What Is the First Sign of Esophageal Cancer?

Esophageal cancer often goes undetected until it has reached an advanced stage. However, there are some early signs of esophageal cancer that individuals can watch for to ensure early detection. One of the first signs of esophageal cancer is trouble swallowing (dysphagia). This often starts with difficulty swallowing solid foods and may progress to problems with swallowing liquids as the cancer grows. Unintentional weight loss, chest pain, and chronic acid reflux are also early indicators of esophageal cancer that should not be ignored. Understanding the early warning signs and risk factors for esophageal cancer is essential for early detection and improved survival rates.

Understanding Esophageal Cancer

Esophageal cancer occurs when cancer cells develop in the lining of the esophagus, the muscular tube that connects the throat to the stomach. The esophagus helps move food and liquids from the mouth to the stomach through a series of muscular contractions. There are two main types of esophageal cancer:

• Squamous Cell Carcinoma: This type forms in the thin, flat cells lining the upper and middle parts of the esophagus. It is more common in people who smoke or drink heavily.

• Adenocarcinoma: This type forms in the glandular cells that produce mucus and other fluids, typically in the lower part of the esophagus. Adenocarcinoma is more common in people with chronic acid reflux or Barrett’s esophagus.

Esophageal cancer is more common in men than in women and tends to develop later in life.

The First Signs of Esophageal Cancer

The earliest and most common symptom of esophageal cancer is difficulty swallowing, also known as dysphagia. At first, this may seem mild, such as feeling like food is sticking in the throat, or the feeling of needing to chew more thoroughly in order to swallow. Over time, the difficulty swallowing increases, as the esophagus becomes narrower, and may lead to an inability to swallow or to choking.

Another early warning sign of esophageal cancer is unexplained weight loss. When swallowing becomes difficult, people are likely to eat less, take smaller bites, or switch to eating softer foods, leading to unintended weight loss. In some cases, the cancer itself causes metabolic changes that result in rapid weight loss even without significant changes in diet.

Other Early Symptoms to Watch For

In addition to trouble swallowing and weight loss, esophageal cancer may present with other early symptoms, such as:

• Chest pain or discomfort, especially when swallowing
• Chronic heartburn or acid reflux that worsens over time
• Hoarseness or chronic cough
• Regurgitation of food or saliva
• Hiccups
• Vomiting
• Anemia

Early diagnosis can be challenging, as many of these symptoms are also linked to other digestive conditions, making it essential to seek medical attention if you are experiencing any of these symptoms.

Risk Factors and Who Is Most at Risk

Several factors increase the risk of developing esophageal cancer, including:

• Chronic acid reflux (GERD): Repeated exposure to stomach acid can damage the lining of the esophagus and lead to Barrett’s esophagus, a precancerous condition.
• Barrett’s esophagus: This condition occurs when the cells lining the lower esophagus change due to prolonged acid exposure.
• Smoking and heavy alcohol use: Tobacco and alcohol both irritate the esophagus, increasing cancer risk.
• Obesity: Excess weight increases the likelihood of developing GERD and Barrett’s esophagus.
• Diet: Diets low in fruits and vegetables and high in processed or smoked meats have been linked to higher esophageal cancer rates.
• Family history: A genetic predisposition can increase the likelihood of developing esophageal cancer.
• Age and sex: The risk increases with age and is higher in men than in women.

How Esophageal Cancer Progresses

Esophageal cancer typically begins in the innermost lining of the esophagus (the epithelium). The tumor then spreads outward into deeper layers of tissue over time. Esophageal cancer may initially progress slowly, but typically progresses quickly once symptoms begin to occur. In more advanced stages, the cancer cells may spread to nearby lymph nodes, bones, the lungs, liver, or other organs.

The progression of esophageal cancer is often classified into stages, according to the American Joint Committee on Cancer (AJCC) TNM system, based on the size of the tumor, the spread to nearby lymph nodes, and the spread to distant sites. Esophageal cancer staging can be complex. The stages of esophageal cancer from 0-4B are simplified below. If you have questions about your stage of cancer and what it means, ask your healthcare provider for more information.

Preventative Measures and Lifestyle Changes

While not all cases of esophageal cancer are preventable, certain lifestyle changes can reduce the risk, such as:

• Quit smoking: Tobacco is a major risk factor for squamous cell carcinoma.
• Limit alcohol consumption: Reducing alcohol intake lowers the risk of esophageal irritation and damage.
• Maintain a healthy weight: Obesity increases the risk of GERD and Barrett’s esophagus.
• Follow a balanced diet: Eating more fruits, vegetables, and whole grains while limiting processed and red meats can support digestive health.
• Manage acid reflux: Over-the-counter antacids, proton pump inhibitors (PPIs), and lifestyle changes can help reduce acid reflux.

Diagnosis and Next Steps

If you experience symptoms such as difficulty swallowing or unexplained weight loss, your doctor may recommend diagnostic tests, including:

• Endoscopy: A thin, flexible tube with a camera is used to examine the esophagus. Various types may be used, including upper endoscopy, endoscopic ultrasound, bronchoscopy, thoracoscopy or laparoscopy.
• Biopsy: Tissue samples are collected and analyzed for cancer cells.
• Barium swallow test: X-rays are taken after swallowing a contrast liquid to highlight the esophagus and show any abnormal areas.
• CT scan or PET scan: Imaging tests help determine if cancer has spread to nearby organs and lymph nodes.
• Esophageal manometry: Measures the strength and coordination of esophageal muscles.

If esophageal cancer is confirmed, the treatment plan will depend on the cancer’s type, stage, and location.

When to Talk to Your Doctor

It’s essential to talk to your doctor if you experience any symptoms of esophageal cancer, particularly difficulty swallowing that persists or worsens, unintentional weight loss, persistent heartburn or acid reflux, chest pain or discomfort, or coughing or hoarseness that lasts for more than two weeks. Additionally, if you have a family history of esophageal cancer or other risk factors, consider talking to your doctor now about regular screenings and lifestyle changes to reduce your risk. Early diagnosis improves the chances of successful treatment and recovery.

Understanding the early signs of esophageal cancer and seeking medical advice when symptoms first appear can make a significant difference in your health outcome in the case of an esophageal cancer diagnosis. Reach out to Allied Digestive Health today to find out more about your options for screening and prevention.