Esophageal Cancer

BACKGROUND

Anatomy

The esophagus is the medical term for the “food pipe.” It connects the lower part of the throat (pharynx) with the stomach. The esophagus begins in the lower neck and ends in the lower abdomen. It lies in the chest just in front of the vertebral column and just behind the trachea (wind pipe). The esophagus has a thin muscular wall and a mucosal lining. In the upper three-fourths of the esophagus this epithelial lining comprises squamous cells. In the lower one-fourth the lining comprises columnar cells forming a glandular lining.

It is noteworthy that the esophagus has no outer coat or serosa. Thus, there is relatively little barrier to prevent cancer cells from spreading into surrounding tissues. Immediately adjacent to the esophagus are the other structures in the mediastinum, including the windpipe, lymph nodes, heart, and major blood vessels.

Epidemiology

Cancer of the esophagus represents about 1% of about all cancers in the United States. There are about 12,000 newly diagnosed cases per year in this country. Cancer of the esophagus is more common in people who use tobacco products and in people who drink alcoholic beverages to excess.

Another factor associated with esophageal cancer is esophageal reflux. People who have severe esophageal reflux for many years can experience changes in their lower esophagus called “Barrett’s esophagus.” A small percentage of people with Barrett’s esophagus will develop esophageal cancer.

Most cancers of the upper esophagus are squamous cell carcinoma. Most cancers of the lower esophagus and gastroesophageal junction are adenocarcinoma.