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Esophageal Cancer

Esophageal cancer is a malignancy that begins in the lining of the esophagus, the tube that carries food from your mouth to your stomach.  There are two types of esophageal cancer:  squamous cell carcinoma, which typically is found in the upper or middle portion of the esophagus; and adenocarcinoma, which tends to develop in the lower esophagus. Treatment is similar for both types of esophageal cancer.

People with gastroesophageal reflux disease (GERD) have increased risk for developing cancer of the esophagus because of the continued reflux of acids into the esophagus.  GERD can lead to Barrett's esophagus or dysplasia, which are pre-cancerous conditions indicated by structural changes in the cells lining the esophagus.  Barrett's esophagus and dysplasia are treatable, although diligent follow-up monitoring is essential to watch for recurrence.  Advocate Christ Medical Center offers advanced non-surgical techniques such as endoscopic ultrasound (endostenography) and endoscopic mucosal resection (EMR) to identify and remove precancerous tissue in the esophagus.

People with esophageal cancer for pre-cancerous conditions often experience difficulty swallowing, pain in the throat, back pain between the shoulder blades, chronic cough, hoarseness, vomiting or unexplained weight loss.

How is it diagnosed?
How is it treated?
How does Advocate Christ Medical Center make a difference?
Frequenstly Asked Questions 

How is it diagnosed?

To determine the cause of these symptoms, your doctor may use several methods to examine the esophagus more closely.

  • Esophagram-a series of X-rays of the esophagus.  Before the X-rays, you may be asked to swallow barium, a contrast material that enhances the X-ray images.
  • Endoscopy (esophagoscopy)-a thin, lighted tube inserted through the mouth and down the throat that enables the doctor to see inside the esophagus.
  • Bronchoscopy-similar to endoscopy, bronchoscopy involves a thin scope inserted through the nose or mouth that allows the physician to see inside the esophagus.
  • Endoscopic ultrasound (endosonography)-an advanced procedure that combines endoscopy and ultrasound to create more detailed images of the esophagus and other digestive tract structures including lymph nodes.  This more detailed information is useful in determining cancer staging for lesions in the esophagus-which is critical information for treatment planning. Endoscopic ultrasound can find tumors less than 1 cm (about 0.4 inch), which can't be seen in a CT scan. 
  • Esophagogastroduodenoscopy (also called EGD or upper endoscopy)-allows the physician to examine the inside of the esophagus, stomach and duodenum using an endoscope.  The endoscope is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. In addition to viewing inside the body, the physician can remove tissue samples for biopsy through the endoscope.
  • Computed tomography (CT or CAT scan) also can assist with staging a cancer by identifying whether cancer has spread to other organs.  CT scan is a diagnostic imaging procedure that combines multiple X-rays and computer technology to produce cross-sectional images ("slices") of organs, bones, muscle and other tissue.
  • Tissue biopsy-a small sample of tissue is taken and analyzed to confirm whether it is malignant (cancerous) or benign (non-cancerous). Detailed pathology testing can reveal important details about the cancer's molecular and cellular characteristics, and is a key step in staging a cancer (determining how advanced the cancer is).

How is it treated?

Surgery is the most common initial treatment for esophageal cancer.  If the cancer is found in early stage, physicians may use minimally invasive endoscopic techniques to remove cancerous tissue and lymph node without major surgery.  If the cancer is more advanced, your surgeon may perform an esophagectomy, a surgical procedure that removes a portion of the esophagus and multiple lymph nodes.  The remaining esophagus is reconnected to the stomach.  A plastic tube or portion of the patient's intestine may be used to reconstruct the esophagus.

Chemotherapy may be used before surgery to shrink a tumorf, or after surgery to destroy remaining cancer cells.  Chemotherapy also may be combined with radiation therapy as an alternative to surgery.  Chemotherapy is anti-cancer drugs that are given over a period of time.

Radiation therapy also may be used before, after or instead of surgery.  Radiation therapy also can help lessen pain and to improve the person's ability to swallow by shrinking tumors that are obstructing the esophagus. Radiation therapy can be targeted directly to tumor sites.

How does Advocate Christ Medical Center make a difference?

The Cancer Institute at Advocate Christ Medical Center offers a complete range of cancer-fighting modalities, using standard, state-of-the-art and investigational approaches.

Using laparoscopic or endoscopic tools, our physicians can remove early-stage esophageal lesions and lymph nodes without major surgery. Patients recover more quickly and have less impact on their ability to swallow normally.

Christ Medical Center is one of the few medical centers in the Chicago region to offer endoscopic ultrasound (also called EUS or endosonography) for staging and removal of tumors in the esophagus or other parts of the digestive tract. This non-surgical technique can find tumors measuring 1 cm (about  0.4 inches)-too tiny to be detected by CT scan, and can determine whether or not cancer has invaded lymph nodes.  When performed before surgery, endoscopic ultrasound reveals details that are significant for planning the most appropriate treatment, such as whether chemotherapy or radiation therapy should be considered before surgery or whether surgery should be avoided because of lymph node involvement. 

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