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Esophageal Cancer

The esophagus is a muscular tube approximately 25-30 centimeters long that connects the throat to the stomach and allows food and liquids to pass through. Its wall is composed of layers of mucosa, submucosa, and muscle. Esophageal cancer most often originates in the cells of the mucosal layer; less commonly, it develops in the muscle tissue.

Although it is not among the most common cancers, it is one of the most lethal. Prognosis improves significantly when the disease is diagnosed and treated at an early stage.

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What Is Esophageal Cancer?

Esophageal cancer develops when the cells lining the inner wall of the organ undergo genetic alterations that cause them to proliferate abnormally and uncontrollably. Over time, these cells may invade surrounding tissues and spread to other parts of the body through the lymph nodes or the bloodstream.

The two main types of esophageal cancer are classified according to the cells from which they originate:

  • Esophageal adenocarcinoma: it arises from mucus‑producing glandular cells. It usually develops in the lower part of the esophagus, near the stomach, and is the most common type in Western countries.
  • Squamous cell carcinoma: it originates in the flat cells that line the inner surface of the esophagus. It most often forms in the upper and middle sections of the organ but can occur anywhere. It is the most common type worldwide.

Together, these two histological types account for approximately 95% of all esophageal cancers. The remaining cases include rare forms such as lymphomas, melanomas, and sarcomas.

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What Are the Symptoms of Esophageal Cancer?

Esophageal cancer is often asymptomatic in its early stages or presents with nonspecific symptoms.

Early signs may include:

  • Dysphagia: difficulty swallowing, which develops gradually – initially with solid foods and later also with liquids.
  • Loss of appetite.
  • Unintentional weight loss, resulting from difficulty swallowing and reduced food intake.

In some cases, the tumor mass obstructs the normal passage of food, leading to food retention, early vomiting, and – if ulcers are present – bleeding.

Slow, prolonged blood loss may cause:

  • Anemia.
  • Dark stools.
  • Persistent fatigue.

Other possible symptoms include heartburn and chest pain.

In advanced stages of the disease, the following may occur:

  • Voice changes.
  • Bone pain.
  • Enlargement of the liver.
  • Persistent cough.

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How Is Esophageal Cancer Diagnosed?

Because it is often symptom‑free in its early stages, esophageal cancer is rarely detected early. According to available data, only 1 in 8 cases is diagnosed before the disease has already spread. Tests used for diagnosis and staging include:

  • Upper gastrointestinal endoscopy (esophagoscopy): a flexible endoscope equipped with a video camera is inserted through the mouth and advanced into the stomach. If suspicious lesions are identified, a biopsy can be performed. This examination also allows assessment of tumor size and any local spread.
  • Endoscopic ultrasound (EUS): often performed in combination with endoscopy, it uses sound waves to obtain detailed images of the esophageal wall, assess the depth of tumor invasion, and detect lymph‑node involvement.
  • Barium swallow X-ray: after ingestion of a barium‑based liquid that coats the esophageal walls, X‑ray imaging can reveal structural abnormalities.
  • Bronchoscopy: indicated when the tumor is located in the upper two‑thirds of the esophagus, to assess possible extension into the airways.
  • CT scan (Computed Tomography): primarily used for tumor staging.
  • PET scan (Positron Emission Tomography): helps detect metastases, evaluate tumor growth rate, and identify abnormalities not visible with other imaging techniques.
  • MRI (Magnetic Resonance Imaging): used in selected cases for a more detailed anatomical assessment.

Risk Factors For Esophageal Cancer

Although the exact cause of esophageal cancer is not yet known, several risk factors are associated with an increased likelihood of developing this disease:

  • Regular consumption of very hot food and beverages.
  • A diet high in processed meats and low in fruits and vegetables.
  • Age over 55.
  • Infections, such as Helicobacter pylori.
  • Pre‑existing esophageal lesions.
  • Gastroesophageal conditions, including gastroesophageal reflux disease (GERD), esophageal achalasia, and Barrett’s esophagus.
  • Male sex.
  • Tobacco and alcohol use.

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How Is Esophageal Cancer Treated?

Treatment selection depends on the histological type, stage, and location of the disease at the time of diagnosis.

As with most cancers, the chances of cure are significantly higher when the tumor is detected early.

The main treatment options, which may be used alone or in combination, include:

  • Surgery: in early‑stage tumors, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) may be performed. In more advanced cases, treatment involves esophagectomy, which entails partial or total removal of the esophagus and, if necessary, part of the stomach.
  • Radiotherapy.
  • Chemotherapy.
  • Immunotherapy.
  • Palliative care: when cure is not achievable, treatment focuses on symptom relief and improving quality of life.

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Reviewed March 2026.