Metastatic (stage 4) esophageal cancer

Overview

Stage 4 esophageal cancer, also called metastatic esophageal cancer, is cancer that starts in the esophagus and has spread to parts of the body outside the esophagus. In stage 4A, esophageal cancer has advanced through the wall of the esophagus and may be found in distant lymph nodes, but it has not spread to other organs. If the cancer has spread to other organs, such as the liver or lungs, it is considered stage 4B.

Metastatic esophageal cancer cannot be cured. But having metastatic cancer does not necessarily mean that death is near. Treatment can help control the cancer, relieve symptoms, improve quality of life and help some people live longer. Treatment may include chemotherapy, immunotherapy, targeted therapy, radiation therapy and supportive care. If treatment is no longer slowing or controlling the cancer, care may focus more on comfort and quality of life.

Types

The two main types of esophageal cancer are adenocarcinoma and squamous cell carcinoma. They develop from different types of cells and are more common in different parts of the esophagus.

• Adenocarcinoma begins in mucus-making glandular cells and most often develops in the lower part of the esophagus, near the stomach.
• Squamous cell carcinoma begins in thin, flat cells that line the esophagus. It is more common in the upper and middle parts of the esophagus but can occur anywhere in the esophagus.

The type of esophageal cancer you have can affect treatment. Cancer cells also may have features that help guide treatment. These features are called biomarkers. Certain tests may help the healthcare team choose targeted therapy or immunotherapy.

Symptoms

Symptoms of metastatic esophageal cancer can come from the cancer in the esophagus or from cancer that has spread to other parts of the body. Trouble swallowing and weight loss are common symptoms.

Other symptoms may include:

• Pain when swallowing.
• Pain behind the breastbone.
• Hoarseness or cough.
• Indigestion or heartburn.
• Food or liquid coming back up after swallowing.
• A lump under the skin or swollen lymph nodes.
• Bleeding in the upper digestive tract.

Symptoms also can depend on where the cancer has spread. Cancer in the lungs may cause shortness of breath. Cancer in the liver may cause yellowing of the skin and eyes, called jaundice, or swelling in the abdomen. Cancer in the bones may cause pain or broken bones. Cancer in the brain may cause headaches, seizures or dizziness.

End-of-life symptoms

Near the end of life, symptoms may change as the body slows down. These changes can happen with many advanced cancers and are not specific to esophageal cancer. Changes in the last weeks and days of life may include:

• Increasing tiredness, drowsiness and weakness.
• Less interest in food and drinks.
• Shortness of breath.
• Trouble swallowing.
• Increasing confusion or decreased awareness.
• Less urine output.
• Changes in breathing, including periods when breathing stops and starts.

No single symptom can predict exactly how much time a person has left. The healthcare team can help manage symptoms and talk with the person and family about what to expect.

When to seek care

Tell your healthcare team about worsening trouble swallowing or other symptoms that make it hard to eat or drink.

Causes

Metastatic esophageal cancer develops when cancer cells break away from the original tumor and spread to other parts of the body. The cells may spread through nearby tissue, the lymphatic system or the bloodstream.

It isn't well known why some esophageal cancers spread and others do not. Cancer cells go through several steps before they can form a tumor in another part of the body.

Risk factors

Certain factors raise the risk of developing esophageal cancer, and the risk factors differ by the type of cancer.

Risk factors for squamous cell carcinoma include:

• Smoking.
• Heavy alcohol use.

Risk factors for adenocarcinoma include:

• Gastroesophageal reflux disease (GERD).
• Barrett's esophagus.
• Obesity.

Complications

Metastatic esophageal cancer can cause complications from the tumor in the esophagus or from cancer that has spread to other parts of the body.

Complications may include:

• Trouble swallowing that makes it hard to eat or drink.
• Weight loss and malnutrition.
• Bleeding in the esophagus or upper digestive tract.
• Bone pain or broken bones when cancer has spread to the bones.
• Shortness of breath or fluid buildup around the lungs.
• Jaundice or fluid buildup in the abdomen, called ascites, when the liver is affected.
• Headaches, dizziness or seizures when cancer has spread to the brain.