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Esophageal cancer

Esophageal carcinoma, adenocarcinoma, squamous cell carcinoma

Esophageal cancer (esophageal carcinoma) is a tumor in the area of the esophagus. Experts distinguish between two types of esophageal cancer according to the type of tissue. Risk factors include smoking and alcohol, as well as chronic reflux of stomach acid ("heartburn"). Difficulty swallowing is a warning sign.

What is esophageal cancer?

Esophageal cancer (esophageal carcinoma) is a malignant tumor of the esophageal mucosa (esophagus). Experts distinguish between two types of esophageal cancer:

  • Adenocarcinomas: These develop from glandular cells. They occur in the lower section of the esophagus.
  • Squamous cell carcinomas: Squamous cell carcinomas develop in the upper and middle esophagus

The most important risk factors for squamous cell carcinoma of the oesophagus are frequent consumption of high-proof alcohol and smoking. Risk factors for adenocarcinoma are chronic heartburn and obesity. Esophageal cancer gradually narrows the esophagus. As the oesophagus is a very flexible organ, those affected usually only have problems absorbing food at a very advanced stage.

Frequency of esophageal cancer

In Switzerland, around 570 people are diagnosed with esophageal cancer every year. This corresponds to around one percent of all cancer cases in Switzerland. Three quarters of men are affected, one quarter of women. Esophageal carcinomas predominantly occur at an older age.

Esophageal cancer: causes and risk factors

The causes of esophageal cancer are not yet fully understood. The risk factors include:

  • Alcohol consumption,
  • Smoking,
  • Overweight,
  • very hot drinks,
  • chronic heartburn,
  • Partial closure of the entrance to the stomach,
  • Acid or alkali burns,
  • Tumors in the mouth and neck area,
  • Radiation in the neck and chest area,
  • Barrett’s syndrome (abnormally altered mucous membrane of the lower esophagus),
  • Congenital malformation of the esophagus (so-called achalasia) or acquired changes (e.g. scars).

Gastric and esophageal tumor center

At the USZ, numerous specialist departments have joined forces to form a gastric and esophageal tumor center. The center is certified according to the guidelines of the German Cancer Society (DKG). A team of experts specializing in the medical treatment of oesophageal cancer works closely together here for the benefit of our patients. At DKG-certified centers, patients are treated according to strict quality criteria and, according to current studies, have a better chance of survival on average.

Esophageal cancer often without symptoms at first

In many patients, esophageal cancer initially causes hardly any symptoms. This is why a disease is only noticed when it is already advanced.

Typical warning signs of esophageal cancer are:

  • Difficulty swallowing and pain when eating due to narrowing of the esophagus,
  • frequent ingestion,
  • Loss of appetite and weight loss,
  • Hoarseness,
  • vomiting for no reason,
  • Blood in the stool (tarry stool),
  • A feeling of pressure or pain behind the breastbone and in the back when the tumor constricts the esophagus and food accumulates in the esophagus; these symptoms are usually less severe with liquid or soft foods such as soups or porridge.

Please do not hesitate to visit us if you have complaints over a longer period of time.

Esophageal cancer: Diagnosis with us

To diagnose esophageal cancer, we will first ask you about your symptoms. Various examinations are also possible.

  • Esophagoscopy (endoscopy of the esophagus)
    During an esophagoscopy, we examine the esophagus using a thin, flexible tube with an integrated camera (endoscope). For the examination you have to swallow the tube as you would for a gastroscopy. That sounds more unpleasant than it actually is. If you wish, you can be given a mild painkiller and/or sedative as a preventive measure. During the examination, we look at your esophageal mucosa with the endoscope and may take small samples (biopsies) from conspicuous areas. The samples help to determine whether a tumor is present and what type of tumor it is. We can also use esophagoscopy to clarify in which section of the esophagus the mucous membrane is affected, whether multiple cancer foci have developed on the mucous membrane and whether the esophagus is narrowed. In addition, tumors that protrude into the esophagus and interfere with eating can be removed superficially during esophagoscopy.
  • X-ray examination
    With the help of an X-ray examination, we can detect whether your esophagus is narrowed by a tumor. To do this, you swallow a contrast agent in the form of a paste. This is why the examination is also called an esophageal bile swallow.
  • Endosonography
    Endosonography is a special form of ultrasound examination. As with esophagoscopy, you will also have to swallow a small tube. An ultrasound device is attached to the tip of the tube, which the doctor can use to examine the inside of the esophagus.
  • Computed tomography (CT)
    A computer tomography (CT) scan of the chest and neck can show whether the tumor has spread to the area surrounding the esophagus and whether lymph nodes or other organs may be affected.
  • Magnetic resonance imaging
    Magnetic resonance imaging (also known as magnetic resonance imaging, MRI) is a tomography scan. An MRI allows us to clearly see how the esophageal cancer has spread within the esophageal wall and its surroundings and to differentiate the tumor from healthy tissue.
  • Positron emission tomography/CT (PET/CT)
    PET/CT shows particularly metabolically active areas, for example metastases. We usually use the radioactively labeled sugar „18F-FDG“ as the radioactive substance.
  • Lung endoscopy (bronchoscopy)
    During a bronchoscopy, we examine the trachea and bronchi using a tube-shaped instrument with an integrated camera (bronchoscope). With the help of this visual examination, we can detect changes in the mucous membrane of the trachea and the subsequent large bronchi and, if necessary, take tissue samples (biopsy). If a lump is causing breathing difficulties, we can partially remove the lump during the lung endoscopy and alleviate the symptoms.
  • Abdominal cavity endoscopy (laparoscopy)
    In some cases, an endoscopy of the abdominal cavity (laparoscopy) is indicated. For example, if the esophageal carcinoma has affected the lower part of the esophagus and is growing into the stomach. This imaging procedure helps the doctor to assess whether the esophageal cancer has formed metastases in the abdominal cavity and the lymph nodes located there. We can also take small tissue samples for further examination as part of a laparoscopy.
  • Staging: Determination of the cancer stage
    The TNM classification helps us to determine the stage of the cancer:

    • T: Extension of the tumor into the depth of the esophageal wall,
    • N: Number of affected lymph nodes (English nodes) and
    • M: Infestation of distant organs by metastases.

Esophageal cancer: prevention, early detection, prognosis

Smoking and excessive alcohol consumption increase the risk of esophageal cancer. You can prevent esophageal cancer by avoiding these addictive substances. Chronic heartburn also increases the risk of illness. If stomach acid repeatedly flows into the esophagus (so-called reflux), the acid burns the mucous membrane. This can develop into beret syndrome. In Barrett’s syndrome, the esophageal mucosa may change into a precursor of esophageal cancer. Consult us if you suffer from heartburn over a longer period of time.

Progression and prognosis of esophageal cancer

If esophageal cancer (esophageal carcinoma) is detected in time, the chances of recovery are good. But this is rarely the case. The more advanced the esophageal cancer, the more difficult it is to treat.

Second opinion for esophageal cancer

When a cancer diagnosis is made, a second medical opinion is an important decision-making tool. The Comprehensive Cancer Center Zurich supports you with a professional expert opinion. They receive a thorough analysis of the situation as well as personal advice and quick answers to their questions.

Esophageal cancer: Treatment

Local treatment of esophageal cancer is usually successful. Provided that no metastases have formed in other organs and the original tumor has not spread too far. Which therapy is suitable for patients depends on the type of tumor and the stage of the tumor.

Treatment details