5 Questions About Esophageal Cancer

Esophageal cancer begins in the esophagus, the long, muscular organ that moves food and liquids from your throat to your stomach.  

There are two types of esophageal cancer: adenocarcinoma and squamous cell carcinoma. Adenocarcinoma is the most common of the two.   

Jose Pimiento, MD, a gastrointestinal surgeon at Moffitt Cancer Center, and nurse practitioner Chuck Jones, who specializes in esophageal cancer, answer common questions about the disease during Esophageal Cancer Awareness Month.  

Is there screening available for esophageal cancer?  

There is no routine screening test for esophageal cancer for the general public. It’s not like breast cancer or colon cancer, where there’s a standard screening program for everyone. That said, screening is recommended for people who fall into a higher-risk category.

The American Gastroenterological Association has a similar recommendation, which applies to people with at least three risk factors, even if they don’t have typical heartburn symptoms. 

The hard truth is that esophageal cancer is most often found after symptoms have already developed, and by that point, the disease can be at a more advanced stage. About 36% of patients already have advanced disease at the time of diagnosis.  

What are the most common symptoms? 

Difficulty swallowing is by far the most common symptom, showing up in about 74% of patients by the time they’re diagnosed. It tends to come on gradually. People often describe the feeling that food is getting stuck or just not going down the way it should. By the time swallowing becomes noticeably difficult, the tumor has usually grown to involve a large portion of the esophagus, which typically means the cancer is more advanced. 

How is esophageal cancer typically treated? 

How we treat esophageal cancer depends on how far along or how advanced it is when we find it, which subtype it is (adenocarcinoma or squamous cell carcinoma) and the patient’s overall health. 

When we catch it early — while it’s still confined to the inner lining of the esophagus — we can often remove it with an endoscopic procedure. That means no major surgery. The cancer is taken out through a scope, and recovery is much easier. This is one of the strongest reasons to push for early detection. 

For more advanced disease, we take a combined approach. This typically means chemotherapy or chemotherapy and radiation that are given before surgery, and in some cases, continued after surgery as well. Surgery includes the resection of a portion of the esophagus, the top part of the stomach, and the surrounding lymph nodes. It can be performed with minimally invasive techniques, including robotic surgery, and can have great long-term results.  Immunotherapy has also become a key part of treatment for many patients alongside chemotherapy. The specific combination depends on the tumor type and its molecular characteristics. 

Jose Pimiento, MD 

When the cancer has spread to distant parts of the body, the focus shifts to systemic treatments that travel through the bloodstream. This includes chemotherapy, immunotherapy, and, in some cases, targeted therapies that target specific features of the tumor. We also have good options for managing symptoms like difficulty swallowing, including procedures to place a small tubular mesh (stent) in the esophagus to keep it open. 

The treatment landscape for esophageal cancer has changed dramatically in just the last few years. Immunotherapy and targeted treatments have opened options that simply didn’t exist a decade ago, and outcomes are improving as a result. 

Are we seeing more cases in younger adults?  

Yes, and the trend is concerning. Esophageal adenocarcinoma, which is the most common subtype in the U.S., has been increasing among adults under 50.

National cancer registry data show an annual increase of roughly 3% per year over the last four decades in this age group. What makes this more worrisome is that younger patients tend to show up with more advanced disease. About 80% of younger patients already have regional or distant spread at the time of diagnosis. This is likely due to the patient and their doctor not thinking about esophageal cancer in someone under 50.  

The most likely explanation for this trend is the increasing rates of obesity and acid reflux in younger people. Both conditions promote Barrett’s esophagus, which is the precursor to esophageal adenocarcinoma. Obesity, especially carrying extra weight around the midsection, puts more pressure on the stomach and makes reflux worse, feeding a cycle that raises cancer risk over time. 

What is your advice to others during Esophageal Cancer Awareness Month? 

Know your risk factors. Chronic acid reflux, obesity (especially around the abdomen), smoking, heavy alcohol use, and a family history of Barrett’s esophagus or esophageal cancer all raise your risk. The encouraging part is that you can change several of these are things. Quitting smoking and managing your weight are the two most impactful steps you can take. Additionally, avoiding eating late at night and avoiding going to bed with a full stomach are paramount to minimizing acid reflux. 

Don’t ignore persistent symptoms. If you’re having progressive trouble swallowing, losing weight without explanation, or dealing with heartburn that isn’t getting better with treatment, you should get it checked out. It doesn’t matter how old you are. These symptoms deserve attention. 

Talk to your doctor about having an upper endoscopy if you have multiple risk factors, even if you’ve never had classic reflux symptoms. A single screening upper endoscopy can find Barrett’s esophagus before it ever has the chance to become cancer. 

The bottom line is that early detection changes everything. When we catch esophageal cancer early, we can treat it with minimally invasive techniques, and the outcomes are dramatically better.