Esophageal Cancer

GENERAL INFORMATION:

What is esophageal cancer? Esophageal cancer is a tumor of the tube connecting the mouth to the stomach. This tube is called the esophagus. Cancer occurs when abnormal cells grow and divide without control or order, often making too much tissue (tumor). Cancer cells may also grow into nearby healthy tissue. They may also break away from the tumor, and travel through the blood stream or lymphatic system to other parts of the body (metastasis).

What causes esophageal cancer? There is no known cause of esophageal cancer. The following may increase the risk of esophageal cancer:

• Alcohol: Drinking too much alcohol for too long. Wine, beer, vodka and other adult drinks contain alcohol.
  
  
• Barrett's esophagus: This disease can happen when you have gastroespohageal reflux (heartburn) for a long time.
  
  
• Diet: Eating foods that have a lot of fat, such as in fried foods, chips, and pork or beef dishes.
  
  
• Gastroesophageal reflux disease: It is also called GERD or heartburn. This is a condition which causes stomach acid to frequently move up the esophagus.
  
  
• Tobacco: The more you smoke or chew tobacco, the greater your risk for esophageal cancer.

What are the signs and symptoms of esophageal cancer? You may not have any signs and symptoms early in esophageal cancer. However, the most common symptom early in the disease is difficulty swallowing. In later esophageal cancer, you may have one or more of the following signs and symptoms:

• Chest or stomach pain or discomfort.
  
  
• Loose bowel movements, blood in the stools, or hard bowel movements.
  
  
• Loss of appetite.
  
  
• Nausea (feeling sick to your stomach) and throwing up.
  
  
• Trouble swallowing, or pain when swallowing.
  
  
• Unplanned weight loss.

How is esophageal cancer diagnosed? You may need one or more of the following tests:

• Barium swallow: A barium swallow is an x-ray of the esophagus and stomach. You will drink a white chalky liquid called barium to help the esophagus show up better on x-ray. A barium swallow takes about 15 to 45 minutes, but x-rays that follow may last up to six hours.
  
  
• Biopsy: Your caregiver may need to do a biopsy to find out if you have esophageal cancer. The results of a biopsy will help you and your caregiver decide on a treatment plan.

• Computerized axial tomography scan: This test is also called a "CAT" scan. A special x-ray machine uses a computer to take pictures of your esophagus and other organs. Your caregivers look at the pictures to see if there is cancer and if it has spread. Before taking the pictures, you may be given dye through an IV in your vein. The dye helps the cancer show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  

• Endoscopy: It is also called an upper GI endoscopy. It may also be called an EGD or esophagogastroduodenoscopy. This test looks at the lining of your esophagus, stomach, and part of your small intestine. The EGD takes about 30 minutes.
  
  
• Magnetic resonance imaging: This test is also called "MRI". Pictures are taken of your pelvis and abdomen (stomach). These pictures can show your caregiver if the cancer has spread.

How is esophageal cancer treated? There are many different ways to treat esophageal cancer. Often two or more kinds of treatment will be used together.

• Surgery: You may need surgery depending on the stage of your cancer. Part of your esophagus may be removed. You may also need to have some lymph nodes taken out. This may help stop the cancer from spreading to other parts of your body.
  
  
• Biologic therapy for cancer: Biologic therapy is medicine given to help your body fight growing cancer cells. It may also make cancer cells weaker and easier to kill. You may need this medicine more than once. You may feel like you have the flu during this therapy.
  
  
• Chemotherapy:
  
  
  • This medicine, often called chemo, is used to treat cancer. It works by killing tumor cells. Chemotherapy may also be used to shrink lymph nodes that have cancer in them. Once the tumor is smaller, you may need surgery to cut out the rest of the cancer.
    
    
  • Many different chemotherapy medicines are used to treat cancer. You may need blood tests often. These blood tests show how your body is doing and how much chemotherapy is needed. Chemotherapy can have many side effects. Caregivers will watch you closely and will work with you to decrease side effects. Chemotherapy can cure some cancers. Even if the chemotherapy does not cure your cancer, it may help you feel better or live longer.
  
  
• Radiation: This is a treatment using x-rays or gamma rays to treat cancer. Radiation kills cancer and keeps the cancer from spreading. It also keeps cancer cells from dividing into new cells, which is one way cancer spreads. Lymph nodes with cancer are also treated with radiation. In some cancers, radiation may be given after surgery to kill cancer cells that were not removed. It may also be given with chemotherapy. Radiation may help decrease pain, control bleeding, and shrink the tumor.

For support and information: Accepting that you have cancer is hard. You and those close to you may feel scared, depressed, angry, or sad. These are normal feelings. Talk to your caregivers, family, or friends about your feelings. You may also want to join a cancer support group. This is a group of people who also have esophageal cancer. Contact the following for more information:

• American Cancer Society
  Phone: 1-800-227-2345
  Web Address: http://www.cancer.org
  

• National Cancer Institute
  Phone: 1-800-422-6237
  Web Address: http://www.cancer.gov
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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