Symptoms of Esophageal Cancer
Symptoms of Esophageal Cancer
Early esophageal cancer may not cause symptoms. As the cancer grows, the list below gives the most common symptoms:
- Food gets stuck in the esophagus, and food may come back up
- Pain when swallowing
- Pain in the chest or back
- Weight loss
- A hoarse voice or cough that doesn't go away within 2 weeks
These symptoms may be caused by esophageal cancer or other health problems. If you have any of these symptoms, you should tell your doctor so that problems can be diagnosed and treated as early as possible.
Diagnosis of Esophageal Cancer
If you have a symptom that suggests esophageal cancer, your doctor must find out whether it's really due to cancer or to some other cause. The doctor gives you a physical exam and asks about your personal and family health history. You may have blood tests. You also may have:
- Barium swallow: After you drink a barium solution, you have
x-rays taken of your esophagus and stomach. The barium solution
makes your esophagus show up more clearly on the x-rays. This
test is also called an upper GI series.
- Endoscopy: The doctor uses a thin, lighted tube (endoscope)
to look down your esophagus. The doctor first numbs your throat
with an anesthetic spray, and you may also receive medicine
to help you relax. The tube is passed through your mouth or
nose to the esophagus. The doctor may also call this procedure
upper endoscopy, EGD, or esophagoscopy.
- Biopsy: Usually, cancer begins in the inner layer of the esophagus. The doctor uses an endoscope to remove tissue from the esophagus. A pathologist checks the tissue under a microscope for cancer cells. A biopsy is the only sure way to know if cancer cells are present.
You may want to ask the doctor these questions before having a biopsy:
- Where will the procedure take place? Will I have to go to the hospital?
- How long will it take? Will I be awake?
- Will it hurt? Will I get an anesthetic?
- What are the risks? What are the chances of infection or bleeding afterward?
- How do I prepare for the procedure?
- How long will it take me to recover?
- How soon will I know the results? Will I get a copy of the pathology report?
- If I do have cancer, who will talk to me about the next steps? When?
Staging for Esophageal Cancer
If the biopsy shows that you have cancer, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment.
Staging is a careful attempt to find out the following:
- how deeply the cancer invades the walls of the esophagus
- whether the cancer invades nearby tissues
- whether the cancer has spread, and if so, to what parts of the body
When esophageal cancer spreads, it's often found in nearby lymph nodes. If cancer has reached these nodes, it may also have spread to other lymph nodes, the bones, or other organs.
Also, esophageal cancer may spread to the liver and lungs.
Your doctor may order one or more of the following staging tests:
- Endoscopic ultrasound: The doctor passes a thin, lighted
tube (endoscope) down your throat, which has been numbed
with anesthetic. A probe at the end of the tube sends out
sound waves that you can't hear. The waves bounce off tissues
in your esophagus and nearby organs. A computer creates
a picture from the echoes. The picture can show how deeply
the cancer has invaded the wall of the esophagus. The doctor
may use a needle to take tissue samples of lymph nodes.
- CT scan: An x-ray machine linked to a computer takes a
series of detailed pictures of your chest and abdomen. Doctors
use CT scans to look for esophageal cancer that has spread
to lymph nodes and other areas. You may receive contrast
material by mouth or by injection into a blood vessel. The
contrast material makes abnormal areas easier to see.
- MRI: A strong magnet linked to a computer is used to make
detailed pictures of areas inside your body. An MRI can
show whether cancer has spread to lymph nodes or other areas.
Sometimes contrast material is given by injection into your
blood vessel. The contrast material makes abnormal areas
show up more clearly on the picture.
- PET scan: You receive an injection of a small amount of
radioactive sugar. The radioactive sugar gives off signals
that the PET scanner picks up. The PET scanner makes a picture
of the places in your body where the sugar is being taken
up. Cancer cells show up brighter in the picture because
they take up sugar faster than normal cells do. A PET scan
shows whether esophageal cancer may have spread.
- Bone scan: You get an injection of a small amount of a radioactive
substance. It travels through the bloodstream and collects
in the bones. A machine called a scanner detects and measures
the radiation. The scanner makes pictures of the bones.
The pictures may show cancer that has spread to the bones.
- Laparoscopy: After you are given general anesthesia, the surgeon makes small incisions (cuts) in your abdomen. The surgeon inserts a thin, lighted tube (laparoscope) into the abdomen.
Lymph nodes or other tissue samples may be removed to check for cancer cells.
Sometimes staging is not complete until after surgery to remove the cancer and nearby lymph nodes.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if esophageal cancer spreads to the liver, the cancer cells in the liver are actually esophageal cancer cells. The disease is metastatic esophageal cancer, not liver cancer. For that reason, it's treated as esophageal cancer, not liver cancer. Doctors call the new tumor "distant" or metastatic disease.
These are the stages of esophageal cancer:
- Stage 0: Abnormal cells are found only in the inner layer of the esophagus. It's called carcinoma in situ.
- Stage I: The cancer has grown through the inner layer to
the submucosa. (The picture shows the submucosa and other
- Stage II is one of the following:
The cancer has grown through the inner layer to the submucosa, and cancer cells have spread to lymph nodes.
Or, the cancer has invaded the muscle layer. Cancer cells may be found in lymph nodes.
Or, the cancer has grown through the outer layer of the esophagus.
- Stage III is one of the following:
The cancer has grown through the outer layer, and cancer cells have spread to lymph nodes.
Or, the cancer has invaded nearby structures, such as the airways. Cancer cells may have spread to lymph nodes.
- Stage IV: Cancer cells have spread to distant organs, such as the liver.