What is the Esophagus

7/31/2019 What is the Esophagus

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What is the esophagus?

The esophagus is in the chest. It's about 10 inches long.

This organ is part of the digestive tract. Food moves from the mouth through the esophagus to

the stomach.

The esophagus is a muscular tube. The wall of the esophagus has several layers:

Inner layer or lining (mucosa): The lining of the esophagus is moist so that food can passto the stomach.

Submucosa: The glands in this layer make mucus. Mucus keeps the esophagus moist. Muscle layer: The muscles push the food down to the stomach. Outer layer: The outer layer covers the esophagus.

Cancer Cells

Cancerbegins in cells, the building blocks that make up tissues. Tissues make up the organs ofthe body.

Normal cells grow and divide to form new cells as the body needs them. When normal cells growold or get damaged, they die, and new cells take their place.

Sometimes, this process goes wrong. New cells form when the body does not need them, and oldor damaged cells do not die as they should. The buildup of extra cells often forms a mass of

tissue called a growth or tumor.

Growths in the wall of the esophagus can be benign (not cancer) or malignant (cancer). Thesmooth inner wall may have an abnormal rough area, an area of tiny bumps, or a tumor. Benigngrowths are not as harmful as malignant growths:

Benign growths:o are rarely a threat to life

o can be removed and probably won't grow back

o don't invade the tissues around them

o don't spread to other parts of the body

Malignant growths:o may be a threat to life sometimes

o can be removed but can grow back

o can invade and damage nearby tissues and organs

o can spread to other parts of the body
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Esophageal cancer begins in cells in the inner layer of the esophagus. Over time, the cancer mayinvade more deeply into the esophagus and nearby tissues.

Cancer cells can spread by breaking away from the original tumor. They may enter blood vessels

or lymph vessels, which branch into all the tissues of the body. The cancer cells may attach toother tissues and grow to form new tumors that may damage those tissues. The spread of cancercells is called metastasis. See the Staging section for information about esophageal cancer thathas spread.

Types of Esophageal Cancer

There are two main types of esophageal cancer. Both types are diagnosed, treated, andmanaged in similar ways.

The two most common types are named for how the cancer cells look under a microscope. Bothtypes begin in cells in the inner lining of the esophagus:

Adenocarcinoma of the esophagus: This type is usually found in the lower part of theesophagus, near the stomach. In the United States, adenocarcinoma is the most commontype of esophageal cancer. It's been increasing since the 1970s.

Squamous cell carcinoma of the esophagus: This type is usually found in the upper partof the esophagus. This type is becoming less common among Americans. Around the world,however, squamous cell carcinoma is the most common type.

Risk Factors

When you get a diagnosis of cancer, it's natural to wonder what may have caused the disease.Doctors can seldom explain why one person develops esophageal cancer and another doesn't.However, we do know that people with certain risk factors are more likely than others to developesophageal cancer. A risk factor is something that may increase the chance of getting a disease.

Studies have found the following risk factors for esophageal cancer:

Age 65 or older: Age is the main risk factor for esophageal cancer. The chance of gettingthis disease goes up as you get older. In the United States, most people are 65 years of ageor older when they are diagnosed with esophageal cancer.

Being male: In the United States, men are more than three times as likely as women todevelop esophageal cancer.

Smoking: People who smoke are more likely than people who don't smoke to developesophageal cancer.

Heavy drinking: People who have more than 3alcoholicdrinks each day are more likelythan people who don't drink to develop squamous cell carcinoma of the esophagus. Heavydrinkers who smoke are at a much higher risk than heavy drinkers who don't smoke. In otherwords, these two factors act together to increase the risk even more.

Diet: Studies suggest that having a diet that's low in fruits and vegetables may increase therisk of esophageal cancer. However, results from diet studies don't always agree, and more
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research is needed to better understand how diet affects the risk of developing esophagealcancer.

Obesity: Being obese increases the risk of adenocarcinoma of the esophagus. Acid reflux: Acid reflux is the abnormal backward flow of stomach acid into the esophagus.

Reflux is very common. A symptom of reflux is heartburn, but some people don't havesymptoms. The stomach acid can damage the tissue of the esophagus. After many years ofreflux, this tissue damage may lead to adenocarcinoma of the esophagus in some people.

Barrett esophagus: Acid reflux may damage the esophagus and over time cause acondition known as Barrett esophagus. The cells in the lower part of the esophagus areabnormal. Most people who have Barrett esophagus don't know it. The presence of Barrettesophagus increases the risk of adenocarcinoma of the esophagus. It's a greater risk factorthan acid reflux alone. Many other possible risk factors (such assmokeless tobacco) havebeen studied. Researchers continue to study these possible risk factors.

Having a risk factor doesn't mean that a person will develop cancer of the esophagus. Mostpeople who have risk factors never develop esophageal cancer.

Symptoms

Early esophageal cancer may not cause symptoms. As the cancer grows, the most commonsymptoms are:

Food gets stuck in the esophagus, and food may come back up

Pain when swallowing

Pain in the chestorback

Weight loss

Heartburn

Ahoarse voiceorcoughthat doesn't go away within 2 weeks

These symptoms may be caused by esophageal cancer or other health problems. If you have anyof these symptoms, you should tell your doctor so that problems can be diagnosed and treated asearly as possible.

Diagnosis

If you have a symptom that suggests esophageal cancer, your doctor must find out whether it'sreally due to cancer or to some other cause. The doctor gives you a physical exam and asksabout your personal and family health history. You may have blood tests. You also may have:

Barium swallow: After you drink a barium solution, you have x-rays taken of youresophagus and stomach. The barium solution makes your esophagus show up more clearlyon the x-rays. This test is also called anupper GI series.
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Endoscopy: The doctor uses a thin, lighted tube (endoscope) to look down your esophagus.The doctor first numbs your throat with an anesthetic spray, and you may also receivemedicine to help you relax. The tube is passed through your mouth or nose to theesophagus. The doctor may also call this procedure upper endoscopy, EGD, oresophagoscopy.

Biopsy: Usually, cancer begins in the inner layer of the esophagus. The doctor uses anendoscope to remove tissue from the esophagus. A pathologist checks the tissue under amicroscope for cancer cells. A biopsy is the only sure way to know if cancer cells arepresent.

You may want to ask the doctor these questions before having a biopsy:

Where will the procedure take place? Will I have to go to the hospital?

How long will it take? Will I be awake?

Will it hurt? Will I get an anesthetic?

What are the risks? What are the chances of infection or bleeding afterward?

How do I prepare for the procedure?

How long will it take me to recover?

How soon will I know the results? Will I get a copy of the pathology report?

If I do have cancer, who will talk to me about the next steps? When?

Staging

If the biopsy shows that you have cancer, your doctor needs to learn the extent (stage) of thedisease to help you choose the best treatment.

Staging is a careful attempt to find out the following

how deeply the cancer invades the walls of the esophagus

whether the cancer invades nearby tissues

whether the cancer has spread, and if so, to what parts of the body

When esophageal cancer spreads, it's often found in nearby lymph nodes. If cancer has reachedthese nodes, it may also have spread to other lymph nodes, the bones, or other organs. Also,esophageal cancer may spread to the liver and lungs.

Your doctor may order one or more of the following staging tests:

Endoscopic ultrasound: The doctor passes a thin, lighted tube (endoscope) down yourthroat, which has been numbed with anesthetic. A probe at the end of the tube sends out
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sound waves that you can't hear. The waves bounce off tissues in your esophagus andnearby organs. A computer creates a picture from the echoes. The picture can show howdeeply the cancer has invaded the wall of the esophagus. The doctor may use a needle totake tissue samples of lymph nodes.

CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of yourchest and abdomen. Doctors use CT scans to look for esophageal cancer that has spread tolymph nodes and other areas. You may receive contrast material by mouth or by injectioninto a blood vessel. The contrast material makes abnormal areas easier to see.

MRI: A strong magnet linked to a computer is used to make detailed pictures of areas insideyour body. An MRI can show whether cancer has spread to lymph nodes or other areas.Sometimes contrast material is given by injection into your blood vessel. The contrastmaterial makes abnormal areas show up more clearly on the picture.

PET scan: You receive an injection of a small amount of radioactive sugar. The radioactivesugar gives off signals that the PET scanner picks up. The PET scanner makes a picture ofthe places in your body where the sugar is being taken up. Cancer cells show up brighter inthe picture because they take up sugar faster than normal cells do. A PET scan showswhether esophageal cancer may have spread.

Bone scan: You get an injection of a small amount of a radioactive substance. It travelsthrough the bloodstream and collects in the bones. A machine called a scanner detects andmeasures the radiation. The scanner makes pictures of the bones. The pictures may showcancer that has spread to the bones.

Laparoscopy: After you are given general anesthesia, the surgeon makes small incisions(cuts) in your abdomen. The surgeon inserts a thin, lighted tube (laparoscope) into theabdomen. Lymph nodes or other tissue samples may be removed to check for cancer cells.

Sometimes staging is not complete until after surgery to remove the cancer and nearby lymphnodes.

When cancer spreads from its original place to another part of the body, the new tumor has thesame kind of abnormal cells and the same name as the primary tumor. For example, ifesophageal cancer spreads to the liver, the cancer cells in the liver are actually esophagealcancer cells. The disease is metastatic esophageal cancer, notliver cancer. For that reason, it'streated as esophageal cancer, not liver cancer. Doctors call the new tumor "distant" or metastaticdisease.

These are the stages of esophageal cancer:

Stage 0: Abnormal cells are found only in the inner layer of the esophagus. It's calledcarcinoma in situ.

Stage I: The cancer has grown through the inner layer to the submucosa. (The pictureshows the submucosa and other layers.)

Stage II is one of the following:o The cancer has grown through the inner layer to the submucosa, and cancer cells have

spread to lymph nodes.

o Or, the cancer has invaded the muscle layer. Cancer cells may be found in lymphnodes.
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o Or, the cancer has grown through the outer layer of the esophagus.

Stage III is one of the following:o The cancer has grown through the outer layer, and cancer cells have spread to lymph

nodes.

o Or, the cancer has invaded nearby structures, such as the airways. Cancer cells mayhave spread to lymph nodes.

Stage IV: Cancer cells have spread to distant organs, such as the liver.

Treatment

People with esophageal cancer have several treatment options. The options aresurgery,radiation therapy,chemotherapy, or a combination of these treatments. For example,radiation therapy and chemotherapy may be given before or after surgery.The treatment that's right for you depends mainly on the following:

where the cancer is located within the esophagus

whether the cancer has invaded nearby structures

whether the cancer has spread to lymph nodes or other organs

your symptoms

your general health

Esophageal cancer is hard to control with current treatments. For that reason, many doctorsencourage people with this disease to consider taking part in a clinical trial, a research study ofnew treatment methods. Clinical trials are an important option for people with all stages ofesophageal cancer. See the Taking Part in Cancer Research section.

You may have a team of specialists to help plan your treatment. Your doctor may refer you tospecialists, or you may ask for a referral. You may want to see a gastroenterologist, a doctor whospecializes in treating problems of the digestive organs. Other specialists who treat esophagealcancer include thoracic (chest) surgeons, thoracic surgical oncologists, medical oncologists, and

radiation oncologists. Your health care team may also include an oncology nurse and a registereddietitian. If your airways are affected by the cancer, you may have a respiratory therapist as partof your team. If you have trouble swallowing, you may see a speech pathologist.

Your health care team can describe your treatment choices, the expected results of each, and thepossible side effects. Because cancer therapy often damages healthy cells and tissues, sideeffects are common. Before treatment starts, ask your health care team about possible sideeffects and how treatment may change your normal activities. You and your health care team canwork together to develop a treatment plan that meets your needs.
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You may want to ask your doctor these questions before your treatment begins:

What is the stage of the disease? Has the cancer spread? Do any lymph nodes show signsof cancer?

What is the goal of treatment? What are my treatment choices? Which do you recommendfor me? Why?

Will I have more than one kind of treatment?

What can I do to prepare for treatment?

Will I need to stay in the hospital? If so, for how long?

What are the risks and possible side effects of each treatment? For example, am I likely tohave eating problems during or after treatment? How can side effects be managed?

What will the treatment cost? Will my insurance cover it?

Would a research study (clinical trial) be appropriate for me?

Can you recommend other doctors who could give me a second opinion about my treatmentoptions?

How often should I have checkups?

Surgery

There are several types of surgery for esophageal cancer. The type depends mainly on where thecancer is located. The surgeon may remove the whole esophagus or only the part that has thecancer. Usually, the surgeon removes the section of the esophagus with the cancer, lymphnodes, and nearby soft tissues. Part or all of the stomach may also be removed. You and yoursurgeon can talk about the types of surgery and which may be right for you.

The surgeon makes incisions into your chest and abdomen to remove the cancer. In most cases,the surgeon pulls up the stomach and joins it to the remaining part of the esophagus. Or a pieceof intestine may be used to connect the stomach to the remaining part of the esophagus. The

surgeon may use either a piece of small intestine or large intestine. If the stomach was removed,a piece of intestine is used to join the remaining part of the esophagus to the small intestine.

During surgery, the surgeon may place a feeding tube into your small intestine. This tube helpsyou get enoughnutritionwhile you heal. Information about eating after surgery is in the Nutritionsection.

You may have pain for the first few days after surgery. However, medicine will help control thepain. Before surgery, you should discuss the plan for pain relief with your health care team. After

surgery, your team can adjust the plan if you need more relief.
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Your health care team will watch for signs of food leaking from the newly joined parts of yourdigestive tract. They will also watch forpneumoniaor other infections, breathing problems,bleeding, or other problems that may require treatment.

The time it takes to heal after surgery is different for everyone and depends on the type ofsurgery. You may be in the hospital for at least one week.

You may want to ask your doctor these questions about surgery:

Do you suggest surgery for me? If so, which type?

Will you remove lymph nodes and other tissue? Will you remove part or all of the stomach?Why?

What are the risks of surgery?

How will I feel after surgery?

How will pain be controlled after surgery?

How long will I be in the hospital?

Am I likely to have eating problems? Will I need a special diet?

Will I need a feeding tube? If so, for how long? How do I take care of it? Who can help me if I

have a problem? Will I have any lasting side effects?

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affectscells only in the treated area.

Radiation therapy may be used before or after surgery. Or it may be used instead of surgery.Radiation therapy is usually given with chemotherapy to treat esophageal cancer.

Doctors use two types of radiation therapy to treat esophageal cancer. Some people receive bothtypes:

External radiation therapy: The radiation comes from a large machine outside the body. Themachine aims radiation at your cancer. You may go to a hospital or clinic for treatment.Treatments are usually 5 days a week for several weeks.

Internal radiation therapy (brachytherapy): The doctor numbs your throat with an anestheticspray and gives you medicine to help you relax. The doctor puts a tube into your esophagus.


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The radiation comes from the tube. Once the tube is removed, no radioactivity is left in yourbody. Usually, only a single treatment is done.

Side effects depend mainly on the dose and type of radiation. External radiation therapy to thechest and abdomen may cause asore throat, pain similar to heartburn, or pain in the stomach or

the intestine. You may havenauseaanddiarrhea. Your health care team can give you medicinesto prevent or control these problems.

Also, your skin in the treated area may become red, dry, and tender. You may lose hair in thetreated area. A much less common side effect of radiation therapy aimed at the chest is harm tothe lung, heart, or spinal cord.

You are likely to be very tired during radiation therapy, especially in the later weeks of externalradiation therapy. You may also continue to feel very tired for a few weeks after radiation therapy

is completed. Resting is important, but doctors usually advise patients to try to stay as active asthey can.

Radiation therapy can lead to problems with swallowing. For example, sometimes radiationtherapy can harm the esophagus and make it painful for you to swallow. Or, the radiation maycause the esophagus to narrow. Before radiation therapy, aplastictube may be inserted into theesophagus to keep it open. If radiation therapy leads to a problem with swallowing, it may be hardto eat well. Ask your health care team for help getting good nutrition. See the Nutrition section formore information.

You may want to ask your doctor these questions before having radiation therapy:

Which type of radiation therapy can I consider? Are both types an option for me?

When will treatment start? When will it end? How often will I have treatments?

Will I need to stay in the hospital?

What can I do to take care of myself before, during, and after treatment?

How will I feel during treatment? Will I be able to drive myself to and from treatment?

How will we know the treatment is working?

How will I feel after the radiation therapy?

Are there any lasting effects?

Chemotherapy

Most people with esophageal cancer get chemotherapy. Chemotherapy uses drugs to destroycancer cells. The drugs for esophageal cancer are usually given through a vein (intravenous).
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You may have your treatment in a clinic, at the doctor's office, or at home. Some people need tostay in the hospital for treatment.

Chemotherapy is usually given in cycles. Each cycle has a treatment period followed by a rest

period.

The side effects depend mainly on which drugs are given and how much. Chemotherapy killsfast-growing cancer cells, but the drug can also harm normal cells that divide rapidly:

Blood cells: When chemotherapy lowers the levels of healthy blood cells, you're more likelyto get infections, bruise or bleed easily, and feel very weak and tired. Your health care teamwill check for low levels of blood cells. If your levels are low, your health care team may stopthe chemotherapy for a while or reduce the dose of drug. There also are medicines that canhelp your body make new blood cells.

Cells in hair roots: Chemotherapy may causehair loss. If you lose your hair, it will growback, but it may change in color and texture.

Cells that line the digestive tract: Chemotherapy can causepoor appetite,nausea andvomiting,diarrhea, ormouth and lip sores. Your health care team can give you medicinesand suggest other ways to help with these problems.

Other possible side effects include a skinrash,joint pain,tingling or numbness in yourhandsandfeet, hearing problems, orswollen feetorlegs. Your healthcare team can suggestways to control many of these problems. Most go away when treatment ends.

You may want to ask your doctor these questions before having chemotherapy:

Which drugs will I get?

When will treatment start? When will it end? How often will I have treatments?

Where will I go for treatment? Will I have to stay in the hospital?

What can I do to take care of myself during treatment?

How will we know the treatment is working?

Will I have side effects during treatment? What side effects should I tell you about? Can Iprevent or treat any of these side effects?

Can these drugs cause side effects later on?

Second Opinion

Before starting treatment, you might want a second opinion about your diagnosis and treatmentplan. You may want to find a medical center that has a lot of experience with treating esophagealcancer. You may even want to talk to several different doctors about all of the treatment options,

their side effects, and the expected results.
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Some people worry that the doctor will be offended if they ask for a second opinion. Usually theopposite is true. Most doctors welcome a second opinion. And many health insurance companieswill pay for a second opinion if you or your doctor requests it.

If you get a second opinion, the second doctor may agree with your first doctor's diagnosis andtreatment plan. Or the second doctor may suggest another approach. Either way, you have moreinformation and perhaps a greater sense of control. You can feel more confident about thedecisions you make, knowing that you've looked at your options.

It may take some time and effort to gather your medical records and see another doctor. In mostcases, it's not a problem to take several weeks to get a second opinion. The delay in startingtreatment usually will not make treatment less effective. To make sure, you should discuss thisdelay with your doctor.

There are many ways to find a doctor for a second opinion. You can ask your doctor, a local orstate medical society, a nearby hospital, or a medical school for names of specialists.

Supportive Care

Esophageal cancer and its treatment can lead to other health problems. You can have supportivecare before, during, or after cancer treatment.

Supportive care is treatment to control pain and other symptoms, to relieve the side effects oftherapy, and to help you cope with the feelings that a diagnosis of cancer can bring. You mayreceive supportive care to prevent or control these problems and to improve your comfort andquality of life during treatment.

Cancer Blocks the EsophagusYou may have trouble swallowing because the cancer blocks the esophagus. Not being able toswallow makes it hard or impossible to eat. It also increases the risk of food getting in yourairways. This can lead to a lung infection like pneumonia. Also, not being able to swallow liquidsor saliva can be very distressing.

Your health care team may suggest one or more of the following options:

Stent: You get an injection of a medicine to help you relax. The doctor places a stent (a tubemade of metal mesh or plastic) in your esophagus. Food and liquid can pass through thecenter of the tube. However, solid foods need to be chewed well before swallowing. A largeswallow of food could get stuck in the stent.

Laser therapy: A laser is a concentrated beam of intense light that kills tissue with heat. Thedoctor uses the laser to destroy the cancer cells blocking the esophagus. Laser therapy maymake swallowing easier for a while, but you may need to repeat the treatment several weekslater.

Photodynamic therapy: You get an injection, and the drug collects in the esophagealcancer cells. Two days after the injection, the doctor uses an endoscope to shine a special


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light (such as a laser) on the cancer. The drug becomes active when exposed to light. Twoor three days later, the doctor may check to see if the cancer cells have been killed. Peoplegetting this drug must avoid sunlight for one month or longer. Also, you may need to repeatthe treatment several weeks later.

Radiation therapy: Radiation therapy helps shrink the tumor. If the tumor blocks theesophagus, internal radiation therapy or sometimes external radiation therapy can be usedto help make swallowing easier.

Balloon dilation: The doctor inserts a tube through the blocked part of the esophagus. Aballoon helps widen the opening. This method helps improve swallowing for a few days.

Other ways to get nutrition: See the Nutrition section for ways to get food when eatingbecomes difficult.

PainCancer and its treatments may cause pain. It may be painful to swallow, or you may have pain inyour chest from the cancer or from a stent. Your health care team or a pain control specialist cansuggest ways to relieve or reduce pain.

Sadness and Other FeelingsIt's normal to feel sad, anxious, or confused after a diagnosis of a serious illness. Some peoplefind it helpful to talk about their feelings. See the Sources of Support section.

NutritionIt's important to meet your nutrition needs before, during, and after cancer treatment. You needthe right amount of calories, protein, vitamins, and minerals. Getting the right nutrition can helpyou feel better and have more energy.

However, when you have esophageal cancer, it may be hard to eat for many reasons. You maybe uncomfortable or tired, and you may not feel like eating. Also, the cancer may make it hard toswallow food. If you're getting chemotherapy, you may find that foods don't taste as good as theyused to. You also may have side effects of treatment such as poor appetite, nausea,vomiting, ordiarrhea.

If you develop problems with eating, there are a number of ways to meet your nutrition needs. Aregistered dietitian can help you figure out a way to get enough calories, protein, vitamins, and

minerals:

A dietitian may suggest a change in the types of foods you eat. Sometimes changing thetexture,fiber, and fat content of your foods can lessen your discomfort. A dietitian may alsosuggest a change in the portion size and meal times.

A dietitian may recommend liquid meals, such as canned nutrition beverages, milk shakes,or smoothies.

If swallowing becomes too difficult, your dietitian and your doctor may recommend that youreceive nutrition through a feeding tube.

Sometimes, nutrition is provided directly into the bloodstream with intravenous nutrition.


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Nutrition After SurgeryA registered dietitian can help you plan a diet that will meet your nutrition needs. A plan thatdescribes the type and amount of food to eat after surgery can help you prevent weight loss anddiscomfort with eating.

If your stomach is removed during surgery, you may develop a problem afterward known as thedumping syndrome. This problem occurs when food or liquid enters the small intestine too fast. Itcan causecramps, nausea,bloating, diarrhea, anddizziness. There are steps you can take tohelp control dumping syndrome:

Eat smaller meals.

Drink liquids before or after eating solid meals.

Limit very sweet foods and drinks, such as cookies, candy, soda, and juices.

Also, your health care team may suggest medicine to control the symptoms.

After surgery, you may need to take daily supplements of vitamins and minerals, such as calcium,and you may need injections of vitamin B12.

You may want to ask a registered dietitian these questions about nutrition:

How do I keep from losing too much weight? How do I know whether I'm getting enough

calories and protein?

What are some sample meals that would meet my needs?

How can I include my favorite foods without causing or worsening digestive problems?

Are there foods or drinks that I should avoid?

What vitamins and minerals might I need to take?

Follow-Up Care

You'll need checkups after treatment for esophageal cancer. Checkups help ensure that anychanges in your health are noted and treated if needed. If you have any health problems betweencheckups, you should contact your doctor.

Checkups may include a physical exam, blood tests,chest x-ray, CT scans, endoscopy, or othertests.

You may want to ask your doctor thesequestions after you have finished treatment:
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How often will I need checkups?

Which follow-up tests do you suggest forme?

Between checkups, what health problemsor symptoms should I tell you about?

Sources of Support

Learning you have esophageal cancer can change your life and the lives of those close to you.These changes can be hard to handle. It's normal for you, your family, and your friends to needhelp coping with the feelings that a diagnosis of cancer can bring.

Concerns about treatments and managing side effects, hospital stays, and medical bills are

common. You may also worry about caring for your family, keeping your job, or continuing dailyactivities. Here's where you can go for support:

Doctors, nurses, and other members of your health care team can answer questions abouttreatment, working, or other activities.

Social workers, counselors, or members of the clergy can be helpful if you want to talk aboutyour feelings or concerns. Often, social workers can suggest resources for financial aid,transportation, home care, or emotional support.

Support groups also can help. In these groups, patients or their family members meet withother patients or their families to share what they have learned about coping with thedisease and the effects of treatment. Groups may offer support in person, over thetelephone, or on the Internet. You may want to talk with a member of your health care teamabout finding a support group.

Information specialists at 1-800-4-CANCER and at LiveHelp(http://www.cancer.gov/help) can help you locate programs, services, and publications. Theycan send you a list of organizations that offer services to people with cancer.

Taking Part in Cancer Research

Doctors all over the country are conducting many types of clinical trials (research studies in whichpeople volunteer to take part). Clinical trials are designed to answer important questions and tofind out whether new approaches are safe and effective.

Research already has led to advances that have helped people live longer, and researchcontinues. Doctors are trying to find better ways to care for people with esophageal cancer:

Surgery: Surgeons are studying whether small cuts can be used instead of long incisions.The surgeon makes small cuts in the neck, chest, and abdomen. The surgeon sees inside

the chest with a laparoscope, and the cancer-containing esophagus is removed.


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Chemotherapy andbiological therapy: NCI is sponsoring a study of biological therapy (amonoclonal antibody) combined with chemotherapy.

Supportive care: Doctors are also testing ways to manage the problems caused by cancerand its treatment.

Even if the people in a trial do not benefit directly, they may still make an important contributionby helping doctors learn more about cancer and how to control it. Although clinical trials maypose some risks, doctors do all they can to protect their patients.

If you're interested in being part of a clinical trial, talk with your doctor.

National Cancer Institute Information Resources

You may want more information for yourself, your family, and your doctor. The following NCIservices are available to help you.

TelephoneNCI's Cancer Information Service (CIS) provides accurate, up-to-date information about cancer topatients and their families, health professionals, and the general public. Information specialiststranslate the latest scientific information into plain language, and they will respond in English orSpanish, as well as through TRS providers for the hearing or speech impaired. Calls to the CISare confidential and free.

Telephone: 1-800-4-CANCER ( 1-800-422-6237 )

InternetNCI's Web site provides information from numerous NCI sources. It offers current informationaboutcancer prevention, screening, diagnosis, treatment, genetics, supportive care, and ongoingclinical trials. It has information about NCI's research programs, funding opportunities, and cancerstatistics.

Web site: http://www.cancer.govSpanish Web site: http://www.cancer.gov/espanol

If you're unable to find what you need on the Web site, contact NCI staff. Use the online contactform at http://www.cancer.gov/contact or send an email to [email protected].

Also, information specialists provide live, online assistance through LiveHelp athttp://www.cancer.gov/help.

Esophagus Cancer At A Glance

While the exact cause(s) of cancer of the esophagus is not known, risk factors have beenidentified.

The risk of cancer of the esophagus is increased by long-term irritation of the esophagus,such as with smoking, heavy alcohol intake, and Barrett'sesophagitis.
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Diagnosis of cancer of the esophagus can be made by barium X-ray of the esophagus andconfirmed by endoscopy with biopsy of the cancer tissue.

Cancer of the esophagus can cause difficulty and pain with swallowing solid food.

Treatment of cancer of the esophagus depends on the size, location, and the extent ofcancer spread, as well as the age and health of the patient.

SOURCE:

U.S. National Institutes of Health, National Cancer Institute

Last Editorial Review: 11/21/2008

Magnetic Resonance Imaging(MRI Scan)Medical Reviewer:

William C. Shiel Jr., MD, FACP, FACR

What is an MRI scan? When are MRI scans used? What are the risks of an MRI scan? How does a patient prepare for an MRI scan and how is it performed? How does a patient obtain the results of the MRI scan?

Pictures of an MRI of the spine MRI Scan At A Glance Patient Discussions: Magnetic Resonance Imaging (MRI Scan) - Helped With Your Diagnosis Find a local Doctor in your town

Tiger Woods: Stress Fracture and Torn ACL

Medical Author: Benjamin Wedro, MD, FAAEMMedical Editor: Melissa Conrad Stppler, MD

June 2008 - In the last few months, Tiger Woods has won nine out of the 12 golf tournaments he has entered. Sowho cares? Whenever he tees it up, it's Tiger against the field, and Tiger always wins. But Tiger has met hismatch. While his mind was willing, his body has suffered a breakdown.

The medical story goes like this. In the midst of his latest winning streak, Tiger ruined his left knee, tearing theanterior cruciate ligament (ACL) and damaging the cartilage. Most people can't easily walk with this injury; Tigerplayed on. In mid-April he underwent arthroscopyto trim the damaged cartilage and began golf practice almostimmediately. Without his surgeon's blessing, he played and won the USGA Open 2008. Only afterwards was itrevealed that he had sustained a stress fracture in his tibia. The pain on his face could now be understood. It is

time to pay the piper. Tiger is done for the year, with knee reconstruction surgery and months of rehab in hisfuture.
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Read more about Tiger Woods injury and recovery prognosis

What is an MRI scan?

An MRI (or magnetic resonance imaging) scan is a radiology technique that uses magnetism,radio waves, and a computer to produce images of body structures. The MRI scanner is a tubesurrounded by a giant circular magnet. The patient is placed on a moveable bed that is insertedinto the magnet. The magnet creates a strong magnetic field that aligns the protons of hydrogenatoms, which are then exposed to a beam of radio waves. This spins the various protons of thebody, and they produce a faint signal that is detected by the receiver portion of the MRI scanner.The receiver information is processed by a computer, and an image is produced.

The image and resolution produced by MRI is quite detailed and can detect tiny changes ofstructures within the body. For some procedures, contrast agents, such as gadolinium, are usedto increase the accuracy of the images.

When are MRI scans used?

An MRI scan can be used as an extremely accurate method of disease detection throughout thebody. In the head, trauma to the brain can be seen as bleeding or swelling. Other abnormalitiesoften found includebrain aneurysms,stroke,tumors of the brain, as well as tumors orinflammation of the spine.

Neurosurgeons use an MRI scan not only in defining brain anatomy but in evaluating the integrityof the spinal cord after trauma. It is also used when considering problems associated with the

vertebrae orintervertebral discsof the spine. An MRI scan can evaluate the structure of the heartandaorta, where it can detectaneurysmsor tears.

It provides valuable information on glands and organs within the abdomen, and accurate

information about the structure of the joints, soft tissues, and bones of the body. Often,

surgery can What are the risks of an MRI scan?

An MRI scan is a painless radiology technique that has the advantage of avoiding x-ray radiationexposure. There are no known side effects of an MRI scan. The benefits of an MRI scan relate toits precise accuracy in detecting structural abnormalities of the body.

Patients who have any metallic materials within the body must notify their physician prior to theexamination or inform the MRI staff. Metallic chips, materials, surgical clips, or foreign material(artificial joints, metallic bone plates, or prosthetic devices, etc.) can significantly distort theimages obtained by the MRI scanner. Patients who haveheart pacemakers, metal implants, ormetal chips or clips in or around the eyeballs cannot be scanned with an MRI because of the riskthat the magnet may move the metal in these areas. Similarly, patients with artificial heart valves,metallic ear implants, bullet fragments, andchemotherapyorinsulin pumpsshould not have MRIscanning.
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During the MRI scan, patient lies in a closed area inside the magnetic tube. Some patients canexperience a claustrophobic sensation during the procedure. Therefore, patients with any historyofclaustrophobiashould relate this to the practitioner who is requesting the test, as well as theradiology staff. A mild sedative can be given prior to the MRI scan to help alleviate this feeling. Itis customary that the MRI staff will be nearby during MRI scan. Furthermore, there is usually ameans of communication with the staff (such as a buzzer held by the patient) which can be usedfor contact if the patient cannot tolerate the scan.

be deferred or more accurately directed after knowing the results of an MRI scan.

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IN THIS ARTICLE

What is an MRI scan? When are MRI scans used? What are the risks of an MRI scan? How does a patient prepare for an MRI scan and how is it performed? How does a patient obtain the results of the MRI scan? Pictures of an MRI of the spine MRI Scan At A Glance Patient Discussions: Magnetic Resonance Imaging (MRI Scan) - Helped With Your Diagnosis MRI Scan Index Find a local Doctor in your town

How does a patient prepare for an MRI scan and how is it performed?

All metallic objects on the body are removed prior to obtaining an MRI scan. Occasionally,patients will be given a sedative medication to decreaseanxietyand relax the patient during theMRI scan. MRI scanning requires that the patient lie still for best accuracy. Patients lie within aclosed environment inside the magnetic machine. Relaxation is important during the procedureand patients are asked to breathe normally. Interaction with the MRI technologist is maintainedthroughout the test. There are loud, repetitive clicking noises which occur during the test as the

scanning proceeds. Occasionally, patients require injections of liquid intravenously to enhance
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the images which are obtained. The MRI scanning time depends on the exact area of the bodystudied, but ranges from half an hour to an hour and a half.

How does a patient obtain the results of the MRI scan?

After the MRI scanning is completed, the computer generates visual images of the area of thebody that was scanned. These images can be transferred to film (hard copy). A radiologist is aphysician who is specially trained to interpret images of the body. The interpretation is transmittedin the form of a report to the practitioner who requested the MRI scan. The practitioner can thendiscuss the results with the patient and/or family.

FutureScientists are developing newer MRI scanners that are smaller, portable devices. These newscanners apparently can be most useful in detecting infections and tumors of the soft tissues of

the hands, feet, elbows, and knees. The application of these scanners to medical practice is nowbeing tested.

Pictures of an MRI of the spine

This patient had a herniated disc between vertebrae L4 and L5. The resulting surgery was adiscectomy


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Picture of herniated disc between L4 and L5


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Cross-section picture of herniated disc between L4 and L5

MRI Scan At A Glance MRI scanning uses magnetism, radio waves, and a computer to produce images of body

structures.

MRI scanning is painless and does not involve x-ray radiation.

Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyescannot be scanned with MRI because of the effect of the magnet.

Claustrophobic sensation can occur with MRI scanning.


CT Scan

(Computerized Tomography, CAT Scan)Medical Author:

Melissa Conrad Stppler, MD

Medical Editor:

Charles Patrick Davis, MD, PhD


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CT scan facts What is a CT scan? Why are CT scans performed? Are there risks in obtaining a CT scan? How does a patient prepare for CT scanning, and how is it performed?

Patient Discussions: CT Scan (Computerized Axial Tomography) - Causes Patient Discussions: Ct Scan - Helped With Your Diagnosis Find a local Doctor in your town

CT scan facts

CT scanning adds X-ray images with the aid of a computer to generate cross-sectional viewsof anatomy.

CT scanning can identify normal and abnormal structures and be used to guide procedures.

CT scanning is painless.

Iodine-containing contrast material is sometimes used in CT scanning. Patients with ahistory ofallergy to iodineor contrast materials should notify their physicians and radiologystaff.

What is a CT scan?

Computerized (or computed) tomography, and often formerly referred to as computerized axialtomography (CAT) scan, is an X-ray procedure that combines many X-ray images with the aid ofa computer to generate cross-sectional views and, if needed, three-dimensional images of the

internal organs and structures of the body. Computerized tomography is more commonly knownby its abbreviated names, CT scan or CAT scan. A CT scan is used to define normal andabnormal structures in the body and/or assist in procedures by helping to accurately guide theplacement of instruments or treatments.

A large donut-shaped X-ray machine or scanner takes X-ray images at many different anglesaround the body. These images are processed by a computer to produce cross-sectional picturesof the body. In each of these pictures the body is seen as an X-ray "slice" of the body, which isrecorded on a film. This recorded image is called a tomogram. "Computerized axial tomography"refers to the recorded tomogram "sections" at different levels of the body.

Imagine the body as a loaf of bread and you are looking at one end of the loaf. As you removeeach slice of bread, you can see the entire surface of that slice from the crust to the center. Thebody is seen on CT scan slices in a similar fashion from the skin to the central part of the bodybeing examined. When these levels are further "added" together, a three-dimensional picture ofan organ or abnormal body structure can be obtained.

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CAT Scan (cont.)Medical Author:

Melissa Conrad Stppler, MD

Medical Editor:

Charles Patrick Davis, MD, PhD

IN THIS ARTICLE

CT scan facts What is a CT scan? Why are CT scans performed? Are there risks in obtaining a CT scan? How does a patient prepare for CT scanning, and how is it performed? Patient Discussions: CT Scan (Computerized Axial Tomography) - Causes Patient Discussions: Ct Scan - Helped With Your Diagnosis

CAT Scan Index Find a local Doctor in your town

Why are CT scans performed?

CT scans are performed to analyze the internal structures of various parts of the body. Thisincludes the head, where traumatic injuries, (such asblood clotsor skull fractures),tumors, andinfections can be identified. In the spine, the bony structure of the vertebrae can be accuratelydefined, as can the anatomy of the intervertebral discs and spinal cord. In fact, CT scan methodscan be used to accurately measure the density of bone in evaluatingosteoporosis.

Occasionally, contrast material (an X-ray dye) is placed into the spinal fluid to further enhance thescan and the various structural relationships of the spine, the spinal cord, and its nerves. Contrastmaterial is also often administered intravenously or through other routes prior to obtaining a CTscan (see below). CT scans are also used in the chest to identify tumors,cysts, or infections thatmay be suspected on achest X-ray. CT scans of the abdomen are extremely helpful in definingbody organ anatomy, including visualizing theliver, gallbladder, pancreas, spleen, aorta, kidneys,uterus, and ovaries. CT scans in this area are used to verify the presence or absence of tumors,infection, abnormal anatomy, or changes of the body caused by trauma.

The technique is painless and can provide extremely accurate images of body structures in

addition to guiding the radiologist in performing certain procedures, such as biopsies of suspectedcancers, removal of internal body fluids for various tests, and the draining of abscesses which are
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deep in the body. Many of these procedures are minimally invasive and have markedlydecreased the need to perform surgery to accomplish the same goal.

Are there risks in obtaining a CT scan?

A CT scan is a very low-risk procedure. The most common problem is an adverse reaction tointravenous contrast material. Intravenous contrast is usually an iodine-based liquid given in thevein, which makes many organs and structures, such as the kidneys and blood vessels, muchmore visible on the CT scan. There may be resultingitching, arash,hives, or a feeling of warmththroughout the body. These are usually self-limiting reactions that go away rather quickly. Ifneeded, antihistamines can be given to help relieve the symptoms. A more serious allergicreaction to intravenous contrast is called an anaphylactic reaction. When this occurs, the patientmay experience severe hives and/or extreme difficulty in breathing. This reaction is quite rare, butis potentially life-threatening if not treated. Medications which may include corticosteroids,antihistamines, and epinephrine can reverse this adverse reaction.

Toxicity to the kidneys which can result inkidney failureis an extremely rare complication of theintravenous contrast material used in CT scans. People withdiabetes, dehydrated individuals, orpatients who already have impaired kidney function are most prone to this reaction. Newerintravenous contrast agents have been developed, such as Isovue, which have nearly eliminatedthis complication.

The amount of radiation a person receives during a CT scan is minimal. In men and nonpregnantwomen, it has not been shown to produce any adverse effects. If a woman is pregnant, there may

be a potential risk to the fetus, especially in the first trimester of thepregnancy. If a woman ispregnant, she should inform her doctor of her condition and discuss other potential methods ofimaging, such as anultrasound, which are not harmful to the fetus. However, most physicianssuggest that all radiation exposure to patients should be kept to a minimum; those patients thatdoctor shop or repeatedly go to emergency departments for a "CT put themselves at risk for

radiation-caused problems.

How does a patient prepare for CT scanning, and how is it performed?

In preparation for a CT scan, patients are often asked to avoid food, especially when contrast

material is to be used. Contrast material may be injected intravenously, or administered by mouthor by an enema in order to increase the distinction between various organs or areas of the body.Therefore, fluids and food may be restricted for several hours prior to the examination. If thepatient has a history of allergy to contrast material (such as iodine), the requesting physician andradiology staff should be notified. All metallic materials and certain clothing around the body areremoved because they can interfere with the clarity of the images.

Patients are placed on a movable table, and the table is slipped into the center of a large donut-shaped machine which takes the X-ray images around the body. The actual procedure can takefrom half an hour to an hour and a half. If specific tests, biopsies, or interventions are performed

by the radiologist during CT scanning, additional time and monitoring may be required. It isimportant during the CT scan procedure that the patient minimizes any body movement by
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remaining as still and quiet as is possible. This significantly increases the clarity of the X-rayimages. The CT scan technologist tells the patient when to breathe or hold his/her breath duringscans of the chest and abdomen. If any problems are experienced during the CT scan, thetechnologist should be informed immediately. The technologist directly watches the patientthrough an observation window during the procedure, and there is an intercom system in theroom for added patient safety.

CT scans have vastly improved the ability of doctors to diagnose many diseases earlier in theircourse and with much less risk than previous methods. Further refinements in CT scantechnology continue to evolve which promise even better picture quality and patient safety. CTscans known as "spiral" or "helical" CT scans can provide more rapid and accurate visualizationof internal organs. For example, many trauma centers are using these scans to more rapidlydiagnose internal injuries after serious body trauma. High resolution CT scans (HRCT) are usedto accurately assess the lungs for inflammation and scarring. CT angiography is a newer

technique that allows noninvasive imaging of the coronary arteries. Note that some CT scannersmay not be able to accommodate patients that weigh over 400 pounds.

REFERENCES:

Braunwald, Eugene, et al. Harrisons's Principles of Internal Medicine. 15th ed. McGraw-Hill,2001.

Tramma, Simone, et al. "Helical CT Scans and Lung Cancer Screening." CDC NIOSH ScienceBlog. 10 Jan. 2011. .

Previous editor:William C. Shiel Jr., MD, FACP, FACR


UltrasoundMedical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Medical Editor:


Introduction What is an ultrasound? What is ultrasonography? For what purposes are ultrasounds used? Diagnostic uses Screening uses Therapeutic uses What are the risks of ultrasound? How do patients prepare for an ultrasound? How are the results of ultrasound interpreted and communicated to the physician?
http://www.medicinenet.com/script/main/art.asp?articlekey=6882http://www.medicinenet.com/script/main/art.asp?articlekey=6882http://www.medicinenet.com/script/main/art.asp?articlekey=6882http://www.medicinenet.com/script/main/art.asp?articlekey=83068http://www.medicinenet.com/script/main/art.asp?articlekey=83068http://www.medicinenet.com/script/main/art.asp?articlekey=6882http://www.medicinenet.com/script/main/art.asp?articlekey=6882http://www.medicinenet.com/script/main/art.asp?articlekey=510&page=1#Introductionhttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=1#Introductionhttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=1#ultrasoundhttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=1#ultrasoundhttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=2#ultrasonographyhttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=2#ultrasonographyhttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=3#purposeshttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=3#purposeshttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=3#diagnostichttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=3#diagnostichttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=4#screeninghttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=4#screeninghttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=4#Therapeutic%20useshttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=4#Therapeutic%20useshttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=4#riskshttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=4#riskshttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=4#preparehttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=4#preparehttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=5#resultshttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=5#resultshttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=5#resultshttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=4#preparehttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=4#riskshttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=4#Therapeutic%20useshttp://www.medicinenet.com/script/main/art.asp?articlekey=510&page=4#screeninghttp://www.medicinenet.com/script/main/art.asp?articl

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