Esophageal cancer is the eighth most common type of cancer and
causes 12,000 deaths per year in the U.S. (2% of all cancer
deaths). One type of esophageal cancer, adenocarcinoma, accounts
for 50% of esophageal cancers and occurs primarily in Caucasian men.
The incidence of adenocarcinoma and deaths from esophageal cancer
have been increasing steadily in the U.S. and western Europe.
Gastroesophageal reflux disease (GERD), in
which acid refluxes from the stomach into the esophagus (known primarily for causing
heartburn) is a condition that afflicts 20% of the populations of the
U.S. and western Europe.
It has been
hypothesized that GERD is an important cause of adenocarcinoma of the esophagus.
Specifically, the hypothesis is that chronic reflux of acid
into the esophagus causes changes in the cells lining the lower esophagus--changes
that are referred to as Barrett's esophagus--that ultimately lead the
cells to become cancerous. It is estimated that ½ to
1% of patients with Barrett's esophagus develop adenocarcinoma each year they
are followed. (This means that during 20 years a patient
with Barrett's esophagus has a 10 to 20% risk of developing adenocarcinoma.) Therefore, it
has been recommended that patients with Barrett's esophagus
undergo regular and frequent endoscopy (every year)
and biopsy of the esophagus so that early malignant changes can
be detected and treated early before cancer spreads.
The esophagus is in the chest. It's about 10 inches long.
This organ is part of the digestive tract. Food moves from the mouth through
the esophagus to the stomach.
The esophagus is a muscular tube. The wall of the esophagus has several
layers:
Inner layer or lining (mucosa): The lining of the esophagus is moist so that
food can pass to the stomach.
Submucosa: The glands in this layer make mucus. Mucus keeps the esophagus
moist.
Muscle layer: The muscles push the food down to the stomach.
Outer layer: The outer layer covers the esophagus.
Cancer Cells
Cancer begins in cells, the building blocks that make up tissues. Tissues
make up the organs of the body.
Normal cells grow and divide to form new cells as the body needs them. When
normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body does not
need them, and old or damaged cells do not die as they should. The buildup of
extra cells often forms a mass of tissue called a growth or tumor.
Growths in the wall of the esophagus can be benign (not cancer) or malignant
(cancer). The smooth inner wall may have an abnormal rough area, an area of tiny
bumps, or a tumor. Benign growths are not as harmful as malignant growths:
Benign growths:
are rarely a threat to life
can be removed and probably won't
grow back
don't invade the tissues around them
don't spread to other parts of
the body
Malignant growths:
may be a threat to life sometimes
can be removed but can
grow back
can invade and damage nearby tissues and organs
can spread to other
parts of the body
Esophageal cancer begins in cells in the inner layer of the
esophagus. Over time, the cancer may invade more deeply into the esophagus and
nearby tissues.
Cancer cells can spread by breaking away from the original tumor. They may
enter blood vessels or lymph vessels, which branch into all the tissues of the
body. The cancer cells may attach to other tissues and grow to form new tumors
that may damage those tissues. The spread of cancer cells is called metastasis.
See the Staging section for information about esophageal cancer that has spread.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Barrett's esophagus occurs as a complication of chronic gastroesophageal reflux disease (GERD), primarily in white males. GERD refers to the reflux of acidic fluid from the stomach into the esophagus (the swallowing tube), and is classically associated with heartburn.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Achalasia is a disease of the esophagus that mainly affects young adults. Abnormal function of nerves and muscles of the esophagus causes difficulty swallowing and sometimes chest pain.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Asbestos exposure lung disease is divided into three main types, asbestosis (lung scarring caused by asbestos fibers), disease of the lining of the lung (pleural plaques, scarring, or fluid accumulation), and lung cancer. Mesothelioma is cancer of the lining of the lung caused by asbestos exposure. Cancers of the larynx, throat, kidney, esophagus, and gallbladder have been linked to asbestos exposure. Treatment is dependant upon the type of condition related to asbestos exposure.
Schatzki (Schatzki's) ring, is a narrow ring of tissue located just above the junction of the esophagus and stomach. The cause of Schatzki ring is not clearly known, however, some doctors believe they are caused by long term acid reflux. The symptoms of a Schatzki ring is primarily poorly chewed food that stays in chunks becoming stuck in the esophagus. Diagnosis of Schatzki's ring is barium x-ray or endoscopy. Treatment is generally a procedure to stretch or fracture the rings.
Heartburn is a burning sensation experienced from acid reflux (GERD). Symptoms of heartburn include chest pain, burning in the throat, difficulty swallowing, the feeling of food sticking in the throat, and a burning feeling in the chest. Causes of heartburn include dietary habits, lifestyle habits, and medical causes. Treatments for heartburn include lifestyle changes, OTC medication, prescription medication, and surgery.
Acid backing up into the larynx (voice box), it causes reflux laryngitis. Irritation of the lining of the esophagus, larynx, and throat can lead to esophagitis, sinusitis, strictures, hoarseness, throat clearing, swallowing problems, asthma, chronic cough, and more. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat. Reflux laryngitis can be treated with OTC medication, prescription medication, and lifestyle changes.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
Smokeless tobacco can have negative health effects such as cancers, poor oral health (gum disease and tooth decay), infertility, pregnancy complications, and nicotine addiction.
Esophagitis is caused by an infection or irritation in the esophagus. An infection can be caused by bacteria, viruses, fungi, or diseases that weaken the immune system. Infections that cause esophagitis include:
Candida. This is a yeast infection of the esophagus caused by the same fungus that
causes vaginal yeast infections. The infection develops in the esophagus when the body's immune system is weak (such as in people with diabetes or
HIV). It is usually very treatable with antifungal drugs.
Herpes. Like Candida, this viral infection can develop in the esophagus when the body's immune system is weak. It is treatable with antiviral drugs.
Irritation causing esophagitis may be caused by any of the following:
GERD, or gastroesophageal reflux disease
Vomiting
Surgery
Medications such as aspirin and other anti-inflammatory drugs