National Cancer Institute


What You Need 

To Know About TM 

Cancer 

of the 

Esophagus 

U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

National Institutes of Health 
For more publications 

This is only one of many free booklets for 

people with cancer. 

Here’s how to get other National Cancer 

Institute (NCI) booklets: 

• Call the NCI’s Cancer Information Service 

at 1–800–4–CANCER (1–800–422–6237) 

• Go to the NCI’s Web site at 

http://www.cancer.gov/publications 

For materials in Spanish 

Here’s how to get NCI materials in Spanish: 

• Call the NCI’s Cancer Information Service 

at 1–800–422–6237 

• Go to the NCI’s Web site at 

http://www.cancer.gov/espanol 
Contents 

About This Booklet 1
 

The Esophagus 2
 

Cancer Cells 2
 

Types of Esophageal Cancer 5
 

Risk Factors 5
 

Symptoms 7
 

Diagnosis 8
 

Staging 9
 

Treatment 13
 

Second Opinion 21
 

Supportive Care 23
 

Nutrition 26
 

Follow-up Care 28
 

Sources of Support 29
 

Taking Part in Cancer Research 30
 

Dictionary 32
 

National Cancer Institute Information Resources 43
 

National Cancer Institute Publications 44
 

U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

National Institutes of Health 

National Cancer Institute 
About This Booklet 

This National Cancer Institute (NCI) booklet is 

about cancer* of the esophagus. Cancer that starts in 

this organ may also be called esophageal cancer. Each 

year in the United States, about 13,000 men and 3,500 

women are told they have this disease. 

Learning about medical care for esophageal cancer 

can help you take an active part in making choices 

about your care. This booklet tells about: 

•	 Diagnosis and staging 

•	 Treatment 

•	 Supportive care and nutrition 

•	 Taking part in research studies 

This booklet has lists of questions that you may 

want to ask your doctor. Many people find it helpful to 

take a list of questions to a doctor visit. To help 

remember what your doctor says, you can take notes or 

ask whether you may use a tape recorder. You may also 

want to have a family member or friend go with you 

when you talk with the doctor—to take notes, ask 

questions, or just listen. 

For the latest information about cancer of the 

esophagus, please visit our Web site at 

http://www.cancer.gov/cancertopics/types/ 

esophageal. Or, contact our Cancer Information 

Service. We can answer your questions about cancer. 

We can also send you NCI booklets and fact sheets. 

Call 1–800–4–CANCER ( 1–800–422–6237) or 

instant message us through the LiveHelp service at 

http://www.cancer.gov/help. 

*Words in italics are in the Dictionary on page 32. The Dictionary 

explains these terms. It also shows how to pronounce them. 

1
 
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 pass to 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 

Cancer begins in cells, the building blocks that make 

up tissues. Tissues make up the organs of the body. 

Normal cells grow and divide to form new cells as 

the body needs them. When normal cells grow old or 

get damaged, they die, and new cells take their place. 

Sometimes, this process goes wrong. New cells 

form when the body doesn’t need them, and old or 

damaged cells don’t die as they should. The buildup of 

extra cells often forms a mass of tissue called a growth 

or tumor. 

2
 
Esophagus

Lymph nodes

Stomach

Small intestine

Submucosa

Inner layer

Muscle layer

Outer layer

Large

intestine

This picture shows the esophagus and nearby organs. 

3
 
Growths in the wall of the esophagus can be benign 

(not cancer) or malignant (cancer). The smooth inner 

wall may have an abnormal rough area, an area of tiny 

bumps, or a tumor. Benign growths are not as harmful 

as malignant growths: 

•	 Benign growths: 

—are rarely a threat to life 

—can be removed and probably won’t grow back 

—don’t invade the tissues around them 

—don’t spread to other parts of the body 

•	 Malignant growths: 

—may be a threat to life 

—sometimes can be removed but can grow back 

—can invade and damage nearby tissues and organs 

—can spread to other parts of the body 

Esophageal cancer begins in cells in the inner layer 

of the esophagus. Over time, the cancer may invade 

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 to other tissues and grow 

to form new tumors that may damage those tissues. 

The spread of cancer cells is called metastasis. See the 

Staging section on page 9 for information about 

esophageal cancer that has spread. 

4
 
Types of Esophageal Cancer 

There are two main types of esophageal cancer. 

Both types are diagnosed, treated, and managed in 

similar ways. 

The two most common types are named for how the 

cancer cells look under a microscope. Both types begin 

in cells in the inner lining of the esophagus: 

•	 Adenocarcinoma of the esophagus: This type is 

usually found in the lower part of the esophagus, 

near the stomach. In the United States, 

adenocarcinoma is the most common type of 

esophageal cancer. It’s been increasing since the 

1970s. 

•	 Squamous cell carcinoma of the esophagus: This 

type is usually found in the upper part of 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 develop esophageal cancer. A risk factor is 

something that may increase the chance of getting a 

disease. 

5
 
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 getting this 

disease goes up as you get older. In the United 

States, most people are 65 years of age or older 

when they are diagnosed with esophageal cancer. 

•	 Being male: In the United States, men are more 

than three times as likely as women to develop 

esophageal cancer. 

•	 Smoking: People who smoke are more likely than 

people who don’t smoke to develop esophageal 

cancer. 

•	 Heavy drinking: People who have more than 3 

alcoholic drinks each day are more likely than 

people who don’t drink to develop squamous cell 

carcinoma of the esophagus. Heavy drinkers who 

smoke are at a much higher risk than heavy drinkers 

who don’t smoke. In other words, 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 the risk of 

esophageal cancer. However, results from diet 

studies don’t always agree, and more research is 

needed to better understand how diet affects the risk 

of developing esophageal cancer. 

•	 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 have symptoms. The stomach 

acid can damage the tissue of the esophagus. After 

many years of reflux, this tissue damage may lead to 

adenocarcinoma of the esophagus in some people. 

6
 
•	 Barrett esophagus: Acid reflux may damage the 

esophagus and over time cause a condition known 

as Barrett esophagus. The cells in the lower part of 

the esophagus are abnormal. Most people who have 

Barrett esophagus don’t know it. The presence of 

Barrett esophagus increases the risk of 

adenocarcinoma of the esophagus. It’s a greater risk 

factor than acid reflux alone. 

Many other possible risk factors (such as smokeless 

tobacco) have been 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. Most people who 

have risk factors never develop esophageal cancer. 

Symptoms 

Early esophageal cancer may not cause symptoms. 

As the cancer grows, the most common symptoms are: 

•	 Food gets stuck in the esophagus, and food may 

come back up 

•	 Pain when swallowing 

•	 Pain in the chest or back 

•	 Weight loss 

•	 Heartburn 

•	 A hoarse voice or cough that doesn’t go away within 

2 weeks 

These symptoms may be caused by esophageal 

cancer or other health problems. If you have any of 

these symptoms, you should tell your doctor so that 

problems can be diagnosed and treated as early as 

possible. 

7
 
Diagnosis 

If you have a symptom that suggests esophageal 

cancer, your doctor must find out whether it’s really 

due to cancer or to some other cause. The doctor gives 

you a physical exam and asks about 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 your esophagus and 

stomach. The barium solution makes your 

esophagus show up more clearly on the x-rays. This 

test is also called an upper GI series. 

•	 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 receive medicine to help 

you relax. The tube is passed through your mouth or 

nose to the esophagus. The doctor may also call this 

procedure upper endoscopy, EGD, or 

esophagoscopy. 

•	 Biopsy: Usually, cancer begins in the inner layer of 

the esophagus. The doctor uses an endoscope to 

remove tissue from the esophagus. A pathologist 

checks the tissue under a microscope for cancer 

cells. A biopsy is the only sure way to know if 

cancer cells are present. 

8
 
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 stage (extent) of the disease to 

help you choose the best treatment. 

Staging is a careful attempt to find out the 

following: 

•	 how deeply the cancer invades the wall of the 

esophagus 

•	 whether the cancer invades nearby tissues 

•	 whether the cancer has spread, and if so, to what 

parts of the body 

9
 
When esophageal cancer spreads, it’s often found in 

nearby lymph nodes. If cancer has reached these 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 your throat, which 

has been numbed with anesthetic. A probe at the end 

of the tube sends out sound waves that you can’t 

hear. The waves bounce off tissues in your 

esophagus and nearby organs. A computer creates a 

picture from the echoes. The picture can show how 

deeply the cancer has invaded the wall of the 

esophagus. The doctor may use a needle to take 

tissue samples of lymph nodes. 

•	 CT scan: An x-ray machine linked to a computer 

takes a series of detailed pictures of your chest and 

abdomen. Doctors use CT scans to look for 

esophageal cancer that has spread to lymph nodes 

and other areas. You may receive contrast material 

by mouth or by injection into 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 inside your 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 contrast material makes abnormal areas show 

up more clearly on the picture. 

10
 
•	 PET scan: You receive an injection of a small 

amount of radioactive sugar. The radioactive sugar 

gives off signals that the PET scanner picks up. The 

PET scanner makes a picture of the places in your 

body where the sugar is being taken up. Cancer cells 

show up brighter in the picture because they take up 

sugar faster than normal cells do. A PET scan shows 

whether esophageal cancer may have spread. 

•	 Bone scan: You get an injection of a small amount 

of a radioactive substance. It travels through the 

bloodstream and collects in the bones. A machine 

called a scanner detects and measures the radiation. 

The scanner makes pictures of the bones. The 

pictures may show cancer 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 the abdomen. 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 lymph nodes. 

When cancer spreads from its original place to 

another part of the body, the new tumor has the same 

kind of abnormal cells and the same name as the 

primary tumor. For example, if esophageal cancer 

spreads to the liver, the cancer cells in the liver are 

actually esophageal cancer cells. The disease is 

metastatic esophageal cancer, not liver cancer. For that 

reason, it’s treated as esophageal cancer, not liver 

cancer. Doctors call the new tumor “distant” or 

metastatic disease. 

11
 
These are the stages of esophageal cancer: 

•	 Stage 0: Abnormal cells are found only in the inner 

layer of the esophagus. It’s called carcinoma in situ. 

•	 Stage I: The cancer has grown through the inner 

layer to the submucosa. (The picture on page 3 

shows the submucosa and other layers.) 

•	 Stage II is one of the following: 

—The cancer has grown through the inner layer to 

the submucosa, and cancer cells have spread to 

lymph nodes. 

—Or, the cancer has invaded the muscle layer. 

Cancer cells may be found in lymph nodes. 

—Or, the cancer has grown through the outer layer 

of the esophagus. 

12
 
•	 Stage III is one of the following: 

—The cancer has grown through the outer layer, 

and cancer cells have spread to lymph nodes. 

—Or, the cancer has invaded nearby structures, such 

as the airways. Cancer cells may have 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 are surgery, 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 doctors encourage 

people with this disease to consider taking part in a 

clinical trial, a research study of new treatment 

methods. Clinical trials are an important option for 

people with all stages of esophageal cancer. See the 

Taking Part in Cancer Research section on page 30. 

13
 
You may have a team of specialists to help plan 

your treatment. Your doctor may refer you to 

specialists, or you may ask for a referral. You may 

want to see a gastroenterologist, a doctor who 

specializes in treating problems of the digestive organs. 

Other specialists who treat esophageal cancer include 

thoracic (chest) surgeons, thoracic surgical 

oncologists, medical oncologists, and radiation 

oncologists. Your health care team may also include an 

oncology nurse and a registered dietitian. If your 

airways are affected by the cancer, you may have a 

respiratory therapist as part of 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 the possible 

side effects. Because cancer therapy often damages 

healthy cells and tissues, side effects are common. 

Before treatment starts, ask your health care team 

about possible side effects and how treatment may 

change your normal activities. You and your health 

care team can work together to develop a treatment 

plan that meets your needs. 

14
 
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 

signs of cancer? 

•	 What is the goal of treatment? What are my 

treatment choices? Which do you recommend 

for me? Why? 

•	 Will I have more than one kind of treatment? 

•	 What are the expected benefits of each type 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 to 

have 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 treatment 

options? 

•	 How often should I have checkups? 

15
 
Surgery 

There are several types of surgery for esophageal 

cancer. The type depends mainly on where the cancer 

is located. The surgeon may remove the whole 

esophagus or only the part that has the cancer. Usually, 

the surgeon removes the section of the esophagus with 

the cancer, lymph nodes, and nearby soft tissues. Part 

or all of the stomach may also be removed. You and 

your surgeon 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 piece of 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 helps you get 

enough nutrition while you heal. Information about 

eating after surgery is in the Nutrition section on page 

26. 

You may have pain for the first few days after 

surgery. However, medicine will help control the pain. 

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. 

Your health care team will watch for signs of food 

leaking from the newly joined parts of your digestive 

tract. They will also watch for pneumonia or other 

infections, breathing problems, bleeding, or other 

problems that may require treatment. 

16
 
The time it takes to heal after surgery is different for 

everyone and depends on the type of surgery. 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 affects cells 

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. 

17
 
Doctors use two types of radiation therapy to treat 

esophageal cancer. Some people receive both types: 

•	 External radiation therapy: The radiation comes 

from a large machine outside the body. The machine 

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 anesthetic spray 

and gives you medicine to help you relax. The 

doctor puts a tube into your esophagus. The 

radiation comes from the tube. Once the tube is 

removed, no radioactivity is left in your body. 

Usually, only a single treatment is done. 

Side effects depend mainly on the dose and type of 

radiation. External radiation therapy to the chest and 

abdomen may cause a sore throat, pain similar to 

heartburn, or pain in the stomach or the intestine. You 

may have nausea and diarrhea. Your health care team 

can give you medicines to prevent or control these 

problems. 

Also, your skin in the treated area may become red, 

dry, and tender. You may lose hair in the treated area. A 

much less common side effect of radiation therapy 

aimed at the chest is harm to the lung, heart, or spinal 

cord. 

You are likely to be very tired during radiation 

therapy, especially in the later weeks of external 

radiation 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 as they can. 

18
 
Radiation therapy can lead to problems with 

swallowing. For example, sometimes radiation therapy 

can harm the esophagus and make it painful for you to 

swallow. Or, the radiation may cause the esophagus to 

narrow. Before radiation therapy, a plastic tube may be 

inserted into the esophagus to keep it open. If radiation 

therapy leads to a problem with swallowing, it may be 

hard to eat well. Ask your health care team for help 

getting good nutrition. See the Nutrition section on 

page 26 for more information. 

You may find it helpful to read the NCI booklet 

Radiation Therapy and You. 

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? 

19
 
Chemotherapy 

Most people with esophageal cancer get 

chemotherapy. Chemotherapy uses drugs to destroy 

cancer cells. The drugs for esophageal cancer are 

usually given through a vein (intravenous). You may 

have your treatment in a clinic, at the doctor’s office, 

or at home. Some people need to stay 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 kills fast-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 likely to get 

infections, bruise or bleed easily, and feel very weak 

and tired. Your health care team will check for low 

levels of blood cells. If your levels are low, your 

health care team may stop the chemotherapy for a 

while or reduce the dose of drug. There also are 

medicines that can help your body make new blood 

cells. 

•	 Cells in hair roots: Chemotherapy may cause hair 

loss. If you lose your hair, it will grow back, but it 

may change in color and texture. 

•	 Cells that line the digestive tract: Chemotherapy 

can cause poor appetite, nausea and vomiting, 

diarrhea, or mouth and lip sores. Your health care 

team can give you medicines and suggest other 

ways to help with these problems. 

Other possible side effects include a skin rash, joint 

pain, tingling or numbness in your hands and feet, 

hearing problems, or swollen feet or legs. Your health 

20
 
care team can suggest ways to control many of these 

problems. Most go away when treatment ends. 

You may find it helpful to read NCI’s booklet 

Chemotherapy and You. 

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 I 

prevent 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 treatment plan. You 

may want to find a medical center that has a lot of 

experience with treating esophageal cancer. You may 

even want to talk to several different doctors about all 

of the treatment options, their side effects, and the 

expected results. 

21
 
Some people worry that the doctor will be offended 

if they ask for a second opinion. Usually the opposite 

is true. Most doctors welcome a second opinion. And 

many health insurance companies will 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 and treatment 

plan. Or the second doctor may suggest another 

approach. Either way, you have more information and 

perhaps a greater sense of control. You can feel more 

confident about the decisions you make, knowing that 

you’ve looked at your options. 

22
 
It may take some time and effort to gather your 

medical records and see another doctor. In most cases, 

it’s not a problem to take several weeks to get a second 

opinion. The delay in starting treatment usually will 

not make treatment less effective. To make sure, you 

should discuss this delay with your doctor. 

There are many ways to find a doctor for a second 

opinion. You can ask your doctor, a local or state 

medical society, a nearby hospital, or a medical school 

for names of specialists. NCI’s Cancer Information 

Service at 1–800–4–CANCER can tell you about 

nearby treatment centers. Other sources can be found 

in the NCI fact sheet How To Find a Doctor or 

Treatment Facility If You Have Cancer. 

Supportive Care 

Esophageal cancer and its treatment can lead to 

other health problems. You can have supportive care 

before, during, or after cancer treatment. 

Supportive care is treatment to control pain and 

other symptoms, to relieve the side effects of therapy, 

and to help you cope with the feelings that a diagnosis 

of cancer can bring. You may receive supportive care 

to prevent or control these problems and to improve 

your comfort and quality of life during treatment. 

You can get information about supportive care on 

NCI’s Web site at http://www.cancer.gov/ 

cancerinfo/coping and from NCI’s Cancer Information 

Service at 1–800–4–CANCER or LiveHelp 

(http://www.cancer.gov/help). 

23
 
Cancer Blocks the Esophagus 

You may have trouble swallowing because the 

cancer blocks the esophagus. Not being able to 

swallow makes it hard or impossible to eat. It also 

increases the risk of food getting in your airways. This 

can lead to a lung infection like pneumonia. Also, not 

being able to swallow liquids or 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 tube made of 

metal mesh or plastic) in your esophagus. Food and 

liquid can pass through the center of the tube. 

However, solid foods need to be chewed well before 

swallowing. A large swallow of food could get stuck 

in the stent. 

•	 Laser therapy: A laser is a concentrated beam of 

intense light that kills tissue with heat. The doctor 

uses the laser to destroy the cancer cells blocking 

the esophagus. Laser therapy may make swallowing 

easier for a while, but you may need to repeat the 

treatment several weeks later. 

•	 Photodynamic therapy: You get an injection, and 

the drug collects in the esophageal cancer cells. Two 

days after the injection, the doctor uses an 

endoscope to shine a special light (such as a laser) 

on the cancer. The drug becomes active when 

exposed to light. Two or three days later, the doctor 

may check to see if the cancer cells have been 

killed. People getting this drug must avoid sunlight 

for one month or longer. Also, you may need to 

repeat the treatment several weeks later. You may 

want to read the NCI fact sheet Photodynamic 

Therapy for Cancer: Questions and Answers. 

24
 
•	 Radiation therapy: Radiation therapy helps shrink 

the tumor. If the tumor blocks the esophagus, 

internal radiation therapy or sometimes external 

radiation therapy can be used to help make 

swallowing easier. 

•	 Balloon dilation: The doctor inserts a tube through 

the blocked part of the esophagus. A balloon helps 

widen the opening. This method helps improve 

swallowing for a few days. 

•	 Other ways to get nutrition: See the Nutrition 

section on page 26 for ways to get food when eating 

becomes difficult. 

Pain 

Cancer and its treatments may cause pain. It may be 

painful to swallow, or you may have pain in your chest 

from the cancer or from a stent. Your health care team 

or a pain control specialist can suggest ways to relieve 

or reduce pain. More information about pain control 

can be found in the NCI booklet Pain Control. 

Sadness and Other Feelings 

It’s normal to feel sad, anxious, or confused after a 

diagnosis of a serious illness. Some people find it 

helpful to talk about their feelings. See the Sources of 

Support section on page 29. 

25
 
Nutrition 

It’s important to meet your nutrition needs before, 

during, and after cancer treatment. You need the right 

amount of calories, protein, vitamins, and minerals. 

Getting the right nutrition can help you feel better and 

have more energy. 

However, when you have esophageal cancer, it may 

be hard to eat for many reasons. You may be 

uncomfortable or tired, and you may not feel like 

eating. Also, the cancer may make it hard to swallow 

food. If you’re getting chemotherapy, you may find 

that foods don’t taste as good as they used to. You also 

may have side effects of treatment such as poor 

appetite, nausea, vomiting, or diarrhea. 

If you develop problems with eating, there are a 

number of ways to meet your nutrition needs. A 

registered 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 the texture, 

fiber, and fat content of your foods can lessen your 

discomfort. A dietitian may also suggest 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 you receive 

nutrition through a feeding tube. 

•	 Sometimes, nutrition is provided directly into the 

bloodstream with intravenous nutrition. 

You may want to read the NCI booklet Eating Hints 

for Cancer Patients. It contains many useful ideas and 

recipes. 

26
 
Nutrition After Surgery 

A registered dietitian can help you plan a diet that 

will meet your nutrition needs. A plan that describes 

the type and amount of food to eat after surgery can 

help you prevent weight loss and discomfort with 

eating. 

If your stomach is removed during surgery, you may 

develop a problem afterward known as the dumping 

syndrome. This problem occurs when food or liquid 

enters the small intestine too fast. It can cause cramps, 

nausea, bloating, diarrhea, and dizziness. There are 

steps you can take to help 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. 

27
 
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 any changes in your 

health are noted and treated if needed. If you have any 

health problems between checkups, you should contact 

your doctor. 

Checkups may include a physical exam, blood tests, 

chest x-ray, CT scans, endoscopy, or other tests. 

28
 
The NCI has publications to help answer questions 

about follow-up care and other concerns. You may find 

it helpful to read the NCI booklet Facing Forward: Life 

After Cancer Treatment. You may also want to read the 

NCI fact sheet Follow-up Care After Cancer Treatment: 

Questions and Answers. 

You may want to ask your doctor these 

questions after you have finished treatment: 

•	 How often will I need checkups? 

•	 Which follow-up tests do you suggest for me? 

•	 Between checkups, what health problems or 

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 need help 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 daily activities. 

Here’s where you can go for support: 

•	 Doctors, nurses, and other members of your health 

care team can answer questions about treatment, 

working, or other activities. 

29
 
•	 Social workers, counselors, or members of the 

clergy can be helpful if you want to talk about your 

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 with other 

patients or their families to share what they have 

learned about coping with the disease and the effects 

of treatment. Groups may offer support in person, 

over the telephone, or on the Internet. You may want 

to talk with a member of your health care team 

about 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. 

They can send you a list of organizations that offer 

services to people with cancer. 

For tips on coping, you may want to read the NCI 

booklet Taking Time: Support for People With Cancer. 

Taking Part in Cancer Research 

Doctors all over the country are conducting many 

types of clinical trials (research studies in which people 

volunteer to take part). Clinical trials are designed to 

answer important questions and to find out whether 

new approaches are safe and effective. 

Research already has led to advances that have 

helped people live longer, and research continues. 

Doctors are trying to find better ways to care for 

people with esophageal cancer: 

30
 
•	 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. 

•	 Chemotherapy and biological therapy: NCI is 

sponsoring a study of biological therapy (a 

monoclonal antibody) combined with chemotherapy. 

•	 Supportive care: Doctors are also testing ways to 

manage the problems caused by cancer and its 

treatment. 

Even if the people in a trial do not benefit directly, 

they may still make an important contribution by 

helping doctors learn more about cancer and how to 

control it. Although clinical trials may pose 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. You may want to read the NCI 

booklet Taking Part in Cancer Treatment Research 

Studies. It describes how treatment studies are carried 

out and explains their possible benefits and risks. 

NCI’s Web site includes a section on clinical trials at 

http://www.cancer.gov/clinicaltrials. It has general 

information about clinical trials as well as detailed 

information about specific ongoing studies of cancer. 

NCI’s Information Specialists at 1–800–4–CANCER 

or at LiveHelp at http://www.cancer.gov/help can 

answer questions and provide information about 

clinical trials. 

31
 
Dictionary 

Definitions of thousands of terms are on the NCI 

Web site in the NCI Dictionary of Cancer Terms. You 

can access it at http://www.cancer.gov/dictionary. 

Abdomen (AB-doh-men): The area of the body that 

contains the pancreas, stomach, intestines, liver, 

gallbladder, and other organs. 

Adenocarcinoma (A-den-oh-KAR-sih-NOH-muh): 

Cancer that begins in cells that line certain internal 

organs and that have gland-like (secretory) properties. 

Anesthetic (a-nes-THEH-tik): A substance that causes 

loss of feeling or awareness. Local anesthetics cause 

loss of feeling in a part of the body. General 

anesthetics put the person to sleep. 

Barium solution: A liquid containing barium sulfate 

that is used in x-rays to highlight parts of the digestive 

system. 

Barium swallow: A series of x-rays of the esophagus. 

The x-ray pictures are taken after the person drinks a 

solution that contains barium. The barium coats and 

outlines the esophagus on the x-ray. Also called 

esophagram and upper GI series. 

Barrett esophagus (BA-ret ee-SAH-fuh-gus): A 

condition in which the cells lining the lower part of the 

esophagus have changed or been replaced with 

abnormal cells that could lead to cancer of the 

esophagus. The backing up of stomach contents 

(reflux) may irritate the esophagus and, over time, 

cause Barrett esophagus. 

Benign (beh-NINE): Not cancerous. Benign tumors 

may grow larger but do not spread to other parts of the 

body. 

32
 
Biological therapy (BY-oh-LAH-jih-kul THAYR-uhpee): Treatment to boost or restore the ability of the 

immune system to fight cancer, infections, and other 

diseases. Also used to lessen certain side effects that 

may be caused by some cancer treatments. Agents used 

in biological therapy include monoclonal antibodies, 

growth factors, and vaccines. These agents may also 

have a direct antitumor effect. Also called 

immunotherapy, biotherapy, biological response 

modifier therapy, and BRM therapy. 

Biopsy (BY-op-see): The removal of cells or tissues for 

examination by a pathologist. The pathologist may 

study the tissue under a microscope or perform other 

tests on the cells or tissue. There are many different 

types of biopsy procedures. The most common types 

include: (1) incisional biopsy, in which only a sample 

of tissue is removed; (2) excisional biopsy, in which an 

entire lump or suspicious area is removed; and (3) 

needle biopsy, in which a sample of tissue or fluid is 

removed with a needle. When a wide needle is used, 

the procedure is called a core biopsy. When a thin 

needle is used, the procedure is called a fine-needle 

aspiration biopsy. 

Bone scan: A technique to create images of bones on a 

computer screen or on film. A small amount of 

radioactive material is injected into a blood vessel and 

travels through the bloodstream; it collects in the bones 

and is detected by a scanner. 

Brachytherapy (BRAY-kee-THAYR-uh-pee): A type of 

radiation therapy in which radioactive material sealed 

in needles, seeds, wires, or catheters is placed directly 

into or near a tumor. Also called radiation 

brachytherapy, internal radiation therapy, and implant 

radiation therapy. 

Calcium (KAL-see-um): A mineral found in teeth, 

bones, and other body tissues. 

33
 
Cancer (KAN-ser): A term for diseases in which
 

abnormal cells divide without control. Cancer cells can
 

invade nearby tissues and can spread to other parts of
 

the body through the blood and lymph systems.
 

Carcinoma in situ (KAR-sih-NOH-muh in SY-too):
 

A group of abnormal cells that remain in the tissue in
 

which they first formed. These abnormal cells may
 

become cancer and spread into nearby normal tissue.
 

Cell: The individual unit that makes up the tissues of
 

the body. All living things are made up of one or more
 

cells.
 

Chemotherapy (KEE-moh-THAYR-uh-pee):
 

Treatment with drugs that kill cancer cells.
 

Clinical trial: A type of research study that tests how
 

well new medical approaches work in people. These
 

studies test new methods of screening, prevention,
 

diagnosis, or treatment of a disease. Also called a
 

clinical study.
 

Contrast material: A dye or other substance that helps
 

to show abnormal areas inside the body. It is given by
 

injection into a vein, by enema, or by mouth. Contrast
 

material may be used with x-rays, CT scans, MRI, or
 

other imaging tests.
 

CT scan: Computed tomography scan (kum-PYOO-ted
 

tuh-MAH-gruh-fee skan). A series of detailed pictures
 

of areas inside the body taken from different angles;
 

the pictures are created by a computer linked to an
 

x-ray machine. Also called computerized tomography
 

and computerized axial tomography (CAT) scan.
 

Digestive tract (dy-JES-tiv): The organs through which
 

food and liquids pass when they are swallowed,
 

digested, and eliminated. These organs are the mouth,
 

esophagus, stomach, small and large intestines, and
 

rectum and anus.
 

34
 
Dumping syndrome: A condition that occurs when 

food or liquid moves too fast into the small intestine. 

Symptoms include cramps, nausea, diarrhea, sweating, 

weakness, and dizziness. Dumping syndrome 

sometimes occurs in people who have had part or all of 

their stomach removed. 

Endoscope (EN-doh-SKOPE): A thin, tube-like 

instrument used to look at tissues inside the body. An 

endoscope has a light and a lens for viewing and may 

have a tool to remove tissue. 

Endoscopic ultrasound (en-doh-SKAH-pik UL-truhSOWND): EUS. A procedure in which an endoscope is 

inserted into the body. An endoscope is a thin, tube-like 

instrument that has a light and a lens for viewing. A 

probe at the end of the endoscope is used to bounce 

high-energy sound waves (ultrasound) off internal 

organs to make a picture (sonogram). Also called 

endosonography. 

Endoscopy (en-DOSS-koh-pee): A procedure that uses 

an endoscope to examine the inside of the body. An 

endoscope is a thin, tube-like instrument with a light 

and a lens for viewing. It may also have a tool to 

remove tissue to be checked under a microscope for 

signs of disease. 

Esophageal cancer (ee-SAH-fuh-JEE-ul KAN-ser): 

Cancer that forms in tissues lining the esophagus (the 

muscular tube through which food passes from the 

throat to the stomach). Two types of esophageal cancer 

are squamous cell carcinoma (cancer that begins in flat 

cells lining the esophagus) and adenocarcinoma 

(cancer that begins in cells that make and release 

mucus and other fluids). 

35
 
Esophagoscopy (ee-SAH-fuh-GOS-koh-pee):
 

Examination of the esophagus using an esophagoscope.
 

An esophagoscope is a thin, tube-like instrument with a
 

light and a lens for viewing. It may also have a tool to
 

remove tissue to be checked under a microscope for
 

signs of disease.
 

Esophagus (ee-SAH-fuh-gus): The muscular tube
 

through which food passes from the throat to the
 

stomach.
 

External radiation therapy (RAY-dee-AY-shun
 

THAYR-uh-pee): A type of radiation therapy that uses
 

a machine to aim high-energy rays at the cancer from
 

outside of the body. Also called external beam
 

radiation therapy.
 

Gastroenterologist (GAS-troh-EN-teh-RAH-loh-jist):
 

A doctor who specializes in diagnosing and treating
 

disorders of the digestive system.
 

General anesthesia (A-nes-THEE-zhuh): Drugs that
 

cause loss of feeling or awareness and put the person
 

to sleep.
 

Incision (in-SIH-zhun): A cut made in the body to
 

perform surgery.
 

Injection: Use of a syringe and needle to push fluids or
 

drugs into the body; often called a “shot.”
 

Internal radiation therapy (in-TER-nul RAY-dee-AYshun THAYR-uh-pee): A type of radiation therapy in
 

which radioactive material sealed in needles, seeds,
 

wires, or catheters is placed directly into or near a
 

tumor. Also called brachytherapy, radiation
 

brachytherapy, and implant radiation therapy.
 

Intravenous (IN-truh-VEE-nus): IV. Into or within a
 

vein. Intravenous usually refers to a way of giving a
 

drug or other substance through a needle or tube
 

inserted into a vein.
 

36
 
Laparoscope (LA-puh-ruh-SKOPE): A thin, tube-like 

instrument used to look at tissues and organs inside the 

abdomen. A laparoscope has a light and a lens for 

viewing and may have a tool to remove tissue. 

Laparoscopy (LA-puh-ROS-koh-pee): A procedure 

that uses a laparoscope, inserted through the abdominal 

wall, to examine the inside of the abdomen. A 

laparoscope is a thin, tube-like instrument with a light 

and a lens for viewing. It may also have a tool to 

remove tissue to be checked under a microscope for 

signs of disease. 

Laser (LAY-zer): A device that concentrates light into 

an intense, narrow beam used to cut or destroy tissue. 

It is used in microsurgery, photodynamic therapy, and 

for a variety of diagnostic purposes. 

Laser therapy (LAY-zer THAYR-uh-pee): The use of 

an intensely powerful beam of light to kill cancer cells. 

Lymph node (limf node): A rounded mass of lymphatic 

tissue that is surrounded by a capsule of connective 

tissue. Lymph nodes filter lymph (lymphatic fluid), and 

they store lymphocytes (white blood cells). They are 

located along lymphatic vessels. Also called a lymph 

gland. 

Lymph vessel (limf): A thin tube that carries lymph 

(lymphatic fluid) and white blood cells through the 

lymphatic system. Also called lymphatic vessel. 

Malignant (muh-LIG-nunt): Cancerous. Malignant 

tumors can invade and destroy nearby tissue and 

spread to other parts of the body. 

Medical oncologist (MEH-dih-kul on-KAH-loh-jist): 

A doctor who specializes in diagnosing and treating 

cancer using chemotherapy, hormonal therapy, and 

biological therapy. A medical oncologist often is the 

main health care provider for someone who has cancer. 

A medical oncologist also gives supportive care and 

may coordinate treatment given by other specialists. 

37
 
Metastasis (meh-TAS-tuh-sis): The spread of cancer 

from one part of the body to another. A tumor formed 

by cells that have spread is called a “metastatic tumor” 

or a “metastasis.” The metastatic tumor contains cells 

that are like those in the original (primary) tumor. The 

plural form of metastasis is metastases (meh-TAS-tuhseez). 

Monoclonal antibody (MAH-noh-KLOH-nul AN-tihBAH-dee): A type of protein made in the laboratory 

that can locate and bind to substances in the body, 

including tumor cells. There are many kinds of 

monoclonal antibodies. Each monoclonal antibody is 

made to find one substance. Monoclonal antibodies are 

being used to treat some types of cancer and are being 

studied in the treatment of other types. They can be 

used alone or to carry drugs, toxins, or radioactive 

materials directly to a tumor. 

MRI: Magnetic resonance imaging (mag-NEH-tik 

REH-zuh-nunts IH-muh-jing). A procedure in which 

radio waves and a powerful magnet linked to a 

computer are used to create detailed pictures of areas 

inside the body. These pictures can show the difference 

between normal and diseased tissue. MRI makes better 

images of organs and soft tissue than other scanning 

techniques, such as computed tomography (CT) or 

x-ray. MRI is especially useful for imaging the brain, 

the spine, the soft tissue of joints, and the inside of 

bones. Also called nuclear magnetic resonance imaging 

(NMRI). 

Mucosa (myoo-KOH-suh): The moist, inner lining of 

some organs and body cavities (such as the nose, 

mouth, esophagus, lungs, and stomach). Glands in the 

mucosa make mucus (a thick, slippery fluid). Also 

called mucous membrane. 

38
 
Mucus (MYOO-kus): A thick, slippery fluid produced 

by the membranes that line certain organs of the body, 

including the nose, mouth, throat, and vagina. 

Oncology nurse (on-KAH-loh-jee): A nurse who 

specializes in treating and caring for people who have 

cancer. 

Organ: A part of the body that performs a specific 

function. For example, the heart is an organ. 

Pathologist (puh-THAH-loh-jist): A doctor who 

identifies diseases by studying cells and tissues under a 

microscope. 

PET scan: Positron emission tomography (PAH-zihtron ee-MIH-shun toh-MAH-gruh-fee) scan. A 

procedure in which a small amount of radioactive 

glucose (sugar) is injected into a vein, and a scanner is 

used to make detailed, computerized pictures of areas 

inside the body where the glucose is used. Because 

cancer cells often use more glucose than normal cells, 

the pictures can be used to find cancer cells in the 

body. 

Photodynamic therapy (FOH-toh-dy-NA-mik 

THAYR-uh-pee): Treatment with drugs that become 

active when exposed to light. These activated drugs 

may kill cancer cells. 

Radiation (RAY-dee-AY-shun): Energy released in the 

form of particles or electromagnetic waves. Common 

sources of radiation include radon gas, cosmic rays 

from outer space, and medical x-rays. 

Radiation oncologist (RAY-dee-AY-shun on-KAH-lohjist): A doctor who specializes in using radiation to 

treat cancer. 

39
 
Radiation therapy (RAY-dee-AY-shun THAYR-uhpee): The use of high-energy radiation from x-rays,
 

gamma rays, neutrons, protons, and other sources to
 

kill cancer cells and shrink tumors. Radiation may
 

come from a machine outside the body (external beam
 

radiation therapy), or it may come from radioactive
 

material placed in the body near cancer cells (internal
 

radiation therapy). Systemic radiation therapy uses a
 

radioactive substance, such as a radiolabeled
 

monoclonal antibody, that travels in the blood to
 

tissues throughout the body. Also called radiotherapy
 

and irradiation.
 

Radioactive (RAY-dee-oh-AK-tiv): Giving off
 

radiation.
 

Reflux: The backward flow of liquid from the stomach
 

into the esophagus.
 

Registered dietitian (dy-eh-TIH-shun): A health
 

professional with special training in the use of diet and
 

nutrition to keep the body healthy. A registered
 

dietitian may help the medical team improve the
 

nutritional health of a patient.
 

Respiratory therapist (RES-pih-ruh-TOR-ee THAYRuh-pist): A health professional trained to evaluate and
 

treat people who have breathing problems or other lung
 

disorders.
 

Risk factor: Something that may increase the chance of
 

developing a disease. Some examples of risk factors
 

for cancer include age, a family history of certain
 

cancers, use of tobacco products, certain eating habits,
 

obesity, lack of exercise, exposure to radiation or other
 

cancer-causing agents, and certain genetic changes.
 

Side effect: A problem that occurs when treatment
 

affects healthy tissues or organs. Some common side
 

effects of cancer treatment are fatigue, pain, nausea,
 

vomiting, decreased blood cell counts, hair loss, and
 

mouth sores.
 

40
 
Speech pathologist (puh-THAH-loh-jist): A specialist 

who evaluates and treats people with communication 

and swallowing problems. Also called a speech 

therapist. 

Squamous cell carcinoma (SKWAY-mus sel KAR-sihNOH-muh): Cancer that begins in squamous cells, 

which are thin, flat cells that look like fish scales. 

Squamous cells are found in the tissue that forms the 

surface of the skin, the lining of the hollow organs of 

the body, and the passages of the respiratory and 

digestive tracts. Also called epidermoid carcinoma. 

Stent: A device placed in a body structure (such as a 

blood vessel or the gastrointestinal tract) to keep the 

structure open. 

Submucosa (sub-myoo-KOH-suh): The layer of tissue 

under the mucosa (inner lining of some organs and 

body cavities that makes mucus). 

Supportive care: Care given to improve the quality of 

life of patients who have a serious or life-threatening 

disease. The goal of supportive care is to prevent or 

treat as early as possible the symptoms of the disease, 

side effects caused by treatment of the disease, and 

psychological, social, and spiritual problems related to 

the disease or its treatment. Also called palliative care, 

comfort care, and symptom management. 

Surgeon: A doctor who removes or repairs a part of the 

body by operating on the patient. 

Surgery (SER-juh-ree): A procedure to remove or 

repair a part of the body or to find out whether disease 

is present. An operation. 

Thoracic surgeon (thoh-RAH-sik SER-jun): A surgeon 

who specializes in operating on organs inside the chest, 

including the heart and lungs. 

41
 
Thoracic surgical oncologist (thoh-RAH-sik SER-jihkul on-KAH-loh-jist): A surgeon who specializes in 

operating on tumors found inside the chest. 

Tissue (TISH-oo): A group or layer of cells that work 

together to perform a specific function. 

Tumor (TOO-mer): An abnormal mass of tissue that 

results when cells divide more than they should or do 

not die when they should. Tumors may be benign (not 

cancerous), or malignant (cancerous). Also called 

neoplasm. 

Upper GI series: A series of x-rays of the esophagus. 

The x-ray pictures are taken after the person drinks a 

solution that contains barium. The barium coats and 

outlines the esophagus on the x-ray. Also called 

esophagram and barium swallow. 

Vitamin B12 (VY-tuh-min): A vitamin that is needed to 

make red blood cells and DNA (the genetic material in 

cells) and to keep nerve cells healthy. It is found in 

eggs, meat, poultry, shellfish, milk, and milk products. 

Vitamin B12, along with folate, may be given to help 

reduce side effects in cancer patients being treated with 

drugs called antimetabolites. Also called cobalamin. 

X-ray: A type of high-energy radiation. In low doses, 

x-rays are used to diagnose diseases by making 

pictures of the inside of the body. In high doses, x-rays 

are used to treat cancer. 

42
 
National Cancer Institute Information 

Resources 

You may want more information for yourself, your 

family, and your doctor. The following NCI services 

are available to help you. 

Telephone 

NCI’s Cancer Information Service (CIS) provides 

accurate, up-to-date information about cancer to 

patients and their families, health professionals, and the 

general public. Information specialists translate the 

latest scientific information into plain language, and 

they will respond in English or Spanish, as well as 

through TRS providers for the hearing or speech 

impaired. Calls to the CIS are confidential and free. 

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

Internet 

NCI’s Web site provides information from numerous 

NCI sources. It offers current information about cancer 

prevention, screening, diagnosis, treatment, genetics, 

supportive care, and ongoing clinical trials. It has 

information about NCI’s research programs, funding 

opportunities, and cancer statistics. 

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

Spanish 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 contact form at 

http://www.cancer.gov/contact or send an email to 

cancergovstaff@mail.nih.gov. 

Also, information specialists provide live, 

online assistance through LiveHelp at 

http://www.cancer.gov/help. 

43
 
National Cancer Institute Publications 

NCI provides publications about cancer, including 

the booklets and fact sheets mentioned in this booklet. 

Many are available in both English and Spanish. 

You may order these publications by telephone, on 

the Internet, or by mail. You may also read them online 

and print your own copy. 

•	 By telephone: People in the United States and its 

territories may order these and other NCI 

publications by calling the NCI’s Cancer 

Information Service at 1–800–4–CANCER. 

•	 On the Internet: Many NCI publications may be 

viewed, downloaded, and ordered from 

http://www.cancer.gov/publications on the 

Internet. People in the United States and its 

territories may use this Web site to order printed 

copies. This Web site also explains how people 

outside the United States can mail or fax their 

requests for NCI booklets. 

•	 By mail: NCI publications may be ordered by 

writing to the address below: 

Publications Ordering Service
 

National Cancer Institute
 

P.O. Box 24128
 

Baltimore, MD 21227
 

Clinical Trials 

•	 Taking Part in Cancer Treatment Research Studies 

44
 
Finding a Doctor, Support Groups, or Other 

Organizations 

•	 How To Find a Doctor or Treatment Facility If You 

Have Cancer (also in Spanish) 

•	 Cancer Support Groups: Questions and Answers 

•	 National Organizations That Offer Services to 

People With Cancer and Their Families (also in 

Spanish) 

Cancer Treatment and Supportive Care 

•	 Radiation Therapy and You (also in Spanish) 

•	 Understanding Radiation Therapy: What To Know 

About External Beam Radiation Therapy (also in 

Spanish) 

•	 Understanding Radiation Therapy: What To Know 

About Brachytherapy (A Type of Internal Radiation 

Therapy) (also in Spanish) 

•	 Chemotherapy and You (also in Spanish) 

•	 Photodynamic Therapy for Cancer: Questions and 

Answers 

•	 Eating Hints for Cancer Patients (also in Spanish) 

•	 Pain Control (also in Spanish) 

Coping with Cancer 

•	 Taking Time: Support for People with Cancer 

•	 Managing Radiation Therapy Side Effects: What To 

Do When You Feel Weak or Tired (Fatigue) (also in 

Spanish) 

45
 
Life After Cancer Treatment 

•	 Facing Forward: Life After Cancer Treatment (also 

in Spanish) 

•	 Follow-up Care After Cancer Treatment: Questions 

and Answers 

•	 Facing Forward: Ways You Can Make a Difference 

in Cancer 

Advanced or Recurrent Cancer 

•	 Coping With Advanced Cancer 

•	 When Cancer Returns 

Complementary Medicine 

•	 Thinking about Complementary & Alternative 

Medicine: A guide for people with cancer 

•	 Complementary and Alternative Medicine in Cancer 

Treatment: Questions and Answers (also in Spanish) 

Caregivers 

•	 When Someone You Love Is Being Treated for 

Cancer: Support for Caregivers 

•	 When Someone You Love Has Advanced Cancer: 

Support for Caregivers 

•	 Facing Forward: When Someone You Love Has 

Completed Cancer Treatment 

•	 Caring for the Caregiver: Support for Cancer 

Caregivers 

46
 
The National Cancer Institute 

The National Cancer Institute (NCI), part of the 

National Institutes of Health, is the Federal 

Government’s principal agency for cancer research 

and training. NCI conducts and supports basic and 

clinical research to find better ways to prevent, 

diagnose, and treat cancer. The Institute also supports 

education and training for cancer research and 

treatment programs. In addition, NCI is responsible 

for communicating its research findings to the 

medical community and the public. 

Copyright permission 

You must have permission to use or reproduce the 

artwork in this booklet for other purposes. The 

artwork was created by private sector illustrators, 

designers, and/or photographers, and they retain the 

copyrights to artwork they develop under contract to 

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NIH Publication No. 08-1557
 

Revised September 2008
 

Printed September 2008