While still relatively uncommon in the U.S., the number of esophageal cancer diagnoses is rising at an alarming rate.  Esophageal cancer diagnoses are one of the most rapidly increasing of cancer types. With increased awareness, diagnosis of esophageal cancer is occurring earlier in many cases.

The two major tumor types are squamous cell carcinoma and adenocarcinoma, which account for over 90% of esophageal cancers. Squamous cell carcinoma is the most common form of esophageal cancer in almost every area of the world except the United States. This is mostly due to socioeconomic reasons with a link between poverty, malnutrition and squamous cell cancer of the esophagus.  There is also a link between smoking and squamous cell esophageal carcinoma. Other links to squamous cell carcinoma include chronic irritation, achalasia, lye ingestion, mediastinal radiation therapy to the mediastinum, esophageal diverticula, Plummer-Vinson syndrome, and tylosis.  The latter is the only genetic disorder identified with esophageal cancer so far.

 In the United States almost 80% of esophageal cancers are adenocarcinomas, and of these 75% occur in the distal esophagus. This major shift from squamous cell carcinoma in the U.S. is felt most likely to be due to acid reflux and obesity. While reflux can be a relatively benign disease, it can also lead to Barrett’s epithelium.  Barrett’s epithelium is abnormal columnar epithelium lining the esophagus, which with chronic irritation from reflux can lead to a pre-malignant lesion. The incidence of Barrett’s changes occur in up to 10% of patients with reflux, with an annual rate of conversion to cancer in 0.5% of reported Barrett’s cases per year. While many new medications are available to treat reflux disease, it is more important than ever to have initial screening in patients with chronic reflux disease as well as long-term surveillance to assure that progression of simple acid reflux is not leading to precancerous change of the esophagus.

The following are images showing markers associated with Barrett’s disease

Figure 2

Diagnosis of esophageal cancer can be made relatively simply, with 75 % of patients having dysphagia and 50% of patients having weight loss; rarely bleeding, pain or cough will be the presenting symptoms. Once clinical presentation has established concern, barium swallow and endoscopy with biopsy confirm the diagnosis in 90% of patients. Further diagnostic testing with CT scanning, endoscopic ultrasound (EUS) and possibly PET scanning will aid in determining resectability. Accurate preoperative staging is extremely important since the morbidity and mortality with this disease varies greatly depending on the stage and method of treatment used.

The following x-ray of a barium swallow shows distal esophageal adenocarcinoma.

Figure 3

The following image is an example of Distal Adenocarcinoma shown through an endoscope or camera in a cable that takes pictures of the inside of your throat/esophagus.

Figure 4

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