Symptoms of Esophageal Cancer

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esophageal cancer symptoms
© Verywell, 2018

The symptoms of esophageal cancer may include difficulty swallowing, regurgitating food, heartburn, weight loss, and a persistent cough. Less common symptoms such as hiccups, pneumonia, or enlarged lymph nodes in the neck and above the collarbone may occur due to the spread of cancer. Having an awareness of the potential symptoms is important, as many people work to address them (say, by consuming more soft foods) before realizing they have a problem.

Frequent Symptoms

Very early on in the disease, people may have few symptoms of esophageal cancer. When symptoms begin to occur, many of them are due to the tumor narrowing the esophagus, making it more difficult for food to pass through. Common symptoms include:

Difficulty Swallowing

Difficulty swallowing (dysphagia) is the most common symptom of esophageal cancer, occurring in 90 percent to 95 percent of people who have symptoms with the disease. If the esophagus narrows because of cancer, food may have a hard time passing through on its way to the stomach. If food goes down, a person may sense that it's taking longer than normal to do so, creating the sensation of "food getting stuck" or leading a person to choke. That said, the esophagus is often markedly narrowed before symptoms occur. 

Swallowing challenges usually begin with larger pieces of solid food (especially meat, bread, and raw vegetables), but can then worsen to include semisolid foods and eventually liquids. At the time of diagnosis, many people note that they have already started to adjust their diet unconsciously, chewing food items more completely and avoiding foods that are more likely to become stuck.

Painful Swallowing

Swallowing may also become painful (odynophagia) for around 20 percent of people. The pain may be felt within a few moments of swallowing when the food or liquids reach the tumor and can't pass. Pain may also occur if the cancer causes an open sore in the lining of the esophagus, or if it invades surrounding tissues. Pain between the shoulder blades in the back or that's throughout the chest may also be felt with swallowing.

Regurgitation of Food or Vomiting

When food won't pass easily through the esophagus, it may come back up whole and undigested. This occurs in around 40 percent of people with esophageal cancer. Vomiting of food or blood may also occur, especially if a tumor begins to bleed. 

Unexplained Weight Loss

Unintentional weight loss is a common symptom of esophageal cancer, present in half of the people at the time of diagnosis. Unintentional weight loss is defined as the loss of 5 percent of body weight or more over a six- to 12-month period. An example would be a 150-pound woman losing 7.5 pounds over a period of six months without a change in diet or exercise habits. Weight loss can be caused both by lack of nutrition due to swallowing difficulties and the metabolism of the tumor itself. 

Heartburn, Chest Pain, and Indigestion

A sensation of burning or pain behind the breastbone (heartburn) is common, and often (at least initially) begins after a large meal. This can be a challenging symptom as heartburn is also a symptom of acid reflux (gastroesophageal reflux disease, GERD), a common risk factor for esophageal cancer. For those who have acid reflux, a change in the quality or severity of heartburn symptoms may signal the presence of cancer.

Along with burning, some people feel chest pressure and fear they are having a heart attack. Since heart disease in women often presents with vague symptoms, such as those just discussed, symptoms of burning and pressure in the chest should always be evaluated by a physician.

Persistent Cough

persistent cough is present in around 20 percent of people who are diagnosed with esophageal cancer. A cough is often dry and annoying and may occur any time of day. Coughing may worsen after eating (often related to one of the complications of esophageal cancer) or may have no relationship to eating.

Hoarseness

A sensation of hoarseness, loss of voice, or the need to clear your throat frequently may be an initial symptom of the disease, especially when there isn't an obvious cause such as a recent upper respiratory infection. Hoarseness often occurs when a tumor involves a nerve known as the recurrent laryngeal nerve. 

Excess Saliva

To help pass food through the esophagus, the body makes more saliva. As it becomes more difficult to swallow, the body produces more saliva to compensate.

Black Stools 

Tarry, black stools, known as melena, may occur due to bleeding from the esophagus. Blood from the esophagus and upper digestive tract turns black due to exposure to stomach acid.

Rare Symptoms

There are also some uncommon, but important symptoms of esophageal cancer. Several of these occur because of the invasion of the tumor into nearby tissues or the spread to other regions of the body.

Hiccups

Hiccups may occur when an esophageal tumor invades the phrenic nerve or diaphragm. Irritation of these structures causes these repeated contractions of the diaphragm.

Shortness of Breath

People may experience shortness of breath due to local spread of the tumor in the chest or aspiration and subsequent pneumonia.

Enlarged Lymph Nodes

Swollen lymph nodes may occur in the area just above the collarbone (supraclavicular nodes) or the neck (cervical lymph nodes).

Tenderness Over Bones

The spread of cancer to bones (bone metastases) may cause tenderness and pain over bones. Sometimes, a fracture may occur through an area of weakened bone. Spread to the bones can also cause an elevated calcium level in the blood (hypercalcemia) that can lead to muscle cramps, weakness, and confusion.

Back Pain

Back pain is fairly common in advanced esophageal cancer due to the invasion of the tumor into the area between the lungs (the mediastinum) or between the membranes that line the heart (the pericardium).

Complications

There are a number of complications that may occur with esophageal cancer. Some of these occur due to local involvement, such as the narrowing of and/or erosion of the esophagus. Others may occur due to the spread of the tumor, and yet others have to do with the difficulty getting adequate nutrition with a narrowed esophagus. Potential complications include:

Esophageal Obstruction

Obstruction of the esophagus is very common and often leads to the symptoms that result in a diagnosis. For many people with the disease, the placement of an esophageal stent is necessary so that eating is possible. Traditional rigid plastic tubes (or as an alternative, period procedures in which the esophagus is dilated) often result in many complications, such as perforation. Newer techniques, such as self-expanding metal splints and anti-reflux devices, offer a much better solution to this common problem.

Tracheoesophageal Fistula

A fistula (an abnormal passageway) may form between the esophagus and the trachea, the tube between the mouth and the bronchi of the lungs, due to tumor invasion and inflammation. When this occurs, contents from the esophagus can pass directly into the trachea and then the lungs. When present, a tracheoesophageal fistula usually causes coughing with swallowing and pneumonia. Treatment may include placing stents in the esophagus and/or trachea. Newer techniques, such as placing umbrella-shaped valves within the bronchi, may also be considered.

Aortoesophageal Fistula

An uncommon, but life-threatening condition may occur when a fistula forms between the esophagus and the aorta, the large blood vessel that carries blood from the heart to the rest of the body. When this occurs, usually late in the course of the disease, the symptoms are often dramatic with bright red bleeding from the mouth and pain in the mid-chest region. When diagnosed promptly, immediate surgery may sometimes resolve the fistula.

Aspiration Pneumonia

Choking on eating or a fistula often leads to the breathing in of the contents of the esophagus and stomach into the lungs. When this occurs, it can lead to aspiration pneumonia, a condition that usually requires hospitalization and intravenous antibiotics.

Hemorrhage (Bleeding)

Major bleeding may also occur due to ulceration and/or perforation of the esophagus, or as a complication of stent placement. Options will depend on the situation but may include cautery (burning the bleeding blood vessels).

Malnutrition

An extremely common complication of esophageal cancer is malnutrition due to the decreased ability to eat and swallow foods. This may require a feeding tube, placed either through the nose or stomach, to provide nutrition.

When to See a Doctor

It's important to see your doctor if you have any of the symptoms mentioned above. While there are many potential causes for most of these symptoms, it's important to seek answers so that appropriate treatment can be initiated no matter the cause. Symptoms are your body's way of alerting you to potential problems. Talk to your doctor, and if you aren't getting answers, ask again. Being your own advocate can make a big difference—sometimes a life and death difference—in getting the care you need and deserve.

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