As with all cancers, esophageal cancer is caused by an abnormal proliferation of cells. The two types of esophageal cancer, squamous cell carcinoma and adenocarcinoma, are named after the specific esophageal cells which grow irregularly. Squamous cell carcinoma is more common in the upper and middle parts of the esophagus, where there is a high concentration of squamous cells, while adenocarcinoma occurs in the lower section of the esophagus, in the secretory/glandular cells. The most common symptoms of esophageal cancer are pain or difficulty swallowing and weight loss, while pain in the upper chest, hoarseness, coughing, indigestion, and heartburn may also indicate a problem. Heartburn has been linked to esophageal cancer primarily through the intermediary condition of Barrett’s Esophagus. Prolonged exposure to acidic stomach contents (as in heartburn) can lead to the development of Barrett’s Esophagus, in which the normal squamous cells change into secretory/glandular cells. These cells are much more likely to become malignant. For these reasons, the American College of Gastroenterology recommends both stomach and esophageal endoscopies for individuals with a recurring history of heartburn.
There are multiple methods used for diagnosing esophageal cancer. In addition to endoscopy, X-rays, Computed Tomography (CT) scans, endoscopic ultrasound, barium swallow, and biopsy may be utilized to determine the presence and/or stage of the cancer. A barium swallow coats the inside of the esophagus such that any growths or irregularities are easier to identify in an X-ray. If any irregularities are seen, endoscopy with biopsy would need to be done to make the diagnosis and guide treatment.
