The Division of Thoracic and General Surgical Oncology has had extensive experience in treating esophageal cancer. Studies have shown that the outcome of patients undergoing these operations are much better when done in centers which perform these procedures regularly.

Causes of Esophageal Cancer
The causes for esophageal cancer in the U.S. differ depending in what type of cancer is being considered. The risk factors for squamous cell cancer include smoking tobacco and heavy use of alcohol The risk factors for adenocarcinoma are less well understood. People who have Barrett's esophagus, an abnormal lining of the bottom part of the esophagus that is related to acid reflux problems, are at increased risk, as are people who have longstanding acid reflux problems alone.

Symptoms of Esophageal Cancer
The most common symptom of esophageal cancer is difficulty swallowing, or the sticking of food before it gets into the stomach. This is usually a progressive problem which begins initially when large pieces of poorly chewed food are swallowed, but can worsen to the point that thin liquids won't go down easily. Esophageal cancer may also cause weight loss, pain with swallowing, regurgitation of undigested food, and bleeding manifested by vomiting blood or passing old blood with bowel movements.

The main symptoms of esophageal cancer, including difficulty swallowing and weight loss, should prompt a visit to your physician. There is no simple way to determine whether you have esophageal cancer. Tests are usually necessary to determine whether there is a growth (or tumor) in the esophagus that is creating problems with swallowing. If such a problem is identified, a biopsy is necessary to confirm the diagnosis.

Tests performed for Esophageal Cancer:
In someone who is suspected of having esophageal cancer, several tests are appropriate. An endoscopy is usually the first step in evaluation. This is an outpatient test performed under sedation in which a flexible telescope is passed through your mouth and down your esophagus into your stomach. The telescope permits the physician performing the test to look at the lining of the esophagus and take a small bite of tissue, or biopsy, of any areas that look suspicious. The tissue is looked at under a microscope to determine whether there is cancer present.

Other common tests include an x-ray of the esophagus and stomach performed while swallowing a liquid that shows up on x-rays, giving your physician a picture of the lining of your esophagus. Most patients will also undergo computed tomography, or a CT scan, of the chest and abdomen to get a picture of the lungs, liver, and other organs surrounding the esophagus.

The main tumor and adjacent lymph nodes are sometimes evaluated using endoscopic ultrasonography, or EUS. This is an endoscopic test that utilizes a special telescope which emits ultrasound waves that can produce a picture of the tumor and surrounding lymph nodes. A bone scan is sometimes performed to determine whether the cancer has spread to the bones. An experimental staging test is PET scanning, which currently is being assessed for its usefulness in evaluating esophageal cancer.

Operations for Esophageal Cancer – preventing large incisions
In line with our philosophy of  the least invasive incisions, we perform most of our operations for esophageal cancer with only an abdominal and small neck incision, we tend to avoid chest incisions altogether.  We are also working on robotic technologies to avoid large incisions and help quicker post-operative recovery.

Treatment Options:
Don’t give up! Keep hope alive! Ask for a second opinion!
For patients in whom the cancer has not spread to other organs, and thus is potentially curable, surgery to remove the majority of the esophagus is the main form of therapy. Many patients also receive chemotherapy (intravenous drug therapy) and radiotherapy (x-ray treatments) after surgery although there is little information to prove that these additional treatments are useful. Many cancers centers are investigating the usefulness of giving chemotherapy and radiotherapy prior to surgery for patients who are potentially curable.

For patients who are found to have cancer spread to other organs or who, for some other reason, can't have surgery, combined chemotherapy and radiotherapy is the most common treatment. Since swallowing difficulties are not always immediately relieved by this combined therapy, other means to improve swallowing are available. These include stretching the esophagus, burning or melting the tumor away using laser treatment, or placement of a flexible tube (or stent) inside the esophagus to maintain the swallowing passage.  We have started using Photo Dynamic Therapy (PDT), a specialized laser treatment, to help people with esophageal cancer to swallow better.