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What Is Esophageal Cancer?

Esophagus cancer, more commonly known as esophageal cancer, starts when cells within the lining of the esophagus mutate or change and begin to multiply. 

The esophagus, a long muscular tube that connects the throat to the stomach, helps move food from the mouth to the stomach to be digested. The esophagus is usually between 10 and 13 inches long and about ¾ of an inch wide in adults. Esophageal cancer can develop anywhere along the esophagus.

Esophageal cancer begins in the cells of the tissue lining the esophageal wall and grows outward through layers called the mucosa, submucosa, muscularis propria, and adventitia.

More common among men than women, according to the National Cancer Institute, esophageal cancer accounts for 1% of all cancers diagnosed in the United States, with more than 18,000 new cases each year. It is estimated that more than 16,000 people will die of esophageal cancer each year, with a five-year relative overall survival rate of 19.9%. This means about 20 out of every 100 people with esophageal cancer will be alive five years after diagnosis. 

Esophageal cancer is often diagnosed at a later stage due to the lack of symptoms until the tumor has grown significantly enough to cause symptoms. This may in part explain the relatively poor overall survival.

According to the American Cancer Society, in Colorado, there are an estimated 290 new cases and 250 deaths from esophageal cancer each year.

Why Come to CU Cancer Center for Esophageal Cancer 

The CU Cancer Center offers patients a one-stop comprehensive evaluation of benign and cancerous conditions of the esophagus and stomach. Our doctors are the only physicians in a 500-mile radius who are part of the National Comprehensive Cancer Network (NCCN) advisory panel. The NCCN establishes treatment guidelines that doctors all across the United States use as a reference. The CU Cancer Center is also one of four National Cancer Institute Designated Comprehensive Cancer Centers in the Rocky Mountain region. 

There are dozens of esophageal cancer clinical trials currently being offered by CU Cancer Center members, giving patients many different treatment options. Specialists at our Esophageal and Gastric Cancer Multidisciplinary Clinic perform more esophageal and stomach cancer operations than any other hospital in Colorado. Treatment of esophageal cancers at specialized and experienced high-volume centers such as the University of Colorado Cancer Center is associated with improved outcomes and survival.

The Esophageal and Gastric Cancer Multidisciplinary Clinic brings together a team of expert surgeons, gastroenterologists, pathologists, oncologists, radiologists, and more focused on the esophagus and stomach. Together, the team analyzes a patient’s diagnosis and recommends a specific treatment plan for the individual by the end of the visit. The Esophageal and Gastric Cancer Multidisciplinary Clinic has a designated point of contact, Megan Marsh, PA-C, for prospective patients, current patients, and referring physicians.

For esophageal and gastric cancers, our team of abdominal and thoracic cancer surgeons specialize in treating these tumors using traditional and laparoscopic techniques. Whenever possible, our doctors look for ways to treat esophageal and gastric conditions using the least invasive techniques that can accomplish the goal. Using minimally invasive techniques offers the potential benefits of a faster recovery, less incisional pain, and fewer wound infections and pulmonary complications.

Our clinical partnership with UCHealth has produced survival rates higher than the state average for all stages of esophageal cancer.

Esophageal Cancer Graph

Number of Patients Diagnosed – UCHealth 237- State of Colorado 868
Number of Patients Surviving – UCHealth 68 – State of Colorado 153
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)

Types of Esophageal Cancer

There are two different types of esophageal cancer, based on the cell type from which the cancer starts.

Squamous cell carcinoma is cancer that starts in the flat, thin squamous cells that line the inner layer of the esophagus, the mucosa. This type of esophageal cancer is the most common worldwide and can form anywhere along the esophagus but is most commonly found in the cervical esophagus. 

Adenocarcinoma is cancer that starts in the gland cells found in the lower thoracic esophagus. Adenocarcinoma is the most common type of esophageal cancer in the United States and is more commonly diagnosed in men. Gastroesophageal junction tumors are adenocarcinomas that start at the junction where the esophagus meets the stomach.

Causes of Esophageal Cancer

Esophageal cancer is caused by DNA changes or mutations that occur within healthy cells. Normal cells in the body go through a life cycle where they grow and divide to form new cells and then die when the body no longer needs them. Cells contain DNA that tells the cell what to do. When a cell’s DNA is damaged, cells continue to grow and divide where they aren’t needed by the body. This buildup of cells becomes a tumor. 

Risk Factors for Esophageal Cancer

Researchers have found several factors that might increase the chance of developing esophageal cancer. These risk factors include:

Age: Esophageal cancer can be diagnosed at any age, but fewer than 15% of cases are found in people younger than age 55.

Gender: Men are three times more likely to get esophageal cancer than women. 

Weight: People who are overweight or obese have a higher chance of developing adenocarcinoma of the esophagus.

Tobacco: The use of cigarettes, cigars, pipes, chewing tobacco, and other tobacco products increase the risk of developing esophageal cancer.

Alcohol: Alcohol increases the risk of developing squamous cell carcinoma more than adenocarcinoma.

Gastroesophageal reflux disease: A condition where acid escapes from the stomach into the lower esophagus, gastroesophageal reflux disease can slightly increase the risk of getting adenocarcinoma of the esophagus.

Barrett’s esophagus: Over time, gastroesophageal reflux disease can damage the inner lining of the esophagus. Barrett’s esophagus occurs when the squamous cells that line the lower portion of the esophagus are replaced with gland cells that are similar to cells found in the lining of the stomach that are more resistant to stomach acid. Over time, these gland cells can mutate, resulting in dysplasia, a pre-cancerous condition. 

Achalasia: A condition that affects the lower esophagus sphincter’s ability to relax properly, not allowing food and liquid to pass into the stomach properly, resulting in food collecting in the lower esophagus. Over time, the lower esophagus can become stretched out and irritated from being exposed to foods for long amounts of time. 

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Information reviewed by Martin McCarter, MD, August 2022.