About Esophageal Cancer

What is Esophageal Cancer?

There are two major types of esophageal cancer:

  • Squamous Cell Carcinoma — Squamous cell develops in the squamous cells that line the esophagus. This type of cancer usually occurs in the middle and upper part of the esophagus, but can be found in other areas of the esophagus as well.
  • Adenocarcinoma — Adenocarcinomas usually arise in glandular tissue in the lower part of the esophagus.

Signs and Symptoms of Esophageal Cancer

Signs and symptoms of esophageal cancer can include any of the following:

  • Difficult or painful swallowing (dysphagia)
  • Pain in the back between the shoulder blades
  • Loss of appetite
  • Swollen glands in the neck or any swelling in the neck that can be felt
  • Coughing up blood
  • Hoarseness or chronic cough

Diagnosing Esophageal Cancer

Esophageal cancer is a treatable disease if found in its early form. Tests and procedures to diagnose esophageal cancer include:

Barium Swallow

During this procedure, you will be asked to swallow a liquid containing barium, which coats the esophagus. Any changes in the shape of the esophagus will show up on x-rays.

Esophagoscopy or Endoscopic Examination

An esophagoscopy is an examination of the inside of the esophagus using an endoscope, which is a thin tube with a light at its end. The endoscope also is able to take tissue samples (biopsy) for evaluation.

Endoscopic Ultrasound

This technique, which uses an endoscope that is connected to an ultrasound machine, sends images to a computer screen. Because it can visualize all of the layers of muscle and tissue in the esophagus, it is the best technique to determine the extent (depth) of the tumor and if there has been any spread to the lymph nodes in the neck.

Additional tests and procedures may be performed to determine if the cancer has spread beyond the esophagus:

Chest X-ray

A simple chest x-ray shows abnormalities in the lungs.


This procedure uses a broncoscope, which is a thin lighted tube that is inserted into the nose or down the throat and into the bronchial tubes of the lungs. It can pick up abnormalities in the trachea and lungs.


A procedure using a laryngoscope, which is a thin, lighted tube, to view the larynx or voice box.

CT Scan

A CT scan utilizes x-rays and a computer to show three-dimensional images of organs in the body.

PET Scan

A PET (positron emission tomography) scan shows cancer growth in other parts of the body by means of a substance called radionuclide glucose (sugar), which is injected into a vein. This substance is “taken up” by cancer cells because they use sugar more readily than normal cells do. In some instances both a PET scan and a CT scan will be used to determine if the cancer has spread beyond the esophagus.


During this procedure, an endoscope is used to examine the inside of the chest. The endoscope is inserted through an incision in the chest wall.


This procedure uses a laparoscope, which is similar to an endoscope, to view internal organs and take tissue samples. It is inserted through an incision in the abdomen.

Risk Factors for Esophageal Cancer

A risk factor is anything that increases a person's chance of getting a disease such as cancer. Risk factors for esophageal cancer include:


A history of smoking cigarettes, inhaling cigar smoke or using chewing tobacco is a major risk factor.

Alcohol Consumption

Alcohol consumption, particularly in combination with tobacco use, significantly increases one's chance for esophageal cancer.

Age and Gender

Most people who develop esophageal cancer are over the age of 60. Men are three times more likely to develop esophageal cancer than women.


Overweight individuals are three times more likely to develop adenocarcinoma of the esophagus, one of two common types of esophageal cancer.

Gastroesophageal Reflux

Gastroesophageal reflux is produced when acid in the stomach goes back up the food pipe (or esophagus). People often call it "heartburn". This acid reflux can irritate the lining of the esophagus and has been associated with cancer of the esophagus.

Barrett’s Esophagus

Barrett's esophagus develops from long-term exposure to stomach acid that occurs with gastric reflux. Individuals with Barrett’s esophagus have a 30-40 percent risk for developing esophageal cancer.


Achalasia is a narrowing of the esophagus that occurs when the esophageal sphincter muscle fails to relax. Six percent of patients with achalasia will likely develop squamous cell esophageal cancer.

Esophageal Webs

Esophageal webs are abnormal protrusions of tissue into the esophagus. This condition — called Plummer-Vinson syndrome or Paterson-Kelly syndrome — occurs in individuals with abnormalities of the tongue, fingernails, spleen and other organs. One in ten people with this syndrome will likely develop esophageal cancer.

Other risk factors include exposure to chemicals such as lye, viruses like the human papilloma virus (HPV), and a previous instance of head and neck cancer.

To learn more about esophageal cancer care at Virginia Mason or to make an appointment, please call (206) 223-6193.