Esophageal cancer is cancer that occurs in the esophagus a long, hollow tube that runs from your throat to your stomach. Your esophagus helps move the food you swallow from the back of your throat to your stomach to be digested.
Esophageal cancer usually begins in the cells that line the inside of the esophagus. Esophageal cancer can occur anywhere along the esophagus. More men than women get esophageal cancer.
Esophageal cancer is the sixth most common cause of cancer deaths worldwide. Incidence rates vary within different geographic locations. In some regions, higher rates of esophageal cancer may be attributed to tobacco and alcohol use or particular nutritional habits and obesity.
Esophageal cancer results when abnormal cells grow out of control in esophageal tissue. Eventually the cells form a mass called a tumor. There are two main types of esophageal cancer:
1) Squamous cell carcinoma begins in the cells (called squamous cells) that line the esophagus. This cancer usually affects the upper and middle part of the esophagus.
2) Adenocarcinoma develops in the tissue that produces mucus that aids in swallowing. It generally occurs in the lower part of the esophagus.

Esophageal cancer may have no obvious symptoms in its early stages. The symptom people notice first is difficulty swallowing. As the tumor grows, it narrows the opening of the esophagus, making swallowing difficult and/or painful. Other symptoms of esophageal cancer can include:
● Pain in the throat or back, behind the breastbone, or between the shoulder blades
● Vomiting or coughing up blood
● Heartburn
● Hoarseness or chronic cough
● Unintentional weight loss

The following factors may raise a person’s risk of developing esophageal cancer:
1) Age. People between the ages of 45 and 70 have the highest risk of esophageal cancer.
2) Gender. Men are 3 to 4 times more likely than women to develop esophageal cancer.
3) Race. Black people are twice as likely as white people to develop the squamous cell type of esophageal cancer.
4) Tobacco. Using any form of tobacco, such as cigarettes, cigars, pipes, chewing tobacco, and snuff raises the risk of esophageal cancer, especially squamous cell carcinoma.
5) Alcohol. Heavy drinking over a long period of time increases the risk of squamous cell carcinoma of the esophagus, especially when combined with tobacco use.
6) Barrett's esophagus. This condition can develop in some people who have chronic gastroesophageal reflux disease or inflammation of the esophagus called esophagitis, even when a person does not have symptoms of chronic heartburn. Damage to the lining of the esophagus causes the squamous cells in the lining of the esophagus to turn into glandular tissue. People with Barrett's esophagus are more likely to develop adenocarcinoma of the esophagus, but the risk of developing esophageal cancer is still fairly low.
7) Diet/nutrition. A diet that is low in fruits and vegetables and certain vitamins and minerals can increase a person's risk of developing esophageal cancer.
8) Obesity. Being very overweight and having too much body fat can increase a person's risk of developing esophageal adenocarcinoma.
9) Lye. Children who have accidentally swallowed lye have an increased risk of squamous cell carcinoma. Lye can be found in some cleaning products, such as drain cleaners.
10) Achalasia. Achalasia is a condition when the lower muscular ring of the esophagus does not relax during swallowing of food. Achalasia increases the risk of squamous cell carcinoma.
11) Human papillomavirus (HPV). Researchers are investigating HPV as a risk factor for esophageal cancer, but there is no clear link that squamous cell esophageal cancer is related to HPV. Sexual activity with someone who has HPV is the most common way someone gets HPV. There are different types of HPV, called strains. Research links some HPV strains more strongly with certain types of cancers. HPV vaccines can prevent people from developing certain cancers.

Most esophageal cancers can be classified as one of two types: adenocarcinoma or squamous cell carcinoma. A third type of esophageal cancer, called small cell carcinoma, is very rare. These different types of cancer begin in different kinds of cells in the esophagus. They develop in unique ways and call for approaches to treatment that are unique to each person.
Adenocarcinoma
Adenocarcinoma is the most common form of esophageal cancer making up more than half of all new cases. It starts out in glandular cells, which are not normally present in the lining of the esophagus. These cells can grow there due to a condition called Barrett’s esophagus, which increases a person’s chance of developing esophageal cancer. Adenocarcinoma occurs mainly at the lower end of the esophagus and the upper part of the stomach.
Adenocarcinoma of the esophagus occurs most often in middle-aged, overweight, white men. The incidence of this disease has grown faster than almost any other cancer. Doctors say the rise may be due to an increase in the number of people with gastroesophageal reflux disease (GERD), a condition in which contents from the stomach, such as acid and bile, move up into the esophagus repeatedly, causing chronic inflammation. Recent studies have shown that treating acid reflux reduces the risk of esophageal cancer.
Squamous Cell Carcinoma
The second most common form of esophageal cancer is squamous cell carcinoma. It begins when squamous cells (thin, flat cells lining the inside of the esophagus) begin to grow uncontrollably. Squamous cell carcinoma of the esophagus is strongly linked with smoking and drinking too much alcohol.
Small Cell Carcinoma
A third, rarer type of esophageal cancer is small cell carcinoma. It begins in neuroendocrine cells, a type of cell that releases hormones into the bloodstream in response to signals from nerves.
These are the stages of esophageal cancer:
Stage 0
Cancer cells are found only in the cells lining the esophagus. This may also be called high-grade dysplasia.
Stage 1
Cancer is in the inside layers of the esophagus.
Stage 2
Cancer has spread to the outer layers of the esophagus. It may also have spread to lymph nodes.
Stage 3
Cancer has spread beyond the esophagus to nearby tissue and has also spread to lymph nodes.
Stage 4
Cancer has spread (metastasized) to another part of the body.

There are many tests used for diagnosing esophageal cancer. Not all tests described here will be used for every person. In addition to a physical examination, the following tests may be used to diagnose esophageal cancer:
1) Barium swallow, also called an esophagram
The patient swallows a liquid containing barium and then a series of x-rays are taken. An x-ray is a way to take a picture of the inside of the body. Barium coats the surface of the esophagus, making a tumor or other unusual changes easier to see on the x-ray. If there is an area looks abnormal, your doctor may recommend an upper endoscopy and biopsy to find out if it is cancerous
2) Upper endoscopy, also called esophagus-gastric-duodenoscopy, or EGD
An upper endoscopy allows the doctor to see the lining of the esophagus. A thin, flexible tube with a light and video camera on the end, called an endoscope, is passed down the throat and into the esophagus while the patient is sedated. Sedation is giving medication to become more relaxed, calm, or sleepy. If there is an abnormal looking area, a biopsy will be performed to find out if it is cancerous. An endoscopy using an inflatable balloon to stretch the esophagus can also help widen the blocked area so that food can pass through until treatment begins.
3) Endoscopic ultrasound
This procedure is often done at the same time as the upper endoscopy. During an ultrasound, sound waves provide a picture of the wall of the esophagus and nearby lymph nodes and structures. During an endoscopic ultrasound, an endoscopic probe with an attached ultrasound that produces the sound waves is inserted into the esophagus through the mouth. The ultrasound is used to find out if the tumor has grown into the wall of the esophagus, how deep the tumor has grown, and whether cancer has spread to the lymph nodes or other nearby structures. An ultrasound can also be used to help get a tissue sample from the lymph nodes.
4) Bronchoscopy
Similar to an upper endoscopy, the doctor passes a thin, flexible tube with a light on the end into the mouth or nose, down through the windpipe, and into the breathing passages of the lungs. A bronchoscopy may be performed if a tumor is located in the upper two-thirds of the esophagus to find out if the tumor is growing into the airway. This part of the airway includes the trachea, or windpipe, and the area where the windpipe branches out into the lungs, called the bronchial tree.
5) Biopsy
Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A biopsy is the removal of a small amount of tissue from the suspicious area for examination. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease
6) Biomarker testing of the tumor
Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor. Results of these tests can help determine your treatment options.
● PD-L1 and microsatellite instability (MSI) testing
Testing may be done for PD-L1 and high microsatellite instability (MSI-H), which may also be called a mismatch repair deficiency. The results of these tests help doctors find out if a treatment called immunotherapy is an option (see Types of Treatment). The PD-1/PD-L1 pathway is an immune checkpoint. These checkpoints are critical to the immune system’s ability to control cancer growth. Many cancers use these pathways to escape the immune system. If specific antibodies are given for treatment to block these pathways, the immune system may be able to overcome the suppression by the cancer. These antibodies are called immune checkpoint inhibitors. Drugs that target this pathway can be effective against MSI high or MSI-H, or PD-L1 positive esophageal cancers. PD-L1 and MSI testing is more common for advanced or stage IV esophageal cancer.
● HER2 testing
Human epidermal growth receptor 2 (HER2) is a specialized protein found on the surface of cells. Many people are more familiar with HER2 when discussing breast cancer. However, doctors are finding that HER2 is also important in other types of cancer. When a cancer has abnormally high levels of HER2, it can drive its growth and spread. These types of cancer are referred to as HER2-positive. For HER2-positive cancers, certain types of targeted therapy may work well to treat these cancers. For patients diagnosed with gastroesophageal adenocarcinoma, ASCO, the American Society for Clinical Pathology (ASCP), and the College of American Pathologists (CAP) recommend HER2 testing to help guide treatment (please note, this link takes you to another ASCO website).
7) Computed tomography (CT or CAT) scan
A CT scan creates takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Usually, a special dye called a contrast medium is given before the scan to provide better detail. This dye is generally injected into a patient’s vein.
8) Magnetic resonance imaging (MRI)
An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. A contrast medium is usually injected into a patient’s vein to create a clearer picture.
9) Positron emission tomography (PET) or PET-CT scan
A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

The approach to treatment depends on the stage and grade of the cancer. Treatment options that may be used for esophageal cancer include:
Surgery
Surgery is the most common treatment for esophageal cancer. Surgery may be done to remove some or most of the esophagus, as well as some tissue around it, in a procedure called esophagectomy. If the esophagus is removed, the doctor may reposition the stomach (moving it up into the chest), or use a piece of intestine to preserve function. The doctor may also remove lymph nodes around the esophagus and look at them under a microscope to see if they contain cancer. Surgery can cure cancer in some patients who have no spread of the tumor beyond the esophagus. Unfortunately, less than 25% of esophageal cancers are discovered this early. Therefore, surgery is often offered to ease symptoms.
Radiation therapy
Radiation therapy is a way of treating disease using radiation (high-energy rays) or radioactive substances. It is used to kill or damage cancer cells, often by aiming a beam of radiation at the tumor. The radiation destroys the cancer cells by interfering with their growth and division. Radiation can be used alone, before surgery to shrink tumors, or after surgery to kill any cancer cells that may remain. During radiation treatments for esophageal cancer, a stent (small tube) is sometimes inserted into the esophagus to keep it open. This is called intraluminal intubation and dilation. Radiation therapy is mainly used as part of a larger treatment regimen to relieve difficulty swallowing.
Chemotherapy
Chemotherapy uses medicines to kill or stop the growth of cancer cells. Some chemotherapy drugs are taken as pills and some are placed directly into the bloodstream through a vein (intravenous). Chemotherapy drugs travel through the bloodstream and can kill cells throughout the body. For esophageal cancer, chemotherapy is sometimes used before surgery to help shrink the tumor. Chemotherapy can be given to control symptoms (palliative), before surgery to shrink the tumor, or can be used in conjunction with radiation.
Endoscopic submucosal dissection (EDS)
Endoscopic submucosal dissection (EDS) or endoscopic mucosal resection (EMR) are procedures to treat early tumors that are smal. The tumors may be removed endoscopically without having to remove the esophagus.
Endoscopic laser therapy
Endoscopic laser therapy may be used to treat more advanced tumors that may cause a blockage in the esophagus. As part of palliative therapy, lasers can be used to cut a hole in the blockage to improve swallowing and allow the patient to eat.
Photodynamic therapy (PDT)
Photodynamic therapy (PDT) uses photoactive drugs (drugs activated by non-thermal light) that are absorbed by cancer cells, thus destroying the cancer cells. This treatment may be used to help ease the symptoms of esophageal cancer, particularly difficulty swallowing.
Clinical trials
People with esophageal cancer may participate in clinical trials. Clinical trials are research programs conducted with patients to evaluate new medical treatments, drugs or devices. New uses for chemotherapy and radiation therapy are being tested in clinical trials.

Survival rates depend on several factors, including the stage of the cancer when it is first diagnosed. The 5-year survival rate of people with cancer located only in the esophagus is 47%. The 5-year survival rate for those with disease that has spread to surrounding tissues or organs and/or the regional lymph nodes is 25%. If it has spread to distant parts of the body, the survival rate is 5%.

Cancer is a life threatening disease that can affect anyone regardless of race, age, and gender. Traditional cancer treatments like radiotherapy and chemotherapy often result in undesirable and uncomfortable side effects such as vomiting, numbness, nausea, and diarrhea to name a few. Herbal medicine is a complementary therapy that some people with cancer use to ease cancer symptoms. Herbal remedies for cancer such as those commonly found in traditional medicine contains antimutagenic, anti-inflammatory, and apoptosis inducing compounds that help in slowing the development of cancer and relieve treatment side effects for patients.

Herbal medicine has a wide variety of applications but all of them rely on the sustainable use of various plant parts such as flowers, leaves, bark, and roots. Each part of a plant features different medicinal properties and uses. Although herbal medicine has countless use cases, cancer care is one of the most practical applications because of how harsh traditional oncology treatments can be on patients.

Herbal remedies are a part of a growing field of medicine called integrative oncology. Research conducted on the use of herbal medicine for cancer complementary therapy has proven herbs can:
• Slows the spread of cancer
• Reduces the side effects of cancer treatment
• Boosts immune system strength and functionality
• Minimizes the symptoms of cancer
• Attacks cancer cells

Several herbs may help control the side effects of conventional cancer treatment. However, doctors do not recommend that cancer patients take herbal medicine while undergoing normal traditional cancer treatment. Herbal medicines may be likely less to cause side effects than traditional drugs. But patients may can still experience complications. Some herbs may can cause negative interactions with chemotherapy drugs. Closely monitor how you feel before and after taking herbal remedies. Patients should always consult with their doctor before trying herbs as a complementary therapy or the supplements to avoid complications.