Esophageal cancer is a disease in which cancerous or malignant cells arise from the lining covering the inside of the esophagus, the hollow, muscular tube that transports food and liquid from the throat to the stomach. The esophagus is made up of several layers of tissue, and although esophageal cancer starts in the inner layer, it can spread outward through the other layers and into the interconnecting lymph nodes.
Thoracic surgeons at UT Southwestern Medical Center provide state-of-the-art surgical techniques with a major focus on early diagnosis, better cancer staging, and multidisciplinary care to enhance the treatment of esophageal cancer. Our NCI-designated Comprehensive Cancer Center, the gold standard for cancer centers, is a center for excellence in patient care, research, and education, and is the only center with this designation in North Texas.
Our experienced team of thoracic surgeons provides comprehensive care for esophageal cancer patients, from diagnosis to creating an individualized treatment plan and follow-up program to help ensure full recovery. Our thoracic surgeons work closely with interventional gastroenterologists, medical oncologists, and radiation oncologists to provide expert multidisciplinary and comprehensive care.
While our surgeons perform traditional open surgeries when needed, the majority of the operations are performed using the latest minimally invasive techniques, including robotic surgery. We are one of the leading and most experienced robotic surgery teams in the world for esophageal cancer. Our group was one of the first to perform a series of robotic esophagectomies, a procedure pioneered by Kemp Kernstine, M.D., Ph.D., who has published extensively about his work in this area.
We also offer advanced imaging capabilities, such as 3-D reconstruction of the cancer, which allows us to better understand the biology of the disease and determine the best treatment.
Types of Esophageal Cancer
The two most common forms of esophageal cancer are named for the type of cells that become cancerous or malignant:
- Adenocarcinoma – composed of glands or secretory cells and most often found in the lower part of the esophagus, near the stomach
- Squamous cell carcinoma – composed of flat cells and most often found in the upper and middle part of the esophagus
In many cases, esophageal cancer is diagnosed after a person begins to notice symptoms. However, early stage cancer often has no warning signs and symptoms develop as the tumor grows and blocks the esophagus or spreads to adjacent tissues.
Esophageal cancer symptoms can include:
- Bone pain
- Bleeding from the esophagus
- Chest pain, pressure, or burning
- Difficulty swallowing (dysphagia)
- Persistent or worsening indigestion or heartburn
- Unintentional weight loss and lack of appetite
There is no standard screening test for esophageal cancer. Diagnosis is usually made by esophagoscopy – a flexible endoscope is inserted, usually through the mouth – with a biopsy. This is often followed by an endoscopic ultrasound to determine the thickness of the tumor or degree of invasion into the deeper layers of the esophagus. In some patients with Barrett’s esophagus (a premalignant condition) regular endoscopic examinations help to identify early noninvasive esophageal cancer, which can be treated with minimally invasive endoscopic techniques and preservation of the esophagus.
Tests and procedures to diagnose esophageal cancer include:
- Barium study of the esophagus
- Esophagoscopy with biopsy
- Esophageal ultrasound with biopsy of the lymph nodes
- Molecular diagnostics
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI)
- Positron emission tomography (PET)
Stages of Esophageal Cancer
If a tissue sample from the tumor shows that you have esophageal cancer, the next step is to find out if the cancer has spread, and if so, how far. This process, called staging, is important in deciding which treatment will be best for you and is based on the result of the diagnostic studies.
Stage 0 – cancer cells are found only in the cells lining the esophagus. This may also be called high-grade dysplasia
Stage I – cancer is in the inside layers of the esophagus
Stage II – cancer has spread to the outer layers of the esophagus. It may also have spread to the lymph nodes
Stage III – cancer has spread beyond the esophagus to nearby tissue and has also spread to the lymph nodes
Stage IV – cancer has spread (metastasized) to another part of the body
Our multidisciplinary team of experts creates a customized treatment plan for each patient based on the location and extent of the tumor and the patient’s level of fitness. Our multidisciplinary team is composed of specialized medical and radiation oncologists, thoracic surgeons, and interventional gastroenterologists.
Our team approach is particularly important in esophageal cancer, which is often best managed using a combination of chemotherapy, radiation therapy, and surgery and which draws on the latest research breakthroughs and advances in medicine.
UT Southwestern’s thoracic surgeons treat esophageal cancer with procedures that include:
- Open thoracotomy
- Minimally invasive and robotic Ivor Lewis esophagectomy
- Minimally invasive and robotic McKeown esophagectomy
- Total or partial esophagectomy with colon interposition
- Total or partial esophagectomy with small bowel (jejunal) interposition
- Radiofrequency ablation
- Cryotherapy ablation
- Esophageal mucosal resection
- Esophageal submucosal dissection
- Endoesophageal laser therapy
Minimally Invasive Surgery
Compared to surgery performed through an open incision, minimally invasive surgery provides several important benefits for patients, including:
- Faster recovery and return to normal activities
- Less pain
- Little scarring
- Minimal blood loss
- No cutting of the ribs or sternum
- Possible improved cure rates for cancer
- Shorter hospital stay
Esophageal surgery procedures in which either portions or the entire esophagus are removed require a seven-to-10 day stay in the hospital and clinic visits afterward until the patient is fully recovered. At the time of surgery, a small feeding tube is placed to provide nutrition directly to the intestines while the newly created esophagus is healing.
UT Southwestern’s Thoracic Surgery team treats thoracic (chest) conditions that can be associated with esophageal cancer. These include:
- Benign (noncancerous) esophageal tumors
- Esophageal motility disorders, including achalasia
- Esophageal nodules and masses, including leiomyoma and gastrointestinal stromal tumors (GISTs)
- Esophageal perforation (a hole in the esophagus that allows liquid or food to leak)
- Esophageal reflux, also known as gastroesophageal reflux disease (GERD)
- Esophageal strictures or narrowings
- Hiatal hernia, including giant hiatal hernia with gastric volvulus (twisted stomach) and paraesophageal hiatal hernia
- Tracheoesophageal fistulas (an abnormal connection between the trachea and esophagus)
UT Southwestern conducts clinical trials aimed at improving the treatment of esophageal cancer. Talk with your doctor to see if a clinical trial may be right for you.
Meet Our Team
UT Southwestern thoracic surgeons who treat esophageal cancer include:
Request an Appointment
To schedule an appointment with an esophageal cancer specialist at UT Southwestern’s facilities in Dallas or to learn more about our services, request an appointment or call 214-645-8300.