Esophagus

Esophageal cancer is cancer that forms in tissues lining the esophagus (the hollow, muscular tube that connects the throat to the stomach which lies behind the trachea and in front of the spine.

Cancer of the esophagus usually begins in the inner layer of the esophageal wall (the mucosa) and grows outward (through the submucosa and the muscle layer). If it spreads through the esophageal wall, it can travel to lymph nodes, blood vessels in the chest, and other nearby organs. Esophageal cancer can also spread to the lungs, liver, stomach, and other parts of the body.

The two major types of esophageal cancer are squamous cell carcinoma (cancer that begins in flat cells lining the esophagus) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).

Squamous cellcarcinoma

Cancer begins in the squamous cells which line the esophagus and is usually detected in the upper and middle part of the esophagus.

Adenocarcinoma

Cancer start in glandular cells of the esophagus. Most adenocarcinomas begin in the lower esophagus where the esophagus joins the stomach.

Very rarely, in less than 1% of tumors of the esophagus, cancers include small cell neuroendocrine cancers, lymphomas, and sarcomas.

The two most common forms of esophageal cancer are named for the type of cells in which the cancer originates.

Squamous cell carcinoma: cancer that forms in squamous cells, the thin, flat cells lining the esophagus. This cancer is most often found in the upper and middle part of the esophagus, but can occur anywhere along the esophagus.

Adenocarcinoma: cancer that begins in glandular cells in the lining of the esophagus that produce and release fluids such as mucus. Adenocarcinomas usually form in the lower part of the esophagus, where the esophagus connects with the stomach.

Stages of squamous cell carcinoma of the esophagus: staging of esophageal cancer depends on where the cancer is found and the extent of its growth.

Stage I Squamous cell carcinoma

Stage IA: cancer has formed in the inner layer of the esophageal wall and closely resemble normal cells.

Stage IB: cancer has formed in the inner layer of the esophageal inner layer but do not resemble healthy cells and/or spread into the middle muscle layer of the esophageal wall.

Stage II Squamous cell carcinoma

Stage IIA: cancer has spread into the muscle layer or the outer connective tissues layer of the esophageal wall and the tumor cells resemble healthy cells or the tumor cells do not look like normal and the cancer is located in the lower esophagus.

Stage IIB: Cancer has spread into the muscle layer or the connective layer of the esophageal wall, tumor is located in the upper of middles esophagus or tumor is in the inner layer, muscle layer and/or 1 or 2 nearby lymph nodes.

Stage III Squamous cell carcinoma

Stage IIIA: cancer is in the inner layer and may have spread into the muscle layer of the esophageal wall. Cancer is found in 3-6 lymph nodes near the tumor, or has spread into the outer layer of the esophageal wall and 1 or 2 nearby lymph nodes, or has spread into the outer layer with lymph node involvement, or has spread into the diaphragm or heart.

Stage IIIB: cancer has spread into the connective layer of the esophageal wall. Cancer is found in 3 to 6 nearby lymph nodes.

Stage IIIC: cancer has spread into the diaphragm or sac around the heart. Cancer is found in 1 to 6 lymph nodes near the tumor, or into other nearby organs, such as the aorta, trachea, or spine and cannot be removed by surgery.

Stage IV Squamous cell carcinoma

Stage IV: cancer has spread to distant organs of the body.

Stages of Adenocarcinoma of the esophagus:

Stage I Adenocarcinoma of the esophagus

Stage IA: cancer has formed in the inner layer of the esophageal wall. Cancer cells resemble normal cells.

Stage IB: cancer has formed in the inner layer of the esophageal wall. The tumor cells no longer resemble normal cells, and may be fast-growing or the cells resemble normal cells but the cancer has spread into the middle muscle layer of the esophagus.

Stage II Adenocarcinoma of the esophagus

Stage IIA: cancer has spread to the muscle layer of the esophageal wall and the tumor cells do not resemble normal cells and grow quickly.

Stage IIB: cancer has spread into the outer layer of the esophageal wall or is present in the inner layer and spread to 1 or two lymph nodes.

Stage III Adenocarcinoma of the esophagus

Stage IIIA: cancer is in the inner layer and may have spread into the muscle layer of the esophageal wall. Cancer is found in 3 to 6 lymph nodes near the tumor or has spread into the outer layer of the esophageal wall and into 1 or 2 lymph nodes near the tumor or has spread into the diaphragm or sac surrounding the heart.

Stage IIB: cancer has spread into the outer layer of the esophageal wall and is found in 3 to 6 lymph nodes near the tumor.

Stage IIIC: cancer has spread into the diaphragm or sac around the heart, has spread to 1 to 6 lymph nodes near the tumor, or into other nearby organs.

Stage IV Adenocarcinoma of the esophagus

Stage IV: Cancer has spread to distant organs of the body.

Treatment of esophageal squamous cell carcinoma and adenocarcinoma:

Stage I: Treatment may include surgery, chemoradiation therapy, and clinical trials.

Stage II: Treatment may include chemoradiation therapy followed by surgery, chemoradiation therapy alone, and clinical trials.

Stage III: Treatment may include chemoradiation followed by surgery, chemoradiation alon, and clinical trials.

Stage IV: Treatment may include an esophageal stent to relieve symptoms, radiation, laser surgery or electrocoagulation, chemotherapy, and clinical trials.

National Cancer Institute Clinical Trials
http://www.cancer.gov/clinicaltrials/results/type/esophageal

Cancer Research Institute NY
Immunotherapy Trials
http://www.theanswertocancer.org/?gclid=CNXz1qilxcACFZJr7AodU00Aqw

Center Watch Clinical Trial Database
https://www.centerwatch.com/clinical-trials/listings/condition/163/esophageal-cancer

ClinicalTrials.gov
This database of publicly and privately supported clinical trials is maintained by the National Library of Medicine at the NIH.
http://www.clinicaltrials.gov/

Coalition of Cancer Cooperative Groups
This organization provides resources and information about clinical trials.
http://www.cancertrialshelp.org/default.aspx

EmergingMed Navigator
EmergingMed offers a phone and Internet-based service that identifies clinical trial options that match a patient’s specific diagnosis, stage and treatment history.
http://www.emergingmed.com

WHO International Clinical Trials Registry Platform Search Portal.
The World Health Organization (WHO) coordinates health matters within the United Nations. This database allows people to search clinical trial registration information from many countries’ registries.
http://apps.who.int/trialsearch/Default.aspx

Esophageal Cancer Action Network
http://www.ecan.org/site/PageServer?pagename=home

Cancer Care
http://www.cancer.net/cancer-types/esophageal-cancer/additional-resources

Cancer.Net cancer resources
http://www.cancercare.org/diagnosis/esophageal_cancer

Pembrolizumab Promising in Advanced Esophageal Cancer
Jan 7, 2018
https://www.medpagetoday.com/hematologyoncology/othercancers/70332

Study Compares Risks of Treatments for Early Esophageal Cancer EndoNurse
July 29, 2014
http://www.endonurse.com/news/2014/07/study-compares-treatments-for-early-esophageal-cancer.aspx

Stage Esophageal Cancer After Neoadjuvant Chemo
The Oncology Report
July 28, 2014
http://www.google.com/search?client=safari&rls=en&q=esophageal+cancer&ie=UTF-8&oe=UTF-8#q=esophageal+cancer&rls=en&tbm=nws

Using Liquid Nitrogen as a Treatment for Early Esophageal Cancer SunSentinel
July 8, 20142014
http://www.google.com/search?client=safari&rls=en&q=esophageal+cancer&ie=UTF-8&oe=UTF-8#q=esophagea

Cancer Support Community
http://www.cancersupportcommunity.org/

Cancer Care: counseling, support groups, financial assistance
http://www.cancercare.org/

ECAA Esophageal Cancer Awareness Association
http://www.ecaware.org/

Daily Strength
http://www.dailystrength.org/c/Esophageal-Cancer/support-group