You may not think about your esophagus much, but you use it every day. It’s the tube that connects your mouth to your stomach. And like so many parts of our bodies, the sensitive tissues lining the esophagus can develop cancer — at any point from near your mouth to near your stomach.
“Esophageal cancer screening is when we look for cancer before you have symptoms,” says Irving Waxman, MD, chief of digestive diseases and nutrition at RUSH MD Anderson Cancer Center. “The biggest benefit of esophageal cancer screening is early diagnosis — and an early diagnosis means more options for treatment, better outcomes and a higher overall survival rate. We can use minimally invasive imaging to make sure that cancer isn’t present.”
More than 22,000 Americans are diagnosed with esophageal cancer every year. Men are more likely than women to get esophageal cancer, and white people are more likely than other races to develop it.
The vast majority (more than 85%) of esophageal cancers are diagnosed in people older than 55. And if you have chronic heartburn (gastroesophageal reflux disease, or GERD), you may also have an increased risk.
There are some risk factors for esophageal cancer that you can control, including:
- Tobacco use. The more tobacco you use and the longer you use it, the higher your risk for esophageal cancer. Someone who smokes a pack of cigarettes a day has twice the risk of esophageal cancer as someone who doesn’t smoke.
- Alcohol use. Alcohol is a carcinogen, or cancer-causing chemical.
- Tobacco and alcohol use together. “If you use tobacco and alcohol, your risk increases much more than using either substance alone,” says Christopher Seder, MD, thoracic surgeon at RUSH MD Anderson.
Catching esophageal cancer early
Symptoms of esophageal cancer, like trouble swallowing and unexplained weight loss, only happen when the cancer has grown large or spread to other parts of the body.
The good news is that doctors can use imaging tests to look inside your body to check for cancer before you have any symptoms. If you have risk factors for esophageal cancer, esophageal cancer screening might be right for you.
What is esophageal cancer screening?
A cancer screening is looking for cancer before you have symptoms. If you are at risk, your doctor can recommend screenings that can detect the cancer before it grows. And early detection of esophageal cancer is pivotal in successful treatment.
If you are at high risk for developing esophageal cancer, your doctor may recommend tests (usually not requiring surgery) to look for changes in your esophagus that indicate pre-cancerous cells or cancer.
What are the risk factors for esophageal cancer?
If you want to get a screening for esophageal cancer, your doctor will first ask questions to learn more about your personal risk.
In addition to tobacco use, alcohol use, age and gender, other risk factors include:
- Malnourishment (not getting enough nutrients or energy from food)
- Excess body weight
- Infection with human papillomavirus, or HPV
- Drinking hot liquids on a regular basis
- Having achalasia
- Having gastroesophageal reflux disease, or GERD
- Having Barrett’s esophagus
Who should get screened for esophageal cancer?
Anyone with an increased risk of esophageal cancer should be screened. Talk with your doctor about your history of alcohol use and smoking, whether you have symptoms of GERD and if you have signs of Barrett’s esophagus. Any of these risk factors may be a sign you need to get screened.
What do you do to screen for esophageal cancer?
All esophageal cancer screenings use imaging tests to look at the lining of your esophagus. This is where the cells will mutate into cancer cells.
“The most common screening for esophageal cancer is esophagoscopy,” Waxman says. “During an esophagoscopy, we put a small tube called a scope down your throat, using a small camera and light to examine the inside of your esophagus, all the way down to the stomach.”
During an esophagoscopy, your doctor can also gently remove cells (either with a small brush or by inflating and deflating a small balloon) from the lining of the esophagus. These cells are then checked under a microscope for signs of cancer.
Your doctor can also use dye on the inside of your esophagus. The dye will reveal any Barrett’s esophagus or other changes that may increase your risk for cancer.
How often should I get an esophageal cancer screening?
There is no standard guidance on how often to get a screening for esophageal cancer. Talk to your doctor about your individual risk factors and your history of conditions such as Barrett’s esophagus.
What happens if they find cancer?
If your doctor sees anything concerning, you may need a biopsy.
“A biopsy is when small pieces of tissue are removed to check for cell changes,” Seder says. “We may take tissue samples at different points in your esophagus. The biopsy can be performed using a scope, which means no incisions.”
The tissue sample from the biopsy is examined under a microscope. If you do get an esophageal cancer diagnosis, many minimally invasive treatment options are available. Your doctor will work with you to find out what kind of treatment you need and how to best take care of you.
