Misdiagnosis can potentially be fatal, as esophageal cancer has a low survival rate in its later stages. Symptoms typically begin to manifest after the cancer becomes advanced, making it difficult to cure. Additionally, many of the symptoms can be attributed to less serious conditions. If misdiagnosed or undiagnosed, esophageal cancer often spreads to the stomach, lungs, or liver.
Esophageal cancer can often be mistaken for:
- Acid reflux
- Esophageal tuberculosis
- Esophageal fistula
Esophageal cancer is characterized by a malignant tumor on the esophagus. The esophagus is the muscular tube-shaped organ that passes food from the mouth, through the pharynx, and into the stomach. Esophageal cancer has a poor prognosis and high death rate if diagnosed in its later stages. The five-year survival rate is roughly 10% to 15%.
Types of Esophageal Cancer
Esophageal cancer typically manifests as a carcinoma arising from the epithelium, or surface lining, of the esophagus. There are two main types: squamous cell carcinoma and adenocarcinoma. A general “rule of thumb” states that cancer in the upper two-thirds of the esophagus is a squamous cell carcinoma. Esophageal cancer in the lower third is often adenocarcinoma. There are also several rare variants of squamous cell carcinoma and non-epithelial tumors, including melanoma, leiomyosarcoma, and lymphoma.
Squamous Cell Carcinoma:
The most common type of esophageal cancer is squamous cell carcinoma. It accounts for roughly 90% to 95% of worldwide esophageal cancer cases. Squamous cell carcinoma is the most common because the esophagus is made of several thin, flat squamous cells resembling roofing shingles. Squamous cells line the upper section of the esophagus. This type of esophageal cancer is associated with alcohol and tobacco consumption.
Adenocarcinoma accounts for roughly 50% to 80% of esophageal cancer cases in the United States. It affects the glandular cells that are located where the esophagus meets the stomach.Esophageal cancer is commonly found in patients with a history of Barrett’s esophagus and gastroesophageal reflux disease (GERD). These conditions are characterized by chronic acid exposure, which is believed to be a link to esophageal cancer.
Symptoms of Esophageal Cancer
Symptoms of esophageal cancer include:
- Dysphagia (difficulty swallowing)
- Odynophagia (painful swallowing)
- Substantial weight loss
- Pain behind the sternum
- Burning sensation similar to heartburn
- Hoarse or raspy cough
- Nausea, vomiting, or food regurgitation
Barium Swallow or Barium Meal
During a barium swallow, the patient ingests barium sulfate before an X-ray. Barium sulfate appears opaque to an X-ray. This provides a detailed, hollow image to be examined for irregularities that indicate esophageal cancer. A barium meal utilizes a radiograph as opposed to an X-ray after barium consumption.
An EGD, or upper endoscopy, is an effective method for esophageal cancer diagnosis. During an EGD, a flexible tube is passed down the esophagus to examine the esophageal wall. If a suspicious lesion is spotted, a biopsy is taken and examined for malignancy.
Computed Tomography (CT) and Positron Emission Tomography (PET)
Once diagnosed, a CT or PET scan is typically used to estimate the stage of the esophageal cancer tumor. They are also used to monitor the abdomen, chest, and pelvis to evaluate if the cancer has spread. Special focus is typically placed on the liver and lymph nodes, as these are commonly affected.