to your healthcare
team. They’re there to help you through this
transition period.
Living with cancer
For resources on living with cancer, you may want
to read our booklet Living with Cancer.
Many sources of help are available for people
with cancer and for their caregivers.
Your healthcare team: If you need practical
help or emotional support, members of
your healthcare team may be able to suggest
services in your community or refer you
to cancer centre staff or mental health
professionals.
Family and friends: People closest to you can
be very supportive. Accept offers of help.
When someone says, “Let me know how I
can help,” tell them what they can do. Maybe
they can run errands, cook a meal or give you
a ride to your doctor’s office.
People who’ve had similar experiences: Talking
with and learning from others who’ve had
similar experiences can be helpful. Consider
visiting a support group or talking with a
cancer survivor in person, over the telephone
or online. Try more than one option to see
which one works best for you.
Yourself: Coping well with cancer doesn’t
mean that you have to be happy or cheerful
all the time. But it can mean looking after
yourself by finding relaxing, enjoyable
activities that refresh you mentally, spiritually
or physically. Take some time to find coping
strategies to help you through this experience.
You may also want to talk to a counsellor for
more help.
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Esophageal Cancer: Understanding your diagnosis
© Canadian Cancer Society 2012
15
Connecting with someone who’s had a similar
cancer experience
We can help you connect with a trained volunteer
who’s been through a similar cancer experience. Our
telephone support program is available everywhere
in Canada, and we also offer in-person and group
support in many locations.
To find out more about what’s available in your area,
you can:
• Call our toll-free Cancer Information Service at
1-888-939-3333 (TTY: 1-866-786-3934)
Monday to Friday, 9 a.m. to 6 p.m.
• Email us at [email protected].
• Visit our website at cancer.ca.
Want to connect with someone online?
If you’d like to connect with someone online, join our
online community, CancerConnection.ca. There are
discussions, blogs and groups that may interest you,
and you’ll find caring, supportive people there.
•
exposure to radiation
•
being underweight, overweight or obese
•
family history
Most people diagnosed with esophageal
cancer are over the age of 60. Men are more
likely to be diagnosed with it than women.
The Canadian Cancer Society
Helping you understand cancer
Now that you know the basics of esophageal
cancer, you may want to learn more. Please
contact us for more in-depth information and
support. Our services are free and confidential.
To contact the Canadian Cancer Society:
•
Call an information specialist toll-free
at 1-888-939-3333 (TTY: 1-866-786-3934)
Monday to Friday, 9 a.m. to 6 p.m.
What causes esophageal cancer?
•
Email us at [email protected].
There is no single cause of esophageal
cancer, but some factors increase the risk
of developing it. Some people can develop
esophageal cancer without any risk factors,
while others who have these factors do not
get it.
•
Visit our website at cancer.ca.
•
Contact your local Canadian Cancer
Society office.
Risk factors for esophageal cancer include:
•
smoking or chewing tobacco
•
drinking alcohol, especially if you also
use tobacco
•
GERD (gastroesophageal reflux disease)
and Barrett’s esophagus
•
having had other cancers in the head,
neck or digestive system
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Esophageal Cancer: Understanding your diagnosis
We’d like to hear from you
Email us at [email protected] if you
have comments or suggestions to help us make this
brochure more useful for you and other readers.
What we do
The Canadian Cancer Society fights
cancer by:
•
doing everything we can to prevent cancer
•
funding research to outsmart cancer
•
empowering, informing and supporting
Canadians living with cancer
•
advocating for public policies to improve
the health of Canadians
•
rallying Canadians to get involved in the
fight against cancer
Contact us for up-to-date information about
cancer, our services or to make a donation.
This is general information developed by the Canadian Cancer Society.
It is not intended to replace the advice of a qualified healthcare provider.
The material in this publication may be copied or reproduced without permission;
however, the following citation must be used: Esophageal Cancer:
Understanding your diagnosis. Canadian Cancer Society 2012.
© Canadian Cancer Society 2012 | Printed November 2012 | 311-049