Siteman Cancer Center brings together the most specialized esophageal cancer expertise in the region, and we move swiftly. If you are facing a recent diagnosis or looking for a second opinion, you are in the right place.
What Is Esophageal Cancer?
Esophageal cancer develops in the lining of the esophagus, which is the muscular tube that carries food and liquid from your throat to your stomach.
There are two main types of esophageal cancer:
- Esophageal squamous cell carcinoma (ESCC): This type forms in the flat cells lining the upper and middle esophagus.
- Esophageal adenocarcinoma (EAC): This usually develops in glandular cells near the stomach.
EAC is the more common form of esophageal cancer in the United States and can develop after a diagnosis of Barrett’s esophagus.
Early identification of these conditions is one of the most powerful tools in survivability. But even if you haven’t caught the cancer early, there is still help available at Siteman.
What Are the First Signs of Esophageal Cancer?
Esophageal cancer often develops without noticeable symptoms in its earliest stages, which is why understanding what to watch for matters.
The most common first sign is dysphagia, or difficulty swallowing, particularly solid foods. Many patients describe a sensation that food feels stuck in the chest.
Other symptoms to watch for include:
- Unintentional weight loss
- Persistent heartburn or acid reflux that is worsening
- Hoarseness or chronic cough
- Pain or pressure behind the breastbone
- Anemia or unexplained fatigue
- Vomiting blood or dark stools (signs of upper GI bleeding)
Experiencing any of these symptoms does not necessarily mean you have esophageal cancer. Many other conditions share these signs. However, symptoms that persist beyond two weeks deserve prompt attention from your physician.
An Accurate Diagnosis Is the Foundation of Effective Treatment
Determining the exact type and stage of esophageal cancer requires a coordinated set of tests. At Siteman, a multidisciplinary team reviews each new patient’s case, called the care team.
Your care team includes experts in:
- Gastroenterology
- Thoracic surgery
- Medical oncology
- Radiation oncology
- Pathology
This care team approach ensures that staging is as accurate as possible before treatment begins.
The importance of this step cannot be overstated because determining the stage of cancer will direct every treatment decision.
Diagnostic tools that WashU Medicine physicians at Siteman could use include:
- Physical exam with medical history
- Esophagoscopy (upper endoscopy), where physicians collect a biopsy
- Chest X-ray with barium swallow
- CT scan
- PET scan
- Endoscopic ultrasound
- MRI
- Bronchoscopy in cases where the cancer is near the airway
How Physicians Stage Esophageal Cancer
Physicians stage esophageal cancer from 0 to 4, where Stage 0 reflects abnormal cells that have not yet become invasive, and Stage 4 indicates cancer that has spread to distant organs. Staging also considers tumor grade, measured on a scale of 1-3, and assesses how aggressive the cancer cells are.
Accurate staging at a high-volume center like Siteman matters. WashU Medicine researchers are leaders in the field who have written about the strengths and weaknesses of common staging methods, defining how staging is conducted in many other cancer centers. They apply the full range of staging tools to build the most complete picture of your cancer before treatment begins.
Survival Rates for Esophageal Cancer
Siteman Cancer Center is a high-volume, highly specialized cancer center, performing more than 70 esophagectomies per year and treating an average of 1,000 patients each year with upper thoracic cancers, including esophageal. This can give you a dramatically different picture of treatment results and survivability rates than national averages.
Aggregate numbers that you might find online include patients treated at all types of centers, at all stages, with widely varying surgical expertise. High- volume centers like Siteman reduce surgical mortality and complication rates and increase long-term survivability.
The stage of your cancer matters, and so does where you receive care. Talk to a Siteman care coordinator to understand what your specific diagnosis means for you.
Our Siteman care coordinators – oncology-trained nurses who help with scheduling, finding the right specialist, and guidance – can help you through the process.
Call us directly or submit a form, and we will call you back.
Esophageal cancer can be treated
Treatment results and survivability depend on the stage at diagnosis, the type of esophageal cancer, and the quality of care you receive. When doctors find esophageal cancer early, they can treat it to cure it. This means the aim is long-term remission and better survival rates. Even in more advanced cases, treatments can control disease, reduce symptoms, and extend quality of life.
Siteman treats the full spectrum of esophageal cancer, from pre-cancerous to complex, advanced-stage disease. Patients can enroll in clinical trials for the latest treatment combinations—including multimodal therapies that combine treatment types to eliminate cancer from all angles. Many of these trials offer more approaches that are not available yet as standard care elsewhere.
Early Detection of Barrett’s Esophagus Can End Cancer Before It Begins
Barrett’s esophagus develops with chronic acid reflux (GERD) that causes stomach contents to go back up into the lower section of the esophagus. This condition irritates the esophagus and can change the normal cells of the lower esophagus, replacing them with intestinal-type cells. Over time, these cells can change and become abnormal. This process is called dysplasia. Eventually, they could develop into cancer.
GERD can impact millions of adults in the US, of whom about 10% will develop Barrett’s esophagus. Among those with high-grade dysplasia, the risk of progression to cancer can be as high as 6% per year. Surveillance is critical for people diagnosed with it.
The good news is that doctors often treat patients found to have high-grade dysplasia or T1a stage with simple, minimally invasive procedures. This means they usually won’t need major surgery.
Treatment for patients with Barrett’s esophagus might include:
- Endoscopic mucosal resection (EMR), which removes abnormal tissue through the scope.
- Radiofrequency ablation (RFA), which uses heat from radio waves to destroy diseased tissue while leaving the deeper layers of the esophagus intact.
Siteman began performing RFAs for Barrett’s esophagus as early as 2009. Physicians from Siteman co-authored the landmark study that introduced RFA for Barrett’s esophagus to the world. Patients with high-grade dysplasia might qualify for this method. It removes the abnormal tissue and greatly lowers cancer risk.