Esophageal cancer. There are different types and locations

The esophagus is the “tube” that food slides through to get from the mouth to the stomach. It’s a biologic conveyer belt. No digestion, just transportation. Cancer of the esophagus has been known for millennia to be very lethal. It arises inside the esophagus and quickly obstructs the lumen -the inside- and blocks the passage of food. Unless something is done the patient starves while the cancer grows and spreads. I’ll discuss the development and current state of surgery and other treatments for this malignancy in subsequent blogs.

There are two types of esophageal cancer, squamous cell cancer and adenocarcinoma. The former arises from the skin-like cells that line the lumen and the latter develops from the glands that are imbedded in the wall of the esophagus. In Asia esophageal cancers are common, are almost all squamous cell and are found in the mid-portion of the esophagus, half-way between the neck and the stomach. In the USA and western Europe esophageal cancer is less common – although the incidence is increasing – most are now adenocarcinomas and are found in the lower part of the esophagus, where it joins the stomach; up till the 1980s the location and type were identical to Asia’s current pattern. The cause of this change in the biology of esophageal cancer is unknown but one theory is that acid reflux, which is exacerbated by obesity, causes the esophageal lining to change from squamous to glandular cells. This condition is called Barrett’s esophagus and has the potential to form adenocarcinomas and may be responsible for the increased frequency with which this disease is diagnosed.

These two cancer types do not behave identically and respond somewhat differently to chemotherapy and radiation but they are similar in that they both are lethal and hard to cure. Hope for the future resides in the fact that newer therapeutic strategies combining several treatment modalities are more and more efficacious.

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