Symptoms, Risk and Diagnosis of Esophageal Cancer

Esophageal cancer affects the squamous cells or mucous-secreting cells of the lining of the esophagus, the muscular tube that carries food from the mouth to the stomach. There are also cell changes considered to be pre-cancerous that must be watched or treated to prevent cancer. A condition called Barrett’s Esophagus is one such condition. The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide if treatment is needed. Some precancerous conditions may initially be handled with active surveillance. Specialists here excel in using technology and their experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified.

Symptoms of Esophageal Cancer

  • Weight loss
  • Painful or difficult swallowing
  • Pain behind the breastbone
  • Hoarseness and cough
  • Indigestion and heartburn
  • Anemia
  • Upper GI bleed or vomiting blood

Risk Factors

  • Older age
  • Being male
  • Being African-American
  • Tobacco use
  • Heavy alcohol use
  • Having chronic acid reflux disease (GERD)
  • Obesity
  • Having Barrett’s Esophagus: This condition is generally caused by having gastric reflux that causes stomach contents to back up into the lower section of the esophagus. Over time, this gastric reflux (GERD) irritates the esophagus, causing cells to change into cells that could become cancerous.


Determining the exact type and stage of esophageal cancer often takes more than one approach:

The following tests and procedures may be used:

  1. Physical exam and history: This examines the patient’s past illnesses and treatments and any signs of disease, such as lumps, a history of gastric reflux or anything else that seems unusual.
  2. Chest X-ray with barium swallow (often called an upper GI series): It can show abnormalities in the esophagus and stomach.
  3. Esophagoscopy: An esophagoscope is inserted through the mouth or nose and down the throat into the esophagus to look for abnormal areas. This thin, tube-like instrument has a light and a lens for viewing, and can accommodate a tool to remove tissue samples for biopsy and microscopic examination.

Staging of Esophageal Cancer

Staging is ranked 0 through 4 and recurrent, meaning the cancer comes back after treatment. Staging also includes the grade of the cancer (1-3) because grade is a function of how aggressive the tumor cells are and how fast they are likely to spread. Because stage is an important factor in treatment options, additional testing to determine stage may include:

CT scan with or without contrast dye: it shows detailed pictures of organs to determine how deep the cancer is within the esophagus or if it is outside the esophagus

PET scan: A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner makes a picture of where glucose is being used in the body. Cancer cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time (PET-CT).

Endoscopic ultrasound (EUS): A thin tube, an endoscope, is inserted into the esophagus through the mouth. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes, forming a picture of body tissues.

MRI: Some patients may benefit from magnetic resonance imaging, which uses magnets and radio waves instead of radiation to take detailed pictures of an area of the body.

Bronchoscopy: In certain cases, a thin, tube-like instrument with a light and a lens for viewing is inserted through the nose or mouth, and accommodates tissue sampling for biopsy.


Chances of recovery and treatment options depend on the following:

  • The stage of the cancer and where it may have spread
  • The size of the tumor
  • The patient’s overall health

Finding esophageal cancer early gives it a better chance of recovery. However, it is often in an advanced stage when diagnosed. At later stages, esophageal cancer can be treated but rarely cured. Clinical trials are a good option for getting the latest treatment.