Chapter 2: Esophageal Cancer and ESCC

In Chapter 1, we discussed nasopharyngeal carcinoma and its symptoms, treatments, and more. In this Chapter, we’re taking a closer look at Esophageal Cancer, particularly Esophageal Squamous Cell Carcinoma.

Esophageal Cancer

As the name suggests, Esophageal Cancer is a general term that refers to any type of cancer that affects the esophagus[1]. The esophagus is a muscular tube that connects the mouth to the stomach. As a part of the digestive system, it helps the body absorb necessary nutrients by transporting foods and liquids from the back of the throat to the stomach[2].

One way to think of your esophagus is as a long, winding slide. When you eat or drink, the foods and liquids slide all the way down to your stomach, where they will be processed and broken down to help you function. Esophageal Cancer happens when the cells in this slide start behaving abnormally.

Types of Esophageal Cancer

Esophageal Cancer can be separated into two main types—Squamous Cell Carcinoma and Adenocarcinoma.

• The globally predominant type is Squamous Cell Carcinoma, which usually begins in the thin, flat cells that make up the inside lining of the esophagus, also known as the squamous mucosa[4, 5].
• Another common type is adenocarcinoma which begins the glandular cells of the esophagus, or cells that secrete substances such as mucus[3].
• A third and rarer type of Esophageal Cancer is known as Small Cell Carcinoma, which begins in cells that release hormones into your bloodstream called neuroendocrine cells[3].

Depending on the type of Esophageal Cancer, a patient may require different treatment methods to better address their disease. Let’s take a closer look at Esophageal Squamous Cell Carcinoma.

Esophageal Squamous Cell Carcinoma

Esophageal Squamous Cell Carcinoma (ESCC) arises from squamous cells lining the esophagus, and it typically occurs in the upper esophagus[4]. If you’re wondering, “What in the world is a squamous cell,” they are the thin, flat cells that construct the inside lining, or squamous mucosa, of your esophagus. Under the microscope, they resemble tiny fish scales[5], which doesn’t sound very flattering, but they have the important role of safeguarding your delicate innards.

Imagine the squamous mucosa as a protective layer that keeps your esophagus-slide from getting hurt. This protective layer is made up of many squamous cells, or miniature shields, and they not only act as a first line of defense for the slide, they also lubricate the slide to assist foods and liquids as they’re passing through. Unfortunately, sometimes these mini shields may go a little wild and start growing dangerously. That is when ESCC occurs.

Facts and Figures

So how many people does Esophageal Cancer and ESCC affect? The American Cancer Society estimates that there will be approximately 20,640 patients diagnosed with esophageal cancer by the end of this year (2022) in the US alone. They also project that approximately 16,410 individuals will die from esophageal cancer[6].

In a recently published article, Morgan et. al reviewed GLOBOCAN 2020’s estimates, which reported a global estimate of 604,100 new Esophageal Cancer cases and 544,100 deaths in 2020. Of these cases, the scientists observed that 85% of them were ESCCs, a shockingly high number that reflects the severity of this particular type of Esophageal Cancer[7]. The American Cancer Society also observed differences in incidences and mortality between different regions of the world—Eastern Asia as well as Southern and Eastern Africa saw more cases of Esophageal Cancer than anywhere else, whereas Western Africa and Central America saw the fewest cases and deaths[6].

The survival rate of ESCC can vary depending on a number of factors, including the stage of the cancer, the patient’s overall health, and the effectiveness of the chosen treatment. According to the American Cancer Society, the overall 5-year survival rate for ESCC is approximately 20%. In other words, on average, about 20% of people with ESCC will live 5 or more years after diagnosis.

Risk Factors and Symptoms

Main risk factors for ESCC include[4, 8]:

• Heavy alcohol consumption
• Heavy smoking
• Chronic acid reflux or heartburn
• Other medical conditions (such as GERD, Barrett’s esophagus, an achalasia)

ESCC also tends to occur more often in men than women.

Symptoms of ESCC do not appear until the cancer has reached an advanced stage. Common symptoms of ESCC include the following[4, 8]:

• Difficulty swallowing
• Chest pain or discomfort
• Weight loss
• Hoarseness or a change in the voice
• Coughing or wheezing
• Heartburn or indigestion
• Regurgitation of food or liquids
• Pain or discomfort in the throat or neck

Treatment

If ESCC is diagnosed, treatment will depend on the stage of the cancer and the overall health of the patient. Treatment options include surgery, radiation therapy, and chemotherapy. In some cases, a combination of these treatments may be used[4].

• Surgery: the most comment type of treatment, in which the cancerous tissue is physically removed
• Chemotherapy and Radiation Therapy: able to kill cancer cells and shrink tumors through the use of drugs (chemotherapy) and high-energy beams (radiation therapy)
• Combination Treatment: common combinations are

1. neoadjuvant therapy—radiation + chemo before surgery
2. chemo and radiation together

Newer treatment options also include targeted drug therapy and immunotherapy. Targeted drug therapy uses drugs that target specific molecules in cancer cells to stop them from growing or spreading. Immunotherapy uses drugs that can help the body’s immune system recognize and attack cancer cells in a more selective manner[9].

Prevention

While there is no sure-fire way to completely prevent ESCC, certain lifestyle changes can help[2, 6]:

• Avoiding tobacco use
• Decreasing alcohol use
• Eating a balanced diet with more fruits and vegetables
• Maintaining a healthy weight

Receiving regular screenings can also increase the chances of detecting cancer early on. If you have reflux and/or heartburn, seek professional treatment. Early detection and treatment can help reduce the risk of developing ESCC as well as other cancers.

Read more about Esophageal Cancer and ESCC at these following sources:

National Cancer Institute: https://www.cancer.gov/types/esophageal

Memorial Sloan Kettering Cancer Center: https://www.mskcc.org/cancer-care/types/esophageal

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Sources Referenced:

1. “Esophageal Cancer Treatment (Adult) (PDQ?)–Patient Version.” National Cancer Institute, November 18, 2021. https://www.cancer.gov/types/esophageal/patient/esophageal-treatment-pdq. 
2. “Esophageal Cancer: Symptoms & causes.” Mayo Clinic. Mayo Foundation for Medical Education and Research, April 19, 2022. https://www.mayoclinic.org/diseases-conditions/esophageal-cancer/symptoms-causes/syc-20356084. 
3. “Types of Esophageal Cancer.” Memorial Sloan Kettering Cancer Center. Accessed December 16, 2022. https://www.mskcc.org/cancer-care/types/esophageal/types-esophageal. 
4. “Esophageal Cancer.” Esophageal Cancer | Johns Hopkins Medicine. Accessed December 16, 2022. https://www.hopkinsmedicine.org/health/conditions-and-diseases/esophageal-cancer. 
5. “Understanding Your Pathology Report.” American Cancer Society. Accessed December 16, 2022. https://www.cancer.org/treatment/understanding-your-diagnosis/tests/understanding-your-pathology-report.html. 
6. “Statistics for Esophageal Cancer: Esophageal Cancer Stats.” American Cancer Society. Accessed December 16, 2022. https://www.cancer.org/cancer/esophagus-cancer/about/key-statistics.html. 
7. Morgan, Eileen, Isabelle Soerjomataram, Harriet Rumgay, Helen G. Coleman, Aaron P. Thrift, Jér?me Vignat, Mathieu Laversanne, Jacques Ferlay, and Melina Arnold. “The Global Landscape of Esophageal Squamous Cell Carcinoma and Esophageal Adenocarcinoma Incidence and Mortality in 2020 and Projections to 2040: New Estimates from Globocan 2020.” Gastroenterology 163, no. 3 (n.d.). Accessed December 16, 2022. https://doi.org/10.1053/j.gastro.2022.05.054. 
8. “Esophageal Cancer.” Columbia University Herbert Irving Comprehensive Cancer Center. Accessed December 16, 2022. https://www.cancer.columbia.edu/cancer-types-care/types/esophageal-cancer/about-esophageal-cancer. 
9. “Esophageal Cancer: Diagnosis & Treatment.” Mayo Clinic. Mayo Foundation for Medical Education and Research, April 19, 2022. https://www.mayoclinic.org/diseases-conditions/esophageal-cancer/diagnosis-treatment/drc-20356090.