Skip to Main Content

Esophageal Cancer

Overview

Cancer of the esophagus is divided into two major types: squamous cell carcinoma and adenocarcinoma, depending on the type of cells that are malignant.

Squamous cell carcinomas arise in cells that line the upper two-thirds of the esophagus. Adenocarcinomas usually develop in the glandular tissue in the lower part of the esophagus. The treatment of these types may be similar but depends upon the details of each individual case.

Our approach to esophageal cancer

UCSF's highly trained gastrointestinal oncologists and surgeons provide the most advanced and effective treatments available for esophageal cancer. Our team will give you a precise diagnosis and design a personalized treatment plan, which may include surgery, chemotherapy, radiation, laser therapy or photodynamic therapy (targeting the cancer with drugs that destroy the malignant cells when exposed to a special light). In some cases, patients need to have the esophagus removed. Our hospital is one of a select group of specialty centers performing minimally invasive esophagectomies – esophagus removal using small incisions, miniature instruments and an endoscope. This option will minimize discomfort and speed recovery time.

In addition, we offer continued care for patients who have completed treatment for gastrointestinal cancers. Our survivorship clinic aims to maximize quality of life and minimize risk of recurrence.

Awards & recognition

  • usnews-neurology

    Among the top hospitals in the nation

  • Best in Northern California and No. 7 in the nation for cancer care

  • NIH-2x

    Designated comprehensive cancer center

Signs & symptoms

Early esophageal cancer usually does not cause symptoms. However, as the cancer grows, symptoms may include:

  • Difficult or painful swallowing
  • Severe weight loss
  • Pain in the throat or back, behind the breastbone or between the shoulder blades
  • Hoarseness or chronic cough
  • Vomiting
  • Coughing up blood

Diagnosis

To help find the cause of symptoms, your doctor will evaluate your medical history and perform a physical exam. Your doctor will likely recommend a chest X-ray and other diagnostic tests. These tests may include the following:

  • Barium swallow. Also called an esophagram, a barium swallow is a series of X-rays of the esophagus. You drink a liquid containing barium, which coats the inside of your esophagus. The barium causes changes in the shape of the esophagus to show up on the X-rays.
  • Gastroesophagoscopy. Also called endoscopy, this is an examination of the inside of the esophagus and stomach using a thin, lighted tube called an endoscope. An anesthetic, a substance that causes loss of feeling or awareness, is usually used during this procedure. If an abnormal area is found, your doctor can collect cells and tissue through the endoscope for a biopsy.
  • Biopsy. Biopsy is a tissue sample for examination by a pathologist to make a diagnosis.

Staging

If the diagnosis is esophageal cancer, your doctor will determine the stage or extent of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to what parts of the body. Knowing the stage of the disease helps the doctor plan treatments. Listed below are descriptions of the four stages of esophageal cancer.

  • Stage I. The cancer is found only in the top layers of cells lining the esophagus.
  • Stage II. The cancer involves deeper layers of the lining of the esophagus, or it has spread to nearby lymph nodes. The cancer has not spread to other parts of the body.
  • Stage III. The cancer has invaded more deeply into the wall of the esophagus or has spread to tissues or lymph nodes near the esophagus. It has not spread to other parts of the body.
  • Stage IV. The cancer has spread to other parts of the body. Esophageal cancer can spread almost anywhere in the body, including the liver, lungs, brain and bones.

Treatments

Surgery

Surgery is the most common treatment for esophageal cancer. Usually, the surgeon removes the tumor along with all or a portion of the esophagus, nearby lymph nodes and other tissue in the area. An operation to remove the esophagus is called an esophagectomy.

The surgeon connects the remaining healthy part of the esophagus to the stomach so that the patient is still able to swallow. The surgeon may also widen the opening between the stomach and the small intestine to allow stomach contents to pass more easily into the small intestine.

Sometimes surgery is done after other treatment is finished.

Chemotherapy

Chemotherapy is the use of anticancer drugs to kill cancer cells. The anticancer drugs used to treat esophageal cancer travel throughout the body and are usually given by injection into a vein or intravenously.

Chemotherapy may be combined with radiation therapy as primary treatment, instead of surgery, or to shrink the tumor before surgery.

Laser therapy

Laser therapy is the use of high-intensity light to destroy tumor cells. Laser therapy affects the cells only in the treated area. Laser therapy is used to destroy cancerous tissue and relieve a blockage in the esophagus when the cancer cannot be removed by surgery. The relief of a blockage can help to reduce symptoms, especially swallowing problems.

Photodynamic therapy

Photodynamic therapy (PDT), a type of laser therapy, involves the use of drugs that are absorbed by cancer cells. When exposed to a special light, the drugs become active and destroy cancer cells. Your doctor may use PDT to relieve symptoms of esophageal cancer, such as difficulty swallowing.

Radiation therapy

Radiation therapy, also called radiotherapy, involves the use of high-energy X-rays to kill cancer cells in the treated area only. The radiation may come from a machine outside the body – external radiation – or from radioactive materials placed in or near the tumor, called internal radiation.

A plastic tube may be inserted into the esophagus to keep it open during radiation therapy. This procedure is called intraluminal intubation and dilation.

Radiation therapy may be used alone or combined with chemotherapy as primary treatment instead of or before surgery, especially if the size or location of the tumor would make an operation difficult. Even if the tumor cannot be removed by surgery or destroyed entirely by radiation therapy, radiation therapy can often help relieve pain and make swallowing easier.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

Recommended reading

FAQ: Cancer Pathology Tissue Slides

Find frequently asked questions regarding cancer pathology tissue slides, such as how to obtain the slides and what to do with them once you do.

FAQ: Cancer Radiology Scans and Reports

Learn the difference between a radiology report and radiology films or scans as well as why your doctor may be requesting these scans and more.

Self-Care for Caregivers

Caregiver fatigue can be brought on by the physical and emotional demands of caring for a loved one with a serious illness. Learn tips to combat caregiver fatigue here.

Communicating with Your Doctor

The relationship with a doctor is a very personal one, built on communication and trust. In choosing a doctor, the "chemistry" between the two of you must work.

Coping with Chemotherapy

Each person experiences side effects from chemotherapy differently, and different chemotherapy drugs cause different side effects. Learn more here.

Delegation to Help with Fatigue

Fatigue caused by cancer treatment can make it difficult to accomplish even the smallest of tasks. Learn how task delegation can help with this fatigue.

Diet for Cancer Treatment Side Effects

Nausea is a common side effect of chemotherapy and radiation therapy. Find practical tips and suggested foods to help with nausea here.

Managing Your Treatment

Living with or caring for someone with cancer can be a full-time job. Here are some tips to reduce stress and help navigate the disease more effectively.

Nutrition and Coping with Cancer Symptoms

Side effects of cancer treatment may affect your eating pattern, requiring new ways to get the calories, protein and nutrients that you need. Learn more.

Questions to Ask Your Doctor

Your time with the doctor is limited, thus it's helpful to prepare for the visit in advance by prioritizing the questions that are important to you. Learn more.

Resources for End of Life

The UCSF Cancer Resource Center has a list of bereavement support groups, counselors, hospice and others dealing with end-of-life issues. Learn more.

Tips for Conserving Your Energy

Cancer and cancer therapy can be accompanied by feelings of extreme fatigue. To help you deal with this fatigue, follow these easy tips help conserve energy.

Using a Medical Calendar and Symptom Log

Take time at the end of each day or each week to reflect back on the symptoms you've had. You can use a calendar to track your symptoms. Learn more here.

Where to get care (2)

    Related clinics (4)

    3

    Cancer Symptom Management

    Cancer Symptom Management

    San Francisco

    Osher Center for Integrative Health

    Osher Center for Integrative Health

    1545 Divisadero St., Fourth Floor
    San Francisco, CA 94115

    2

    Cancer Survivorship and Wellness Institute

    Cancer Survivorship and Wellness Institute

    See both of our San Francisco locations.

    3

    Psycho-Oncology

    Psycho-Oncology

    San Francisco

    Support services

    Support Group

    Art for Recovery

    Creativity can help people with serious illnesses cope, heal and express what they're going through. Find out about our program and how to join.

    Fitness

    Cancer Exercise Counseling

    Our one-on-one exercise training sessions, customized for your needs and abilities, can complement other cancer treatments and speed your recovery.

    Patient Resource

    Cancer Nutrition Counseling

    UCSF Health offers free nutrition counseling to our patients with cancer, as well as nutrition seminars that are open to anyone. Learn more.

    Support Group

    Cancer Support Groups

    These groups offered by the Ida and Joseph Friend Patient and Family Cancer Support Center are free and available to all patients, whether or not you get your health care at UCSF.

    Fitness

    Core & More Class for Cancer Patients

    A strong body helps you fight cancer and enjoy life. Join this class to stabilize your core, strengthen your muscles and improve overall fitness. For cancer patients and caregivers!

    Patient Resource

    Friend to Friend Specialty Shops

    A one-stop boutique for patients with cancer. Get professional help with wigs, prostheses, sun-protective clothing, makeup, skin care and more.

    Class

    Meditation & Guided Imagery for Cancer Patients

    Drop in for a free class designed to help you heal, relax and find balance during your treatment. UCSF and non-UCSF patients are welcome.

    Patient Resource

    Oncology Social Work

    Social workers offer support, problem-solving, help accessing UCSF cancer-related resources and more. Find out how to contact the social worker for your clinic.

    Patient Resource

    Patient & Family Cancer Support Center

    The center offers wellness programming, community, support groups, classes, workshops and more at no cost to people facing cancer and their loved ones.

    Support Group

    Peer Support Programs for Cancer

    Patients are matched with peer support volunteers according to criteria such as diagnosis, cancer stage, age or gender. Speak to someone who's "been there."

    Share