Esophageal Cancer | Symptoms & Treatment | MedStar Health

Our multidisciplinary specialists use novel diagnostic and surgical approaches to care for patients with esophageal cancer.

At MedStar Health, our experts are skilled at diagnosing and treating the disease with advanced therapies and minimally invasive surgery, when possible. Through our comprehensive and integrated Lung and Esophageal Center, we work as a team under one roof at each of the locations we see patients. This enables us to seamlessly coordinate care by reducing additional appointments and expediting treatment when necessary.

Timely treatment is important because this form of cancer can be aggressive. This type of cancer develops inside the esophagus, which is a muscular tube that carries swallowed food and drink to the stomach. It's a rare disease, but it's on the rise. If you've been diagnosed with this cancer, you need a team of specialists who have access to emerging technologies and drugs that may offer promising outcomes. Because we're part of the Georgetown Lombardi Comprehensive Cancer Center, you'll benefit from access to the latest research and clinical trials to find new and better ways to treat the disease.

In addition to treating this type of cancer, our specialists work diligently to prevent it. Because there are several risk factors known for the disease, we can help you identify and modify your chances of developing the disease or catching it early when there are more treatment options.

Symptoms and risk factors

Difficulty swallowing may be a sign of cancer in the esophagus.

  • In early stages, this type of cancer usually does not produce symptoms. However, as it grows, symptoms of esophageal cancer may include:
  • Difficult or painful swallowing
  • Severe weight loss
  • Pain in the throat or back, behind the breastbone, or between the shoulder blades
  • Hoarseness or chronic cough
  • Vomiting
  • Coughing up blood

These symptoms may be caused by cancer or other conditions, so it's important to see a doctor to determine the cause. Survival rates are highest when it’s detected early.

Heavy alcohol and tobacco use increases your risk of the disease.

The exact causes of cancer of the esophagus are unknown and there are slightly different risk factors for both types of esophageal cancer. However, studies show that any of the following factors can increase the risk of developing the disease:

  • Age: Esophageal cancer is more likely to occur as people get older, and most people who develop this cancer are over age 60.

  • Gender: Cancer of the esophagus is more common in men than in women.

  • Obesity: Being overweight increases your risk of esophageal adenocarcinoma, which is typically found closer to the stomach

  • Tobacco use: Smoking cigarettes or using smokeless tobacco is one of the major risk factors for this type of cancer.

  • Alcohol use: Chronic and/or heavy use of alcohol is another risk factor for this cancer. People who use both alcohol and tobacco have an exceptionally high risk, as scientists believe these substances increase each other's harmful effects.

  • Barrett's esophagus: Tissues at the bottom of the esophagus can become irritated if stomach acid frequently backs up into the esophagus — a problem called gastric reflux. Over time, cells in the irritated part of the esophagus may change and begin to resemble the cells that line the stomach. This condition, known as Barrett's esophagus, is a precancerous condition that may develop into cancer.

  • Gastroesophageal reflux disease (GERD): GERD occurs when acid flows backward from the stomach to the esophagus. This can cause irritation, inflammation, and pain (heartburn) and may increase the risk of cancer in the esophagus.

  • Achalasia: This condition occurs when food becomes lodged in the esophagus. Achalasia develops if a muscular defect prevents the lower esophageal sphincter from relaxing and emptying contents into the stomach.

  • History of cancer: Patients who have had other head and neck cancers have an increased chance of developing a second cancer in the head and neck area.

  • Other types of irritation: Other causes of significant irritation or damage to the lining of the esophagus, such as swallowing lye or other acidic substances, can increase the risk of developing this cancer.

Screening and prevention

Adopt healthy lifestyle changes to lower your risk of this type of cancer.

A few lifestyle changes are suggested to prevent or reduce the risk of developing esophageal cancer. The good news is that most of these prevention tips will also help prevent many other types of cancer.

  • If you smoke, stop! This may be the single most important thing you can do to prevent this cancer and improve your overall health. Smoking causes acid reflux and also damages cell DNA of the esophagus.
  • Limit alcohol consumption. Many esophageal squamous cell carcinomas and adenocarcinomas result from heavy alcohol consumption over the years. Abstaining from alcohol or drinking in moderation can greatly reduce your risk. Aim to have no more than one drink daily (for women) or two drinks daily (for men).
  • Eat a healthy diet. Eating healthy foods is a good way to reduce your risk for many diseases. Fresh fruits and vegetables, especially those that are dark green or yellow, are great for cancer prevention.
  • Keep a healthy weight. Being significantly overweight increases your risk of developing this cancer and other serious health problems, such as diabetes, cardiovascular disease, and stroke. Talk to your family physician about developing a plan to lose weight by eating well and exercising regularly.
  • Don't let heartburn go untreated. Chronic heartburn raises your risk factor. If you experience heartburn often, see your doctor.

If you have Barrett's esophagus, you may benefit from regular screening.

Unlike other types of cancer, we do not regularly screen most people for esophageal cancer. If you have a high risk, like a history of Barrett's esophagus or chronic acid reflux, you may be referred to our Gastrointestinal Cancer Prevention program where our specialists can help you manage your chances of developing the disease. Your personalized risk management plan may involve a screening test that uses endoscopy to find cancer early while it's more easily treated. During an endoscopy screening, a gastroenterologist uses an endoscope (thin lighted tube attached to a small camera) to evaluate the upper digestive tract for anything abnormal.

Diagnosis

Endoscopy is the most common way we detect and diagnose esophageal cancer.

If you have symptoms, a gastroenterologist may perform several tests and procedures to determine if you have cancer. If a diagnostic test confirms you have a cancerous tumor, we'll gather additional information about your tumor, which will help us design a treatment plan that will be most effective in addressing your cancer.

Diagnostic tests and tools may include:

  • Reviewing your symptoms and medical history: We'll conduct a physical exam and ask you about your symptoms and history of any other related health conditions.

  • Biopsy: We use a thin, lighted tube called an endoscope to view the inside of your esophagus (called an esophagoscopy). We may also take a small tissue sample from the esophagus, which we'll send to pathology. Then, a specialist in this type of cancer will evaluate the cells from under a microscope to determine their characteristics.

  • Imaging: If the tissue sample confirms cancer, we will use advancing imaging technology to understand how far it has spread. This may include:

    • CT scans

    • PET scans

    • MRIs

    • Endoscopic ultrasounds, during which an endoscope is attached to an ultrasound probe

    • Bronchoscopy

The staging process indicates how advanced the cancer is based on its size and whether or not it has spread (metastasized).

  • Stage 0: Cancer is located in the inner lining of the esophagus (sometimes called high-grade dysplasia)
  • Stage I: Cancer has spread to the inner layers of the esophagus wall (mucosa)
  • Stage II: Cancer has spread to the outer layers of the esophagus wall (muscle and connective tissues)
  • Stage III: Cancer has spread to nearby tissue and/or some lymph nodes
  • Stage IV: Cancer has spread to other organs in the body, such as the liver

Types of cancer

Cancer that begins in the esophagus is divided into two major types depending on the kind of cells that are malignant. The distinction between the two is important because it may affect how we approach treatment.

  • Squamous cell carcinoma occurs in the squamous cells lining the esophagus and usually occurs in the upper and middle parts of the esophagus.
  • Adenocarcinoma occurs in glandular tissue, most often in the lower part of the esophagus near the stomach.

If cancer comes back after treatment, it is called recurrent esophageal cancer.

Treatments

Our esophageal specialists are skilled at treating all stages of disease.

As with any cancer, treatment depends on many factors, including the size, location, extent of your tumor, and your general health. At MedStar Health, patients benefit from individualized care plans that involve input from several specialists to ensure we consider all of your options. Treatment may include surgery, chemotherapy, and/or radiation, including novel therapies backed by the latest research and clinical trials.

Patients are treated by a team of doctors with expertise in different areas, including:

  • Gastroenterologists who specialize in diagnosing and treating disorders of the digestive system
  • Surgeons who focus exclusively on treating conditions affecting the esophagus and lungs
  • Medical oncologists who specialize in treating cancer with medication
  • Radiation oncologists who specialize in using radiation to treat cancer
  • Nurse practitioners who may serve as your point of contact and aid in your care coordination

The role of nutrition

Because cancer treatment may make the mouth sensitive and at risk for infection, doctors often advise patients to see a dentist for a dental exam and treatment before cancer treatment begins. Other specialists may also round out your care team, including dietitians who will help to optimize your nutrition before, during and after treatment. This form of cancer can make it harder to swallow and maintain a healthy weight, so you may need to make changes to your diet to ensure you get enough of the right nutrients. These eating adjustments may involve smaller, more frequent meals, eating different types of food, and/or modifying how you eat (e.g., through a straw or at a certain temperature).


Surgery

The majority of patients with esophageal cancer undergo surgery as part of their treatment plan. For patients with very early-stage cancer, a gastroenterologist may perform an endoscopic mucosal resection to remove the cancerous tissue while preserving the esophagus. However, most patients receive an esophagectomy, which surgically removes the tumor and affected esophageal tissue. Then, the stomach is attached to what's left of the healthy esophagus. You may need a stent or a feeding tube during recovery to ensure you receive adequate nutrition during the healing process.

At MedStar Health, our thoracic surgeons are skilled at performing esophagectomies using minimally invasive techniques, including robotic-assisted surgery. Minimally invasive surgery allows patients to recover faster than open surgery and it may even result in better outcomes. Not every patient is a candidate for minimally invasive surgery, and our doctors are experts in determining which approach will offer the best result for you.

Patients who cannot undergo surgery may benefit from stenting. A stent is a metal mesh, plastic, or silicone tube placed in the esophagus, which can help alleviate symptoms and make it easier to eat.

Learn More About Thoracic Surgery

Chemotherapy

Chemotherapy uses drugs to kill cancer cells wherever they are. Because it affects the entire body, it's called systemic therapy. Doctors who use chemotherapy to treat cancer are called medical oncologists. At MedStar Health, your medical oncologist is often the quarterback of your care team who helps you to navigate care and understand your treatment options, whether you have early or late-stage form of cancer.

When your cancer has spread through the walls of the esophagus and/or nearby lymph nodes, it's considered to be locally advanced. In these cases, you may benefit from chemotherapy in combination with radiation therapy before surgery (chemoradiation) or just chemotherapy before and after surgery. These decisions are made on a case-by-case basis depending on what your doctor thinks will be the safest, most effective way to address your cancer.

Learn More About Chemotherapy

Immunotherapy and targeted therapy

For patients who are not candidates for surgery or when surgery or radiation is not enough to cure metastatic disease, we may use genomic profiling to find any targetable genetic mutations. Novel treatments may more effectively attack tumors with these specific characteristics using targeted therapy drugs or immunotherapies that harness the power of the body's immune system to kill cancer cells. At MedStar Health, we're involved in clinical trials that test the role of these therapies in various stages of esophageal cancer.

Learn More About Immunotherapy

Learn More About Targeted Therapy

Radiation therapy

Radiation therapy uses high-energy beams to shrink or eliminate tumors. When it comes to treating cancer in the esophagus, radiation may be used in combination with chemotherapy (chemoradiation) to make a tumor smaller before surgery. In some instances, we can even eliminate the need for surgery altogether by using this combined approach.

Our radiation oncologists are experts in using the latest technologies to safely deliver the right amount of radiation to the esophagus. In fact, we're one of few cancer programs that have radiation oncologists dedicated to treating only patients with gastrointestinal cancers. This focused expertise makes us uniquely experienced in specialized radiation techniques to treat the esophagus, including:

  • External radiation therapy, which delivers radiation from outside of your body. When treating the esophagus, we integrate respiratory motion technology to track the precise position of your tumor while you breathe. This type of radiation may be delivered using the following:
    • Proton beam therapy is an exceptionally precise form of radiation that minimizes the impact of radiation to critical organs, like the heart and lungs
    • Intensity-Modulated Radiation Therapy (IMRT) adjusts the movement and intensity of the radiation beams to minimize radiation exposure to healthy tissue
    • Image-Guided Radiation Therapy (IGRT) uses imaging technology to create a mold of your tumor's size, shape, and location so that radiation can be more precise
  • Internal radiation therapy (brachytherapy) delivers radiation through tiny radioactive "seeds" planted in the esophagus.

Learn More About Radiation Therapy

Looking for expert cancer care?

With multiple locations throughout the region, patients have access to many of the nation’s renowned cancer specialists offering high quality care, second opinions and a chance for better outcomes close to where they live and work. Georgetown Lombardi Comprehensive Cancer Center, one of the nation’s comprehensive cancer centers designated by the National Cancer Institute (NCI), serves as the research engine allowing patients access to clinical trials that often lead to breakthroughs in cancer care.

Our locations

Distance from Change locationEnter your location

MedStar Franklin Square Cancer Center at Loch Raven Campus

5601 Loch Raven Blvd.
Russell Morgan Building
First Floor
Baltimore, MD 21239

MedStar Georgetown Cancer Institute at MedStar Franklin Square Medical Center

9103 Franklin Square Dr.
The Harry and Jeanette Weinberg Cancer Institute
Suite 220
Baltimore, MD 21237

MedStar Georgetown Cancer Institute at MedStar St. Mary’s Hospital

25500 Point Lookout Rd.
First Fl.
Leonardtown, MD 20650

MedStar Health: Gastroenterology at MedStar Washington Hospital Center

110 Irving Street, NW
Room 3A-3
Washington, DC 20010

Why choose us

Our specialists are dedicated to caring for patients with esophageal cancer, and this focused expertise makes us highly experienced. Your care team involves doctors with specialty training in treating gastrointestinal cancers with the latest techniques in surgery, radiation, medication, and interventional radiology. We work together as a team, meeting regularly in multidisciplinary tumor boards that allow us to collaborate on a treatment plan that is designed to meet your unique needs.

We offer state-of-the-art diagnostic, therapeutic, and surgical options backed by the latest research. Through our partnership with the Georgetown Lombardi Comprehensive Cancer Center, a National Cancer Institute-designated comprehensive cancer center our patients benefit from state-of-the-art research, technology, and clinical trials before they're widely available elsewhere. We regularly participate and lead investigations and clinical trials that offer novel therapies and new combinations of treatments to improve patient outcomes. Many times, we're the first or one of few to provide these options before they're widely available.

You'll receive comprehensive care that addresses your health holistically. You're more than just a diagnosis, and we are dedicated to meeting any needs that arise during your cancer journey. Your care team may involve dietitians, psychologists, social workers, nurses, and others who will help you maintain the best quality of life possible during and after treatment. We also offer access to peer-to-peer mentoring programs, support groups, educational events, and other opportunities to connect with others who have been where you are and can encourage you along your journey.

Awards and recognition

Recipient of an Accreditation with Commendation, the highest level of approval, from the American College of Surgeons’ Commission on Cancer (CoC)

Numerous surgeons, medical oncologists, and surgical oncologists recognized as "Top Doctors" by both Baltimore Magazine and the Washingtonian

Magnet® designation from the American Nurses Credentialing Center (ANCC)

Clinical trials and research

Clinical trials

Clinical trials are important for advancing esophageal treatment options, and we routinely participate in and lead trials that we believe offer benefits to our patients. If you have esophageal cancer, talk to one of our doctors to see if you may be eligible for a clinical trial.

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Research

Our oncologists regularly collaborate with scientists to investigate new therapeutics and treatment combinations. For example, we've learned that adding immunotherapy to chemotherapy upfront can improve outcomes for patients with metastatic esophageal cancer. This discovery has led to several FDA approvals, and we continue researching if this approach can benefit patients with early-stage disease as well.

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Patient stories

Support services

At MedStar Health, we know your needs extend beyond your cancer treatment. That's why we offer a full range of support services to help you feel your best and thrive as you navigate treatment and survivorship. Our team is here to help address any physical, emotional, or spiritual needs you may have.

Learn More About Cancer Support Services

Genetic counseling

Our board-certified genetic counselors offer comprehensive services to help you identify and manage your hereditary risk of cancer. Some cancers are caused by inherited gene mutations. If you have these mutations, genetic counseling can help you understand and minimize your risk of developing a secondary GI cancer.

Learn More About Genetic Counseling

Personalized rehabilitation

Our comprehensive rehabilitation services may include several types of therapies designed to help improve your quality of life. For some, physical therapy is helpful for regaining strength and endurance following treatment. Other patients may benefit from the help of nutritionists and speech-language pathologists who can help address challenges in eating, swallowing, or breathing.

Learn More About Cancer Rehabilitation

Survivorship

As a cancer survivor, we're here for you however you need us. If you need support in adopting a healthy lifestyle that may prevent recurrent or secondary cancer, we can help you quit smoking or adjust your diet. If you need someone to talk through your experience with, our counselors, social workers, and support groups can help you navigate life after treatment. And if pain or side effects linger, we'll build a personalized plan that addresses your needs.

Learn More About the Cancer Survivorship Program