The symptoms of esophageal cancer may include difficulty swallowing, regurgitating food, heartburn, weight loss, and a persistent cough. Less common symptoms such as hiccups, pneumonia, or enlarged lymph nodes in the neck and above the collarbone may occur due to the spread of cancer. Having an awareness of the potential symptoms is important, as many people work to address them (say, by consuming more soft foods) before realizing they have a problem.
Very early on in the disease, people may have few symptoms of esophageal cancer. When symptoms begin to occur, many of them are due to the tumor narrowing the esophagus, making it more difficult for food to pass through. Common symptoms include to Next page
Difficulty swallowing (dysphagia) is the most common symptom of esophageal cancer, occurring in 90 percent to 95 percent of people who have symptoms with the disease. If the esophagus narrows because of cancer, food may have a hard time passing through on its way to the stomach. If food goes down, a person may sense that it’s taking longer than normal to do so, creating the sensation of “food getting stuck” or leading a person to choke. That said, the esophagus is often markedly narrowed before symptoms occur.
Swallowing challenges usually begin with larger pieces of solid food (especially meat, bread, and raw vegetables), but can then worsen to include semisolid foods and eventually liquids. At the time of diagnosis, many people note that they have already started to adjust their diet unconsciously, chewing food items more completely and avoiding foods that are more likely to become stuck.
Regurgitation of Food or Vomiting
When food won’t pass easily through the esophagus, it may come back up whole and undigested. This occurs in around 40 percent of people with esophageal cancer. Vomiting of food or blood may also occur, especially if a tumor begins to bleed.
Unintentional weight loss is a common symptom of esophageal cancer, present in half of the people at the time of diagnosis. Unintentional weight loss is defined as the loss of 5 percent of body weight or more over a six- to 12-month period. An example would be a 150-pound woman losing 7.5 pounds over a period of six months without a change in diet or exercise habits. Weight loss can be caused both by lack of nutrition due to swallowing difficulties and the metabolism of the tumor itself.
Heartburn, Chest Pain, and Indigestion
A sensation of burning or pain behind the breastbone (heartburn) is common, and often (at least initially) begins after a large meal. This can be a challenging symptom as heartburn is also a symptom of acid reflux (gastroesophageal reflux disease, GERD), a common risk factor for esophageal cancer. For those who have acid reflux, a change in the quality or severity of heartburn symptoms may signal the presence of cancer.Along with burning, some people feel chest pressure and fear they are having a heart attack. Since heart disease in women often presents with vague symptoms, such as those just discussed, symptoms of burning and pressure in the chest should always be evaluated by a physician.
A persistent cough is present in around 20 percent of people who are diagnosed with esophageal cancer. A cough is often dry and annoying and may occur any time of day. Coughing may worsen after eating (often related to one of the complications of esophageal cancer) or may have no relationship to eating.
A sensation of hoarseness, loss of voice, or the need to clear your throat frequently may be an initial symptom of the disease, especially when there isn’t an obvious cause such as a recent upper respiratory infection. Hoarseness often occurs when a tumor involves a nerve known as the recurrent laryngeal nerve.
To help pass food through the esophagus, the body makes more saliva. As it becomes more difficult to swallow, the body produces more saliva to compensate.
Tarry, black stools, known as melena, may occur due to bleeding from the esophagus. Blood from the esophagus and upper digestive tract turns black due to exposure to stomach acid.
There are also some uncommon, but important symptoms of esophageal cancer. Several of these occur because of the invasion of the tumor into nearby tissues or the spread to other regions of the body.
Hiccups may occur when an esophageal tumor invades the phrenic nerve or diaphragm. Irritation of these structures causes these repeated contractions of the diaphragm.
People may experience shortness of breath due to local spread of the tumor in the chest or aspiration and subsequent pneumonia.
Swollen lymph nodes may occur in the area just above the collarbone (supraclavicular nodes) or the neck (cervical lymph nodes).
The spread of cancer to bones (bone metastases) may cause tenderness and pain over bones. Sometimes, a fracture may occur through an area of weakened bone. Spread to the bones can also cause an elevated calcium level in the blood (hypercalcemia) that can lead to muscle cramps, weakness, and confusion.
Back pain is fairly common in advanced esophageal cancer due to the invasion of the tumor into the area between the lungs (the mediastinum) or between the membranes that line the heart (the pericardium).