What is the survival rate for esophageal?

Esophageal Cancer

Esophageal cancer starts in your esophagus, the long muscular tube that moves food from your throat to your stomach. Most people don’t notice symptoms until after the cancer has spread. If detected early, healthcare providers may be able to eliminate the cancer with surgery and other treatments. When they can’t cure the cancer, they focus on extending lifespan, easing symptoms and maintaining quality of life.

Overview

Gene Link to Esophageal Cancer

What is esophageal cancer?

Esophageal cancer is the 10th most common cancer in the world. It starts in the tissues in your esophagus, the long muscular tube that moves food from your throat to your stomach. Tumors caused by esophageal cancer may not cause noticeable symptoms until the cancer has spread.

Healthcare providers treat early-stage esophageal cancer with surgery to remove the tumors or ease symptoms. They may use treatments such as chemotherapy, radiation therapy and immunotherapy to treat more advanced or later-stage esophageal cancer. When they can’t cure the cancer, they focus on helping people live longer, easing symptoms and maintaining quality of life. Medical researchers are working on treatments that will help people with esophageal cancer live longer.

How does esophageal cancer affect my body?

Esophageal cancer happens when cancerous cells in your esophageal tissue begin to multiply, eventually creating a tumor. Esophageal cancer is aggressive, but many people don’t notice symptoms until after the cancer has spread. That’s because your esophagus stretches to make room for big things, like large bites of food. As the tumor grows, it starts to block your esophagus’ opening. You may have trouble swallowing or notice that it hurts to swallow.

There are two types of esophageal cancer:

• Adenocarcinoma: This is the most common type of esophageal cancer in the U.S. It develops in the tissue that makes mucus that helps you swallow. It usually affects the lower part of your esophagus.
• Squamous cell carcinoma: This type begins in squamous cells that line your esophagus. Squamous cell esophageal cancer usually affects the upper and middle parts of your esophagus.

Is there a cure for esophageal cancer?

Sometimes, healthcare providers can do surgery to remove small tumors. Unfortunately, only 25% of people with this cancer receive a diagnosis before the cancer spreads.

Who’s affected by esophageal cancer?

Esophageal cancer affects about 4 in 100,000 people in the U.S. It typically affects men and people designated male at birth (DMAB) who are age 60 or older. It’s more common in men and people DMAB than in women and people designated female at birth (DFAB). People who are Black and people who are Asian with this condition usually have squamous cell esophageal cancer. People who are white are more likely to have adenocarcinoma esophageal cancer.

Symptoms and Causes

What are esophageal cancer symptoms?

Difficulty swallowing is the first symptom people may notice. Other symptoms include:

• Pain in your throat or back, behind your breastbone or between your shoulder blades.
• Vomiting or coughing up blood.
• Heartburn.
• Hoarseness or chronic cough.
• Unintentional weight loss.

How quickly does esophageal cancer progress (get worse)?

Esophageal cancer typically grows very rapidly. Your esophagus is very flexible and expands around the tumor as it grows. This is why people often don’t have symptoms until the cancer has spread.

What’s the main cause of esophageal cancer?

Healthcare providers don’t know the exact cause, but they’ve identified risk factors that increase the chance of developing esophageal cancer, including:

• Tobacco use: This includes smoking and using smokeless tobacco.
• Alcohol use: Chronic and/or heavy use of alcohol increases the risk of esophageal cancer.
• Obesity: Being overweight or having obesity may cause inflammation in your esophagus that could become cancer.
• Barrett’s esophagus and chronic acid reflux: Barrett’s esophagus is a change in the cells at the lower end of your esophagus that occurs from chronic untreated acid reflux. Even without Barrett’s esophagus, people with long-term heartburn have a higher risk of esophageal cancer.
• Human papillomavirus (HPV): HPV is a common virus that can cause tissue changes in your vocal cords and mouth and on your hands, feet and genitals.
• History of cancer: People who’ve had cancer of the neck or head have a greater risk for esophageal cancer.
• Other disorders: Esophageal cancer is linked to some rare and/or inherited conditions. One is achalasia, an uncommon disease that makes it hard for you to swallow. Another disorder is tylosis, a rare, inherited disorder in which excess skin grows on the palms of your hands and the soles of your feet.
• Occupational exposure to certain chemicals: People exposed to dry cleaning solvents over a long time are at higher risk of developing esophageal cancer.

Diagnosis and Tests

How do healthcare providers diagnose esophageal cancer?

A healthcare provider will ask questions about your symptoms and medical history. They may do the following tests to diagnose the condition:

• Barium swallow: Healthcare providers look at your esophagus through a series of X-rays. It’s called a barium swallow because people drink a liquid with barium. Barium makes it easier for healthcare providers to see your esophagus on the X-ray.
• Computed tomography (CT)scan: This test helps healthcare providers determine if tumors have spread to your chest and abdomen (belly).
• Esophagogastroduodenoscopy (EGD): Healthcare providers use a thin flexible tube called an endoscope to look at the inside of your esophagus.
• Esophageal endoscopic ultrasound: Sound waves create images of the inside of your esophagus. Healthcare providers may do this test as part of an EGD.
• Biopsy: During the EGD, healthcare providers may remove a small piece of tissue to examine under a microscope to see if there are any cancer cells.

Healthcare providers use what they learn in diagnosis to classify or stage esophageal cancer. Cancer staging systems lay the foundation for cancer treatment.

When healthcare providers stage esophageal cancer, they look at factors such as cancer tumor location and depth, if it has spread to nearby lymph nodes and if the cancer has spread to other distant tissues or organs.

They also establish tumor grades. Tumor grades tell your provider whether tumor cells look and act like healthy cells. Low-grade tumors are slow-growing tumors and may be less aggressive. High-grade tumors have cells that divide very quickly and can be more aggressive.

Management and Treatment

How do healthcare providers treat esophageal cancer?

Esophageal cancer treatment depends on the cancer stage and grade. Treatment options include:

• Surgery: An esophagectomy is the most common treatment for early-stage esophageal cancer. It involves removing some or most of your esophagus and surrounding tissue. Surgeons create a new esophagus by pulling up part of your stomach into your chest and neck.
• Radiation therapy: Radiation kills or damages cancer cells by aiming a radiation beam at the tumor. Healthcare providers may use radiation as adjuvant therapy before or after surgery.
• Chemotherapy: Chemotherapy kills cancer cells or stops them from growing.
• Endoscopic submucosal dissection(ESD): Surgeons may use ESD to treat very early-stage esophageal cancer.
• Endoscopic mucosal resection(EMR): Surgeons use this procedure to remove tumors in the mucous lining of your esophagus.
• Endoscopic laser therapy: This treatment eases symptoms when tumors may block your esophagus, making it hard for you to swallow.
• Photodynamic therapy(PDT): Photodynamic therapy destroys tumors with drugs called photosensitizers. Light activates these drugs and creates a chemical reaction that kills cancer.
• Targeted therapy: Some esophageal cancer cells carry an unusually high amount of the HER2 protein. This protein helps cancer cells grow. In targeted therapy, healthcare providers treat esophageal cancer with drugs targeting HER2 proteins.
• Immunotherapy: This treatment involves immune checkpoint inhibitors. These drugs help restore your immune system’s response to esophageal cancer cells.

Care at Cleveland Clinic

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Prevention

How do I reduce my risk of developing esophageal cancer?

You may be able to reduce your risk by eating well so you’re at a weight that’s right for you and that you can maintain. You may also reduce your risk by avoiding activities such as using tobacco, frequently drinking lots of alcohol or working around certain solvents. Having an HPV infection is a risk factor for esophageal cancer. Ask your healthcare provider if you should receive the HPV vaccine.

There isn’t a recommended way to screen for esophageal cancer. But if you have Barrett’s esophagus or certain other conditions, your healthcare provider may recommend screening. Your healthcare provider may do an EGD to do this screening. If your healthcare provider recommends screening, they’ll let you know how often you should have screening.

Outlook / Prognosis

What can I expect if I have esophageal cancer?

That depends on factors like your overall health and if you received a diagnosis before the tumor spread. Healthcare providers often successfully treat early-stage esophageal cancer. About 46% of people treated for early-stage esophageal cancer are alive five years after diagnosis.

Healthcare providers may not be able to destroy the cancer, especially if it’s already spread. They can provide treatment to help you live well as long as you’re able, maintain quality of life and ease symptoms. They may recommend palliative care that can help you live comfortably and without pain.

Living With

How do I take care of myself?

Esophageal cancer surgery may have significant side effects like nausea and vomiting or heartburn. You may need help to manage these side effects. Many people treated for esophageal cancer have the following issues:

• Difficulty eating: Esophageal cancer makes you lose weight because you can’t swallow food or it hurts to swallow food. Treatment may remove the cancer, but you still may have trouble swallowing. If that’s your situation, ask your healthcare provider for suggestions such as eating smaller meals or drinking nutritional supplements.
• Dumping syndrome: This happens when your stomach takes the place of your esophagus. Your stomach may not be able to hold food for digestion so food passes too quickly into your intestines. Dumping syndrome symptoms may include nausea, vomiting, diarrhea, stomach cramps, sweating or flushing of the skin.

Yes, it can come back. You can reduce that risk by:

• Limiting alcohol: Frequently drinking a lot of alcohol increases your risk that esophageal cancer will come back.
• Avoiding tobacco: Tobacco use is another risk factor for esophageal cancer returning. If you smoke, please try to stop. Ask your healthcare provider if you want help to stop smoking.

When should I see my healthcare provider?

That depends on your situation. People who had early-stage cancer removed with surgery will have a different follow-up schedule from people who’ve advanced cancer that’s spread.

If your treatment was successful, your healthcare provider may recommend checkups every three to six months for the first two years after treatment and then checkups every six to 12 months for the next three years. Your healthcare provider may do a physical examination, blood tests, imaging tests and endoscopy.

What questions should I ask my healthcare provider?

Esophageal cancer is a life-threatening illness. If you have this condition, you may want to ask a healthcare provider the following questions:

• What kind of esophageal cancer do I have?
• What stage is my cancer?
• What treatments do you recommend?
• Is there a cure?
• If there isn’t a cure, what can you do to help me?
• How long can I live with this cancer?
• Do I need any genetic or biomarker testing done?

A note from Cleveland Clinic

Esophageal cancer is the 10th most common cancer in the world. It’s also one of the most challenging cancers to treat. That’s because it causes symptoms that people may not notice until after the cancer has spread. Often, there’s no cure for esophageal cancer. In that situation, healthcare providers concentrate on treatments that will help people live as long as possible and have the best quality of life for as long as possible. Few things in life are more difficult than hearing you’re sick and there’s no cure. You may need time and help to come to terms with your situation. Healthcare providers understand that and will do everything they can to help you, such as recommending speaking with a mental health specialist.

What is the survival rate for esophageal?

ON THIS PAGE: You will find information about the estimated number of people who will be diagnosed with esophageal cancer each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors, and no 2 people with cancer are the same. Use the menu to see other pages.

Every person is different, with different factors influencing their risk of being diagnosed with this cancer and the chance of recovery after a diagnosis. It is important to talk with your doctor about any questions you have around the general statistics provided below and what they may mean for you individually. The original sources for these statistics are provided at the bottom of this page.

How many people are diagnosed with esophageal cancer?

In 2023, an estimated 21,560 adults (17,030 men and 4,530 women) in the United States will be diagnosed with esophageal cancer. Worldwide, an estimated 604,100 people were diagnosed with esophageal cancer in 2020.

In the United States, the disease is most common in White people, who are more likely to be diagnosed with adenocarcinoma. Black people are more likely to be diagnosed with squamous cell carcinoma. This diagnosis is less common in people of other races and ethnicities in the United States, including American Indians, Alaska Natives, Hispanic Americans, Asian Americans, and Pacific Islander Americans. Esophageal cancer accounts for 1% of cancers diagnosed in the United States. The disease is more common in other parts of the world.

It is estimated that 16,120 deaths (12,920 men and 3,200 women) from this disease will occur in the United States in 2023. Esophageal cancer is the seventh most common cause of cancer death among men in the United States. In 2020, an estimated 544,076 people worldwide died from the disease.

What is the survival rate for esophageal cancer?

There are different types of statistics that can help doctors evaluate a person’s chance of recovery from esophageal cancer. These are called survival statistics. A specific type of survival statistic is called the relative survival rate. It is often used to predict how having cancer may affect life expectancy. Relative survival rate looks at how likely people with esophageal cancer are to survive for a certain amount of time after their initial diagnosis or start of treatment compared to the expected survival of similar people without this cancer.

Example: Here is an example to help explain what a relative survival rate means. Please note this is only an example and not specific to this type of cancer. Let’s assume that the 5-year relative survival rate for a specific type of cancer is 90%. “Percent” means how many out of 100. Imagine there are 1,000 people without cancer, and based on their age and other characteristics, you expect 900 of the 1,000 to be alive in 5 years. Also imagine there are another 1,000 people similar in age and other characteristics as the first 1,000, but they all have the specific type of cancer that has a 5-year survival rate of 90%. This means it is expected that 810 of the people with the specific cancer (90% of 900) will be alive in 5 years.

It is important to remember that statistics on the survival rates for people with esophageal cancer are only an estimate. They cannot tell an individual person if cancer will or will not shorten their life. Instead, these statistics describe trends in groups of people previously diagnosed with the same disease, including specific stages of the disease.

The 5-year relative survival rate for esophageal cancer in the United States is 21%. Treatment for the disease has slowly improved the survival rate. In the 1960s and 1970s, the overall 5-year survival rate was around 5%.

The survival rates for esophageal cancer vary based on several factors. These include the stage of cancer, a person’s age and general health, and how well the treatment plan works.

The 5-year relative survival rate of people with cancer located only in the esophagus is 47%. The 5-year relative survival rate for those with disease that has spread to surrounding tissues or organs and/or the regional lymph nodes is 26%. If it has spread to distant parts of the body, the relative survival rate is 6%.

Experts measure relative survival rate statistics for esophageal cancer every 5 years. This means the estimate may not reflect the results of advancements in how esophageal cancer is diagnosed or treated from the last 5 years. Talk with your/ doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society’s (ACS) publication, Cancer Facts & Figures 2023; the ACS website; and the International Agency for Research on Cancer website. (All sources accessed February 2023.)

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by esophageal cancer. Use the menu to choose a different section to read in this guide.

Esophageal Cancer

The esophagus is a muscular tube measuring 20-25 cm (8-10 in) long and 2-3 cm (0.75-1.25 in) wide that serves as a conduit for moving food and drink from the mouth to the stomach. Two major types of esophageal cancers exist, as follows:

Esophageal cancer can occur in the esophagus,

• Squamous cell carcinoma arises from the surface (epithelial) cells that line the esophagus.
• Adenocarcinoma arises from the esophageal glands or within a segment of Barrett’s esophagus
• Although tumors can arise anywhere in the esophagus, adenocarcinoma arises more frequently in the lower portion while squamous cell carcinoma arises more frequently in the upper part of the esophagus.
• Other tumor types are rarely seen (lymphoma, melanoma, or sarcoma).
• Symptoms of esophageal cancer usually do not show up until the disease has reached an advanced stage.
• Five-year survival for esophageal cancer can exceed 50% for stage 1 and then drop to 0% for stage 4.

What Is Esophageal Cancer?

Esophageal cancer is a disease where the tissues of the tube-like structure that connects the throat to the stomach (esophagus) become malignant (cancer).

Esophageal cancers may be generally termed «esophagus cancer» or more specifically termed in relation to their location and type such as «gastroesophageal junction adenocarcinoma» (meaning an adenoma located where the stomach and esophagus are connected).

What Are Symptoms and Signs of Esophageal Cancer?

• Symptoms of esophageal cancer usually do not show up until the disease has reached an advanced stage.
• The most common symptom is difficulty swallowing (dysphagia).
  • Initially, swallowing solids is difficult.
  • Over time, even swallowing liquids becomes difficult.
  • Weight loss
  • Central chest pain and/or pain behind the breastbone
  • Pain upon swallowing
  • Vomiting
  • Chronic cough and/or hoarseness
  • Symptoms of gastrointestinal bleeding
    • Black stools
    • Vomiting blood or material that looks like coffee grounds

    What Causes Esophageal Cancers?

    According to the American Cancer Society and others who treat esophageal cancers, the exact cause or causes of this disease are not known. However, researchers suspect that certain risk factors (see below) may cause DNA damage in cells that may result in the disease.

    What Are the Risk Factors for Esophageal Cancer?

    Both types of esophageal cancer more commonly affect men older than 60 years, but the risk factors for adenocarcinoma are different from those of squamous cell carcinoma.

    • Adenocarcinoma of the esophagus is most commonly seen within a segment of Barrett’s esophagus, where they arise from chronic peptic sores in the lower esophagus. This is an acquired condition characterized by precancerous cells that replace the standard cellular lining of the lowest portion of the esophagus. The condition occurs as a complication of chronic reflux of gastric contents (GERD) into the lower esophagus.
    • Squamous cell carcinoma occurs more commonly in people who heavily use tobacco and alcohol or who have previously swallowed some caustic substance, for example, lye condition. The disease is also more common in people who have been diagnosed with squamous cell cancer of the head and neck.
    • Men are up to five times more likely than women to be diagnosed with esophageal cancer.
      • Among men, African Americans have the highest rate, more than 2.7 times greater than the rate for non-Hispanic white men.
      • Incidence rates generally increase with age in all racial and ethnic groups.
      • Nutritional deficiencies related to a lack of fresh fruit and vegetables
      • Drinking hot beverages
      • A range of chewing and smoking habits
      • HPV infection (squamous cell cancer of the esophagus)

      What Types of Specialists Diagnose and Treat Esophageal Cancers?

      Your team of doctors may include

      • gastroenterologists,
      • oncologists,
      • surgeons,
      • radiation oncologists,
      • pathologists, and
      • support personnel such as dietitians.

      Together, they can develop diagnostic tests and treatments best suited for your individual disease.

      How Is Esophageal Cancer Diagnosed? 4 Stages

      The best diagnosis is based on findings from an endoscopic examination of the esophagus.

      • This study may be carried out either in a hospital or in a doctor’s office.
      • The doctor administers a topical anesthetic to the throat to suppress the gag reflex. Doctors frequently give intravenous (IV) sedation just before the procedure.
      • The doctor then inserts an endoscope into the esophagus. An endoscope is a thin, flexible plastic tube that contains fiberoptic bundles.
        • Using a tiny camera in the endoscope, the doctor searches the surface of the esophagus for areas of concern and may biopsy tissue.
        • Doctors define esophageal tumors in terms of their size and location.
          • Stage I — Tumor limited to the top layers of the cell lining
          • Stage II — Tumor extending deeper into muscle layers of the esophagus or into adjacent lymph nodes
          • Stage III — Tumor extensively involving the wall of the esophagus, adjacent tissues, or lymph nodes
          • Stage IV — Tumor involving distant parts of the body (metastases) and may involve the liver, lungs, brain, or bones
          • CT scan of the chest and abdomen
          • Chest X-ray
          • PET scan in combination with CT scan
          • Nuclear bone scans
          • Thoracoscopy

          What Is the Treatment for Esophageal Cancer?

          Treatment for esophageal cancer depends on the results of tests and your underlying health.

          • People with advanced heart or lung disease may not be candidates for aggressive therapy.
          • In many cases, esophageal cancer has advanced too far for any available treatment to work.
            • In these cases, the doctor considers the following palliative procedures:
              • Placing a metal or plastic tube (stent) in the esophagus to allow passage of food and liquids
              • Radiation therapy
              • Photodynamic therapy (tissues are sensitized chemically and then treated with a focused light source internally)
              • Widening (cautious dilation) of the esophagus or laser destruction of the esophageal tumor
              • Other palliative procedures (electrocoagulation, laser ablation, for example)
              • Pain management
              • Managing complications such as bleeding

              Is There a Surgery for Esophageal Cancer?

              In otherwise healthy people with localized disease, surgery may offer the best chance at long-term survival.

              • Surgery involves removing the diseased portion of the esophagus and connecting the remaining portion to the stomach (resection).
              • Preoperative chemotherapy and radiation often accompany surgery.
              • Studies now underway will determine whether a combination of chemotherapy and radiation therapy without surgery is as effective as surgery in lengthening long-term survival. Present results give conflicting opinions. Research continues.

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              Is Esophageal Cancer Curable? What Is the Survival Rate for Esophageal Cancer?

              When esophageal cancer spreads to organs beyond the esophagus, long-term survival is uncommon. The chance of recovery improves when doctors detect cancer at an early stage.

              Five-year survival for esophageal cancer can exceed 50% for stage 1, and then drop to

              • 20% in stage 2,
              • 10%-15% in stage 3, and
              • essentially zero for stage 4.

              Once cancer invades the muscle layer of the esophagus, most people already have developed widespread cancer.

              • For these people, cancers invariably come back following surgical removal. Few people survive long-term.
              • Following completion of therapy, whether with surgery, radiation, chemotherapy, or a combination of these, the patient needs regular follow-up endoscopic examinations as well as repeat CT scans of the chest and abdomen.
              • Often, people who undergo surgery on their esophagus develop significant side effects, such as narrowing at the site of the surgery. They require frequent esophageal dilatations or insertion of stents.

              How Can I Prevent Esophageal Cancer?

              

              The esophagus lies between the mouth and the stomach and serves as a conduit for food and liquids to the gastrointestinal tract.

              • Reducing the use of tobacco and alcohol can reduce the frequency of squamous cell carcinoma of the esophagus. Today it is recognized that HPV infection increases the risk of squamous cell carcinoma of the esophagus three-fold. HPV vaccination programs for young men and women can be expected to reduce the risk of this disease over time.
              • Adenocarcinoma of the esophagus is a frequent complication in Barrett’s esophagus, which may be found in some people with symptoms of gastroesophageal reflux disease (GERD).
                • People with frequent symptoms of acid reflux (heartburn or regurgitation) should undergo screening with endoscopy.
                • People with Barrett’s esophagus should have regular endoscopic tests to detect precancerous changes in the esophageal lining.
                • They also require tight control of the symptoms of gastroesophageal reflux, which may include dietary and lifestyle changes as well as medications and possible surgery, to prevent the progression of Barrett’s esophagus.

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                Esophageal Cancer Symptom

                Dysphagia

                Dysphagia means difficulty swallowing. Odynophagia means painful swallowing. Sometimes it is not easy for individuals to distinguish between these two problems.

                Dysphagia has many causes. First, there may be physical (anatomical) obstruction to the passage of food. Second, there may be abnormalities in the function (functional abnormalities) of the nerves of the brain, throat, and esophagus whose normal function is necessary to coordinate swallowing. Finally, there also may be abnormalities of the muscles of the throat and esophagus themselves.