Mount Sinai - Esophageal Cancer

Overview

Esophageal cancer is a disease in which cancer cells grow in the esophagus – a tube that transports food from the mouth to the stomach.

The American Cancer Society has determined that esophageal cancer cases are about three times more common among men than among women, and almost three times more common among African Americans than among whites.

There are two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. At one time, squamous cell carcinoma was by far the more common of the two cancers, and was once responsible for almost 90% of all esophageal cancers. However, more recent medical studies show that squamous cell cancers make up only about 50% of esophageal cancers today. Since the entire esophagus is normally lined with squamous cells, squamous cell carcinoma can occur anywhere along the length of the esophagus.

The other common type of esophageal cancer, adenocarcinoma, starts in glandular tissue, which normally does not cover the esophagus. Before an adenocarcinoma can develop, glandular cells must replace an area of squamous cells, for example as in Barrett's esophagus.

Successful care of a patient with esophageal cancer is based on applying a fully integrated, comprehensive, multi-method approach. At Mount Sinai, we ensure that all health needs are precisely coordinated based on patient and family needs.

Staging of Cancer

Esophageal cancer is staged with a CT scan of the chest and abdomen, endoscopic ultrasound (EUS) and PET (Positron Emission Tomography) scan. Biopsies of the tumor by the EUS are often helpful to determine the accurate stage. If the tumor is early stage (typically not involving lymph nodes), then an esophagectomy, or removal of the esophagus, may be appropriate for potential cure.

Coordinated Care

Our multidisciplinary approach is second to no other. Our team provides a seamless approach to the diagnosis, treatment, and follow up of patients who are affected by swallowing and reflux disorders. This includes:

Gastroenterology
Otolaryngology
Speech and swallowing therapy
Thoracic surgery
Medical and Radiation oncology
Radiology

Follow-Up Care

Our comprehensive approach includes enrolling patients in a registry that will permit early detection of any change in the nature of the disease. Studies have shown that close monitoring of patients provides earlier and more targeted and effective intervention.

Patient Screenings and Tests

Mount Sinai offers the widest possible spectrum of screening and diagnostic tests including but not limited to:

Barium swallow

Also called an esophagram, this is a series of x-rays of the esophagus. The patient drinks a liquid containing barium, which coats the inside of the esophagus. The barium makes any changes in the shape of the esophagus show up on the x-rays.

During the procedure, you will drink barium, a thick, white, milkshake-like liquid. Barium coats the inside lining of the esophagus, stomach, and duodenum and makes them show up more clearly on x-rays. The radiologist can also see ulcers, scar tissue, abnormal growths, hernias, or areas where something is blocking the normal path of food through the digestive system. Using a machine called a fluoroscope, the radiologist is also able to watch your digestive system work as the barium moves through it. This part of the procedure shows any problems in how the digestive system functions, for example, whether the muscles that control swallowing are working properly. As the barium moves into the small intestine, the radiologist can take x-rays of it as well.

An upper GI series takes 1 to 2 hours. X rays of the small intestine may take 3 to 5 hours. The procedure is not uncomfortable. The barium may cause constipation and white-colored stool for a few days after the procedure.

Esophagoscopy

Also called endoscopy, this is an examination of the inside of the esophagus using a thin-lighted tube called an endoscope. An anesthetic (substance that causes numbness) is usually used during this procedure. If an abnormal area is found, the doctor can collect cells and tissue through the endoscope for examination under a microscope.

Biopsy

A biopsy is a diagnostic test that involves collecting small pieces of esophageal tissue, usually through a needle, for examination under a microscope to assess for cancer cells, tissue changes or other conditions.

Chest X-Ray

An x-ray of the chest area

CT Scan

A type of x-ray that uses a computer to make pictures of structures inside the body. A computed tomography (CT), a thin X-ray beam rotates as small detectors measure the amount of X-rays which make it through the patient or particular area of interest. A computer analyzes the data to construct a cross-sectional (axial) image. These images can be stored, viewed on a monitor, or printed on film. In addition, three-dimensional models of organs can be created by stacking the individual images, or "slices".

Bone Scan

A test to determine if the cancer has spread to the bones. A bone scan is a nuclear medicine test that detects areas of increased or decreased bone metabolism (turnover). This is accomplished by determining how much of a radioactive isotope collects in the bones of the body. The test is performed to identify abnormal processes involving the bone such as tumor, infection, or fracture.