Dr. M.J. Bazos, MD Patient Handout


About Your Diagnosis

The esophagus is the part of the digestive tract that connects the throat with the stomach. Cancer of the esophagus is more common in Asia and China than in the United States. Approximately 12,000 new cases of esophageal cancer were diagnosed last year in the United States. The cause of esophageal cancer is unknown, but there are risk factors, such as heavy alcohol and tobacco use, that increase your chances of getting this cancer. Acid reflux (back up) from the stomach to the esophagus that occurs over a long time can lead to Barrett’s esophagus, which can convert to esophageal cancer. Esophageal cancer is not contagious. The cancer is detected by means of one of two radiographic (xray) studies, a barium swallow examination or esophagography. The easiest way for a physician to diagnose esophageal cancer is to obtain tissue with an endoscope (a lighted tube passed through the mouth into the esophagus). The tissue is examined with a microscope.

Living With Your Diagnosis
Most cancers of the esophagus occur in the lower part of the esophagus. Difficulty in swallowing solid foods is the typical symptom. As the tumor grows, liquids become difficult to swallow, and you can have pain with swallowing. The cancer usually spreads to nearby structures (lung, windpipe, lymph glands, and liver). This can cause hoarseness, coughing, coughing of blood, vomiting of blood, and chest pain.

Once the diagnosis is made, you undergo a staging process. Staging of esophageal cancer tells you the extent of the disease and whether it has spread. Staging usually includes a physical examination, blood tests, radiographs (x-rays) of the chest, and computed tomography (CT) of the chest and abdomen. Laryngoscopy (examination with a lighted tube passed into the voice box) can be performed if it looks like the cancer has spread into the larynx (voice box). Bronchoscopy can be performed if it is believed the cancer has spread into the lungs or the tubes that lead into the lungs (trachea and bronchi). Esophageal cancer is a difficult cancer to cure unless it is detected in its earliest stage. Therapy for esophageal cancer depends on the extent of disease; it can include surgical, radiation, and chemotherapy. An operation on the esophagus is called esophagectomy. In the operation the surgeon removes the part of the esophagus with the tumor and nearby lymph glands. If the cancer completely blocks the esophagus, tubes are placed to reopen the esophagus and allow nutrition. Complications of surgical treatment are infection, pneumonia, and breathing and swallowing problems. Radiation therapy is used instead of surgical treatment when the tumor is too large to remove or when the patient cannot withstand an operation. The side effect of radiation therapy is dry, red, itchyburning skin over the treated area. If the irradiation was over the neck and chest, dry mouth, sore throat, cough can occur. Chemotherapy can be used with radiation if surgical treatment is not possible. Sometimes radiation and chemotherapy are tried before surgical intervention. The patient and oncologist decide this together. Side effects of chemotherapy can be easy bruising, bleeding, fever, nausea, vomiting, and hair loss.

The DOs
• Report any symptoms of pain or difficulty swallowing.
• Ask for second opinions.
• Ask about your prognosis. This is a difficult cancer to cure.
• Understand that nutrition is important both before and after the operation. Because there are difficulty and pain with swallowing, marked weight loss occurs before and especially the days to weeks after the operation. It is important to eat high-calorie foods and nutritional supplements. A nutritionist can be a good resource.
• Ask for emotional support groups, psychiatrists, and social workers to help with coping, rehabilitation, travel, financial issues, and home care.

The DON’Ts
• Do not smoke.
• Do not drink alcohol in excess.
• Do not miss follow-up appointments with your physicians. You have a team of physicians and health care providers, including a primary care physician, surgeon, oncologist, radiation oncologist, nutritionist, physical therapist, and social worker.

When to Call Your Doctor
• If you are having pain with swallowing, difficulty swallowing, or food becoming stuck after eating.
• If you cough up blood or vomit blood.
• If you are short of breath, coughing, and have a fever.
• If you have a fever after chemotherapy.
• If you cannot eat and continue to lose weight.
• If you have pain.