getting stuck when swallowing. Other symptoms
include unintentional weight loss and sensations
that are a combination of pressure and DYSPEPSIA
(heartburn). Unfortunately these symptoms are
vague enough that many people can ignore them
or perceive them as insignificant, allowing the
cancer to progress undetected.
The diagnostic path may include BARIUM SWAL-
LOW, a series of X-rays to visualize the upper gas-
trointestinal tract, and ENDOSCOPY, in which the
gastroenterologist directly views the esophagus
using a flexible, lighted scope. Endoscopy allows
biopsy of suspicious tissue. Procedures to help
determine how far the cancer has spread include
endoscopic ULTRASOUND, COMPUTED TOMOGRAPHY(CT)
SCAN, MAGNETIC RESONANCE IMAGING (MRI), and
POSITRON EMISSION TOMOGRAPHY(PET) SCAN.
Treatment Options and Outlook
The findings of the diagnostic procedures deter-
mine treatment options, which include
- Surgery to remove the cancerous portion of the
esophagus and nearby tissue; this treatment is
most effective when the cancer remains con-
fined to the area of the esophagus where it
originated. The surgeon then pulls the stomach
up to connect it to the shortened esophagus, or
uses a segment of intestine (called a graft) to
construct a replacement for the removed sec-
tion.
•RADIATION THERAPY to kill the cancerous cells;
this treatment typically shrinks but does not
eliminate the cancer, providing relief from
swallowing difficulties.
•CHEMOTHERAPY attacks cancer cells throughout
the body; this treatment is most effective when
the cancer has spread to other locations in the
body.
Treatment often combines these approaches.
Each approach has significant risks and side
effects. As with all cancers, early detection signifi-
cantly improves the effectiveness of treatment.
Risk Factors and Preventive MeasuresThe key risk factors for esophageal cancer are Bar-
rett’s esophagus and a combination of smoking
and excessive alcohol consumption. Preventive
measures to reduce the risk factors for esophageal
cancer include- SMOKING CESSATION
- moderation in ALCOHOLconsumption
- WEIGHT LOSS AND WEIGHT MANAGEMENT
- management of chronic conditions that irritate
the esophagus, notably GERD - regular esophageal endoscopy for people who
have Barrett’s esophagus
See also ADENOMA-TO-CARCINOMA TRANSITION;
CANCER PREVENTION; CANCER RISK FACTORS; CANCER
PREVENTION; CANCER TREATMENT OPTIONS AND DECI-
SIONS; SMOKING AND HEALTH; STAGING AND GRADING OF
CANCER.esophageal spasm Nonfunctional and often
painful contractions of the muscles that line the
wall of the ESOPHAGUS. The main symptom of
esophageal SPASMis difficult and painful swallow-
ing. The spasms may involve only one portion of
the esophagus or the entire length of the esopha-
gus. Doctors do not know what causes esophageal
spasm, though eating foods or drinking beverages
that are extremely hot or extremely cold often
triggers a spasm. The diagnostic path often
includes manometry, a procedure that measures
pressures within the esophagus. Treatment
options include medications to relax smooth MUS-
CLEsuch as nitrates and calcium channel antago-
nist (blocker) medications. BOTULINUM THERAPY, in
which botulinum toxin injected into portions of
the esophagus to paralyze it, relieves symptoms in
many people.
See also ESOPHAGITIS.esophageal varices Enlarged and weakened
veins in the walls of the ESOPHAGUS. Esophageal
varices result from PORTAL HYPERTENSION, a condi-
tion of impaired BLOODflow into the LIVER, and are
potentially life-threatening should they rupture
and HEMORRHAGE. Portal hypertension is a common
complication of conditions such as CIRRHOSISand
chronic HEPATITISthat cause SCARtissue to develop
within the liver. Symptoms include GASTROINTESTI-
NAL BLEEDING(VOMITINGblood or passing blood in
the stool), thirst that increased fluid consumption
does not quench, lightheadedness, and mentalesophageal varices 41