How Long Does Esophageal Cancer Take to Develop?

Esophageal cancer is classified according to the type of cells that are involved. The type of esophageal cancer helps to determine the appropriate treatment options. Types of esophageal cancer include:

• Adenocarcinoma: Adenocarcinoma is the most common form of esophageal cancer and begins in the cells of mucus-secreting glands in the esophagus. In adenocarcinoma, squamous cells that normally line the esophagus are replaced by gland cells. This typically occurs in the lower esophagus.
• Squamous cell carcinoma: The squamous cells are flat, thin cells that line the surface of the esophagus. Squamous cell carcinoma occurs most often in the upper and middle portions of the esophagus. Squamous cell carcinoma is the most prevalent esophageal cancer worldwide.
• Other rare types: Some rare forms of esophageal cancer include small cell carcinoma, sarcoma, lymphoma, melanoma. and choriocarcinoma.

The staging system most often used for esophageal cancer is the TNM system of the American Joint Committee on Cancer (AJCC), which is based on three key pieces of information:

• The extent (size) of the tumor (T)
• The spread to the nearby lymph nodes (N)
• The spread (metastasis) to distant sites (M)

The grade of the tumor describes how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grades I to III are used to describe esophageal cancer.

There may be no signs or symptoms in the early stages. However, in more advanced esophageal cancer, the following symptoms are seen:

• Difficulty or pain when swallowing
• A feeling that something is stuck in the food pipe
• Weakness due to anemia
• Bloody vomit
• Weight loss
• Pain in the chest and behind the breastbone
• Dry cough
• Hoarseness
• Indigestion and heartburn

Esophageal cancer occurs when cells in the esophagus develop changes (mutations) in their deoxyribonucleic acid (DNA). The changes allow cells to grow and divide out of control. The accumulating abnormal cells form a tumor in the esophagus that can grow to invade nearby structures and spread to other parts of the body. The exact cause of the mutations is not known. Several factors increase a person's risk of developing esophageal cancer. These include

• Smoking or other use of tobacco
• Heavy alcohol use
• Gastroesophageal reflux disease (GERD), which is a condition where the contents and acid from the stomach go back up into the esophagus
• Poor nutritional status
• Barrett’s esophagus, which is a condition that affects the lower part of the esophagus and can lead to esophageal cancer. Barrett’s esophagus may be caused by GERD. Over time, stomach acid in the esophagus can cause changes in the cells that increase the risk for adenocarcinoma.

The diagnosis of esophageal cancer is made after reviewing the symptoms, medical history and performing examinations. Also, certain diagnostic tests are conducted to make a definitive diagnosis and determine if the cancer has spread or metastasized outside of the esophagus. The important tests include

• Barium swallow X-ray
• Endoscopy
• Biopsy
• Computed tomography (CT) scans and chest X-rays
• Positron emission tomography (PET) scan
• Endoscopic ultrasound or endosonography
• Laparoscopy
• Thoracoscopy

Treatment of esophageal cancer depends on many factors, including the stage of cancer and the overall health of the patient. The treatment options are

• Surgery: A part or whole esophagus may be removed.
• Radiation therapy: Radiation is used to kill cancer cells.
• Chemotherapy: Powerful drugs that attack cancer cells throughout the body. Typically, this is used in combination with radiation therapy and/or surgery.
• Targeted therapy: Newer treatments that target specific aspects of cancer to curb cancer growth and spread.
• Immunotherapy: This therapy influences the immune system to attack cancer cells.
• Photodynamic therapy: This therapy targets cancer cells with special laser light.
• Electrocoagulation: This uses electric current to destroy cancer cells.
• Cryotherapy: This procedure freezes cancer cells to help shrink a tumor.
• Endoscopic mucosal resection: This may be done to treat precancers, very small or early cancers. This procedure removes the inner lining of the esophagus.
• Radiofrequency ablation treatment: This is done using a device that targets cancer cells with radiofrequency energy. This is sometimes used for early cancers.