What is screening?
General Information About Esophageal Cancer
Esophageal Cancer Screening
Risks of Esophageal Cancer Screening
Get More Information From NCI
Changes to This Summary (08/21/2007)
Questions or Comments About This Summary
About PDQ

What is screening?

Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.

Scientists are trying to better understand which people are more likely to get certain types of cancer. They also study the things we do and the things around us to see if they cause cancer. This information helps doctors recommend who should be screened for cancer, which screening tests should be used, and how often the tests should be done.

It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test. Screening tests are given when you have no cancer symptoms.

If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.

Refer to the following PDQ summaries for information about prevention, diagnosis, and treatment of esophageal cancer:

• Prevention of Esophageal Cancer ¹
• Esophageal Cancer Treatment ²

General Information About Esophageal Cancer

Key Points for This Section

Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus. Esophageal cancer is found more often in men. Smoking, heavy alcohol use, and Barrett esophagus can affect the risk of developing esophageal cancer.

Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus.

The esophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach. The wall of the esophagus is made up of several layers of tissue, including mucous membrane, muscle, and connective tissue. Esophageal cancer starts in the inside lining of the esophagus and spreads outward through the other layers as it grows.

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The stomach and esophagus are part of the upper digestive system.

The two most common types of esophageal cancer are named for the type of cells that become malignant (cancerous):

• Squamous cell carcinoma: Cancer that begins in squamous cells, the thin, flat cells lining the esophagus. This cancer is most often found in the upper and middle part of the esophagus but can occur anywhere along the esophagus. This is also called epidermoid carcinoma.
• Adenocarcinoma: Cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the esophagus produce and release fluids such as mucus. Adenocarcinomas usually form in the lower part of the esophagus, near the stomach.

Esophageal cancer is found more often in men.

Men are about three times more likely than women to have esophageal cancer. There are more new cases of esophageal adenocarcinoma each year and fewer new cases of squamous cell carcinoma. Squamous cell carcinoma of the esophagus is found more often in blacks than in whites. The chance of developing esophageal cancer increases with age.

Smoking, heavy alcohol use, and Barrett esophagus can affect the risk of developing esophageal cancer.

Anything that increases the chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor.

Risk factors for squamous cell esophageal cancer include the following:

• Using tobacco.
• Drinking a lot of alcohol.
• Being malnourished (lacking nutrients and/or calories).
• Being infected with human papillomavirus (HPV).
• Having tylosis.
• Having achalasia.
• Having swallowed lye (a chemical found in some cleaning fluids).
• Drinking very hot liquids on a regular basis.

Risk factors for esophageal adenocarcinoma include the following:

• Having gastroesophageal reflux disease (GERD).
• Having Barrett esophagus.
• Having a history of using drugs that relax the lower esophageal sphincter (the ring of muscle that opens and closes the opening between the esophagus and the stomach).
• Being overweight.

Esophageal Cancer Screening

Key Points for This Section

Tests are used to screen for different types of cancer. There is no standard or routine screening test for esophageal cancer. Tests that may detect (find) esophageal cancer are being studied: Esophagoscopy Biopsy Brush cytology Balloon cytology Chromoendoscopy Fluorescence spectroscopy

Tests are used to screen for different types of cancer.

Some screening tests are used because they have been shown to be helpful both in finding cancers early and in decreasing the chance of dying from these cancers. Other tests are used because they have been shown to find cancer in some people; however, it has not been proven in clinical trials that use of these tests will decrease the risk of dying from cancer.

Scientists study screening tests to find those with the fewest risks and most benefits. Cancer screening trials also are meant to show whether early detection (finding cancer before it causes symptoms) decreases a person's chance of dying from the disease. For some types of cancer, the chance of recovery is better if the disease is found and treated at an early stage.

There is no standard or routine screening test for esophageal cancer.

Screening for esophageal cancer is under study with screening clinical trials taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site ³.

Tests that may detect (find) esophageal cancer are being studied:

Esophagoscopy

A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope is inserted through the mouth or nose and down the throat into the esophagus. An esophagoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

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Esophagoscopy. A thin, lighted tube is inserted through the mouth and into the esophagus to look for abnormal areas.

Biopsy

The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. Taking biopsy samples from several different areas in the lining of the lower part of the esophagus may detect early Barrett esophagus. This procedure may be used for patients who have risk factors for Barrett esophagus.

Brush cytology

A procedure in which cells are brushed from the lining of the esophagus and viewed under a microscope to see if they are abnormal. This may be done during an esophagoscopy.

Balloon cytology

A procedure in which cells are collected from the lining of the esophagus using a deflated balloon that is swallowed by the patient. The balloon is then inflated and pulled out of the esophagus. Esophageal cells on the balloon are viewed under a microscope to see if they are abnormal.

Chromoendoscopy

A procedure in which a dye is sprayed onto the lining of the esophagus during esophagoscopy. Increased staining of certain areas of the lining may be a sign of early Barrett esophagus.

Fluorescence spectroscopy

A procedure that uses a special light to view tissue in the lining of the esophagus. The light probe is passed through an endoscope and shines on the lining of the esophagus. The light given off by the cells lining the esophagus is then measured. Malignant tissue gives off less light than normal tissue.

Risks of Esophageal Cancer Screening

Key Points for This Section

Screening tests have risks. The risks of esophageal cancer screening tests include the following: Finding esophageal cancer may not improve health or help a person live longer. False-negative test results can occur. False-positive test results can occur. Side effects may be caused by the test itself.

Screening tests have risks.

Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying from cancer.

The risks of esophageal cancer screening tests include the following:

Finding esophageal cancer may not improve health or help a person live longer.

Screening may not improve your health or help you live longer if you have advanced esophageal cancer or if it has already spread to other places in your body.

Some cancers never cause symptoms or become life-threatening, but if found by a screening test, the cancer may be treated. It is not known if treatment of these cancers will help you live longer than if no treatment were given, and treatments for cancer may have serious side effects.

False-negative test results can occur.

Screening test results may appear to be normal even though esophageal cancer is present. A person who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if there are symptoms.

False-positive test results can occur.

Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn't) can cause anxiety and is usually followed by more tests (such as biopsy), which also have risks.

Side effects may be caused by the test itself.

There are rare but serious side effects that may occur with esophagoscopy and biopsy. These include the following:

• A small hole (puncture) in the esophagus.
• Problems with breathing.
• Heart attack.
• Passage of food, water, stomach acid, or vomit into the airway.
• Severe bleeding that may need to be treated in a hospital.

Get More Information From NCI

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There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

Find Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator ⁶. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

Changes to This Summary (08/21/2007)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

Questions or Comments About This Summary

If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s Contact Form ⁷. We can respond only to email messages written in English.

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ⁵. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether a method of finding cancer earlier can help people to live longer. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients and those who are at risk for cancer. During screening clinical trials, information is collected about the effects of a new screening method and how well it works. If a clinical trial shows that a new method is better than one currently being used, the new method may become "standard." People who are at high risk for a certain type of cancer may want to think about taking part in a clinical trial.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site ⁸. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Glossary Terms

Not normal. An abnormal lesion or growth may be cancerous, premalignant (likely to become cancer), or benign.

Cancer that begins in cells that line certain internal organs and that have gland-like (secretory) properties.

A chemical substance found in beer, wine, and liquor. Alcohol is also found in some medicines, mouthwashes, essential oils (scented liquid taken from plants), and household products.

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

A condition in which the cells lining the lower part of the esophagus have changed or been replaced with abnormal cells that could lead to cancer of the esophagus. The backing up of stomach contents (reflux) may irritate the esophagus and, over time, cause Barrett esophagus.

The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.

Tissue removed from the body and examined under a microscope to determine whether disease is present.

A measurement of the energy content of food. The body needs calories as to perform its functions, such as breathing, circulating the blood, and physical activity. When a person is sick, their body may need extra calories to fight fever or other problems.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called a clinical study.

Supporting tissue that surrounds other tissues and organs. Specialized connective tissue includes bone, cartilage, blood, and fat.

The process of identifying a disease, such as cancer, from its signs and symptoms.

A method used to identify a disease.

Cancer that forms in tissues lining the esophagus (the muscular tube through which food passes from the throat to the stomach). Two types of esophageal cancer are squamous cell carcinoma (cancer that begins in flat cells lining the esophagus) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).

Examination of the esophagus using an esophagoscope. An esophagoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.

The muscular tube through which food passes from the throat to the stomach.

A test result that indicates that a person does not have a specific disease or condition when the person actually does have the disease or condition.

A test result that indicates that a person has a specific disease or condition when the person actually does not have the disease or condition.

The backward flow of stomach acid contents into the esophagus (the tube that connects the mouth to the stomach). Also called esophageal reflux or gastric reflux.

An organ that makes one or more substances, such as hormones, digestive juices, sweat, tears, saliva, or milk. Endocrine glands release the substances directly into the bloodstream. Exocrine glands release the substances into a duct or opening to the inside or outside of the body.

A member of a family of viruses that can cause abnormal tissue growth (for example, genital warts) and other changes to cells. Infection with certain types of human papillomavirus increases the risk of developing cervical cancer. Also called HPV.

Cancerous. Malignant tumors can invade and destroy nearby tissue and spread to other parts of the body.

A disorder caused by a lack of proper nutrition or an inability to absorb nutrients from food.

The moist, inner lining of some organs and body cavities (such as the nose, mouth, lungs, and stomach). Glands in the mucous membrane make mucus (a thick, slippery fluid). Also called mucosa.

A thick, slippery fluid made by the membranes that line certain organs of the body, including the nose, mouth, throat, and vagina.

A chemical compound (such as protein, fat, carbohydrate, vitamin, or mineral) contained in foods. These compounds are used by the body to function and grow.

Being too heavy for one’s height. Excess body weight can come from fat, muscle, bone, and/or water retention. Being overweight does not always mean being obese.

A doctor who identifies diseases by studying cells and tissues under a microscope.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

Something that may increase the chance of developing a disease. Some examples of risk factors for cancer include age, a family history of certain cancers, use of tobacco products, certain eating habits, obesity, lack of exercise, exposure to radiation or other cancer-causing agents, and certain genetic changes.

Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), Pap smear (cervix), and PSA blood level and digital rectal exam (prostate). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

A ring-shaped muscle that relaxes or tightens to open or close a passage or opening in the body. Examples are the anal sphincter (around the opening of the anus) and the pyloric sphincter (at the lower opening of the stomach).

Flat cell that looks like a fish scale under a microscope. These cells cover inside and outside surfaces of the body. They are found in the tissues that form the surface of the skin, the lining of the hollow organs of the body (such as the bladder, kidney, and uterus), and the passages of the respiratory and digestive tracts.

Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

A group or layer of cells that work together to perform a specific function.

A plant with leaves that have high levels of the addictive chemical nicotine. The leaves may be smoked (in cigarettes, cigars, and pipes), applied to the gums (as dipping and chewing tobacco), or inhaled (as snuff). Tobacco leaves also contain many cancer-causing chemicals, and tobacco use and exposure to secondhand tobacco smoke have been linked to many types of cancer and other diseases. The scientific name is Nicotiana tabacum.

To eject some or all of the contents of the stomach through the mouth.