Esophageal Cancer Overview
Esophageal cancer forms in tissues lining the esophagus, the muscular tube through which food passes from the throat to the stomach.
The lining of the esophagus is the most common region where cancer may begin. When these cells of the upper two thirds of the esophagus degenerate into a malignant tumor, the type of esophageal cancer is described as squamous cell cancer. Cancers that develop in the lower third of the esophagus are described as adenocarcinoma.
Wellstar Health System provides superior care for esophageal cancer, offering a comprehensive spectrum of top-notch physicians, treatment options and diagnostic tools. In addition, Wellstar offers innovative advantages in the fight against esophageal cancer including:
- Dedicated GI surgeons, who practice state-of-the-art care in a collegial atmosphere, as well as medical oncologists with special interest in esophageal cancer.
- Cutting-edge technology including the CyberKnife, a highly advanced radiation alternative to surgery that provides new hope to patients with inoperable or complex tumors. Wellstar was the first health system in Georgia to this technology.
- The entire spectrum of diagnostic and interventional treatments—including radiofrequency, resections, endoscopic esophageal removals and spine wands for pain relief.
- Intensity Modulated Radiation Therapy (IMRT), a treatment that allows for the radiation to be tailored to the size and placement of the tumor, while sparing healthy tissue.
- A GI Tumor Board, which meets weekly to present patient cases and craft a personalized treatment plan. The conference is attended by medical oncology, radiation oncology, radiology, pathology, and a team of surgeons including specially trained liver and pancreas surgeons, colorectal surgeons and general surgeons specializing in minimally invasive surgery.
- Clinical trials—more than 200 patients are enrolled annually in Wellstar programs.
While some of these symptoms can also be signs of something far less serious, it is important to see your Wellstar physician if any of these symptoms persist for more than two weeks. Symptoms of esophageal cancer include:
- Difficulty swallowing
- Chest pain unrelated to eating
- Backwards movement of food through the esophagus and possibly mouth (regurgitation)
- Severe, persistent heartburn
- Vomiting blood
- Weight loss
- Alcohol use
- Bile reflux, gastroesophageal reflux disease or Barrett's Esophagus, a condition that involves the abnormal presence of cells in the lower esophagus.
- Chewing tobacco or smoking
- Poor nutrition
- Drinking very hot liquids
Esophageal Cancer Prevention
It is important to refrain from tobacco use and limit alcohol consumption to avoid esophageal cancer. People with symptoms of severe gastroesophageal reflux should seek medical attention.
Reduce Your Risk
- If you smoke, please consider getting help to quit through one of Wellstar's tobacco cessation programs. Wellstar physicians know that not smoking is one of the most important things a person can do to avoid cancer.
- Avoid excess body fat by limiting caloric intake and/or balance caloric intake with ample moderate-to-vigorous exercise.
- Limit alcoholic beverages to no more than one a day.
- Seek medical attention if you experience symptoms of severe gastroesophageal reflux.
Tests and Screenings
In part because esophageal cancer is not as common as other cancers, there are no routine screening tests for the disease. Your Wellstar physician might employ one of several methods to detect esophageal cancer which might include:
- Upper Endoscopy: This test is designed to allow your Wellstar doctor see the lining of the esophagus, stomach and the first section of the small intestine. An endoscopy involves a thin flexible, lighted tube that is placed your throat while you're sedated. If the doctor sees anything abnormal, he or she can take a tissue sample from the suspicious area.
- Upper GI series: A GI series will first involve the patient drinking a liquid containing the mineral barium. The barium will then coat the lining of the esophagus and an x-ray will be able to detect anything that isn't normal in the lining of the gastric organs.
- Endoscopic ultrasound (EUS): In an ultrasound, sound waves are used to make images of your esophagus and related areas. In addition to diagnosing esophageal cancer, an ultrasound can determine whether the cancer has spread, and, if so, where. WellStar does more than many university settings, using endoscopic ultrasounds for staging of cancer.
- Computed Tomography or CT Scan: A CT scan is a technique for imaging body tissues and organs, during which X-ray transmissions are converted to detailed images, using a computer to synthesize x-ray data. A CT scan is conducted with a scanner that rotates around the body to capture detailed images of the organs and tissues inside the body. This method is more sensitive and precise than the chest x-ray.
- Positron emission tomography (PET): Positron emission tomography (PET) scanning has been used to improve the detection of cancer. PET scanning is a powerful tool for staging lung cancer and it is capable of detecting cancer in lung tissues, lymph nodes, bones and other organs in the body.
- Magnetic Resonance Imagery or MRI: During MRI, a powerful magnet linked to a computer makes detailed pictures of areas inside the body, predominately the brain. Wellstar offers an "open" MRI for those uncomfortable with the closed-tube traditional model.
Diagnosis of Esophageal Cancer
If screening tests or check-ups reveal abnormal results, your Wellstar physician will perform further evaluations regarding esophageal cancer as well as determine the extent to which it has spread.
Esophageal Cancer Stages
When esophageal cancer is diagnosed, your Wellstar physician will categorize it by the current stage. Each stage describes the progression of the disease and whether the cancer has spread to other parts of the body. You should talk to your Wellstar physician to understand each stage, and what it means for your treatment plan.
Esophageal Cancer Treatment
Your team of specialists in medical oncology, surgery, radiation oncology, radiology and pathology will work together to assess your best course of esophageal cancer treatment. That will involve the creation of a coordinated plan, staging the disease and designing a personalized treatment plan consistent with the highest standards of care. Your treatment will be tailored to your specific type of esophageal cancer, and it may involve a combination of surgery, radiation and chemotherapy.
Wellstar offers some of the best esophageal cancer physicians in the nation and some of the top surgeons.
You may have several different surgical options, depending on the location of your tumor and whether it has spread. For early stage disease, the tumor and nearby tissue may be the only things that the surgeon will need to remove.
In some cases, lymph nodes are removed. This is done usually so the surgeon can discern whether the cancer has spread to other parts of the body.
Some patients with esophageal cancer may be candidates for a visit to Wellstar's STAT Cancer Clinic, where they can be seen by radiation oncology, medical oncology, pulmonary medicine and thoracic surgery specialists simultaneously at one appointment to develop a comprehensive treatment plan.
Chemotherapy is the use of drugs given by mouth or injection to destroy cancer cells. It can be used to assist in the cure of cancer patients or to prolong life or the quality of life. Adjuvant (after surgery) chemotherapy is administered in certain circumstances when the patient is at high risk for recurrence. Chemotherapy can also be used concurrently with radiation for a cure in Stage 3 esophageal cancer patients. Stage 4 patients are often treated with chemotherapy or targeted therapies to prolong survival and control symptoms.
Medical oncologists at Wellstar believe in a personalized approach to esophageal cancer therapy—often guided by the genetics of the cancer and the condition of the patient.
At Wellstar, radiation is administered by radiation oncologists in coordination with medical oncologists and surgeons. And several innovative radiation therapies are offered, including two found to be extremely effective against difficult cases of esophageal cancer:
- Intensity Modulated Radiation Therapy (IMRT) allows modulation of radiation across the tumor, while sparing healthy surrounding tissue.
- The CyberKnife, an advanced form of non-invasive radiation therapy that allows treatment of cancer that previously was inoperable or complex. Wellstar is the first health system in Georgia to offer the CyberKnife.
Ongoing Care for Esophageal Cancer
Oncology Nurse Navigator Program
Wellstar's Oncology Nurse Navigator Program is designed to team a "nurse navigator" with patients and their families. The nurse navigator not only anticipates what patients and their families need, but helps them work through the treatment system.
Cancer care at Wellstar is more than advanced technology, clinical research, and highly specialized physicians and nurses. It includes an array of supportive care services to improve the patient experience before, during and after treatment. All of these services are available within the Wellstar system, including:
- Counseling services for individuals, couples and families.
- Nutrition services, which allow cancer patients to stay strong through treatment and eat healthier foods that lower cancer risk.
- Physical therapy centers, which allow many rehab options and lymphedema therapy.
- Smoking cessation programs, which offer support to patients who need to come off cigarettes and nicotine. Special services are offered to those who have made prior attempts.
- Retail stores that offer wigs, mastectomy bras and other cancer support products.
- Genetic counseling services, which offer patients and family members who are at high risk to be tested for genetic abnormalities after meeting with a certified genetic counselor.
- Healthplace, which offers programs for cancer patients to regain strength and fight fatigue after chemotherapy or radiation therapy.
Wellstar offers caring and compassionate hospice care for patients and their families in one of Georgia's oldest hospice programs serving Bartow, Cherokee, Cobb, Douglas and Paulding counties. Our certified palliative care physicians and certified registered nurses are dedicated to providing compassionate, quality care in various settings, including home hospice, inpatient hospice nursing homes, assisted living facilities and nursing homes.