The esophagus is the long muscular tube that travels from the throat to the stomach. Its main purpose is to help move food through the body. Esophageal cancer affects this tube and can cause a wide variety of issues. Typically, the cancer begins in the cells that line the interior of the esophagus. As it progresses, it can damage the deeper tissues and muscles. Most cases of esophageal cancer have no symptoms until the disease has reached an advanced stage.
One of the most common symptoms of esophageal cancer is difficulty swallowing or dysphagia. People often feel as though food becomes stuck in their throat or chest, and they may even begin to choke. Early on, dysphagia is usually mild, though it will likely worsen as the cancer progresses because tumors grow within and along the esophagus, narrowing the passage.
Many people with esophageal cancer begin to lose weight inadvertently. This happens for a variety of reasons. Primarily, people eat less due to dysphagia. They may also change their diets to include fewer solid foods and more liquid items. Additionally, it is common for cancer to lead to decreased appetite. Interestingly, some people with esophageal cancer develop a metabolism increase. Studies suggest this is because tumor growth has a direct effect on energy expenditure.
Sometimes, people with esophageal cancer experience pain or discomfort at the center of the chest. Others feel pressure or a burning sensation. These sensations are not necessarily direct symptoms of esophageal cancer; they are usually fringe effects. Acid reflux, heartburn, or gastroesophageal reflux disease can all cause chest pain and are also symptoms of esophageal cancer. In some instances, a person with esophageal cancer has a sensory disorder that causes hypersensitivity of the esophagus. Additionally, some experts suggest chest pain is a physical manifestation of anxiety.
One of the stranger symptoms of esophageal cancer is frequent hiccups. These natural and involuntary contractions of the diaphragm usually occur following meals or certain beverages. However, when they happen frequently over a long period, they can signify a serious medical issue. Esophageal cancer can spread from the esophagus into the vagus or phrenic nerves that serve the diaphragm. As cancer worsens, the hiccups become more common.
Esophageal cancer can cause coughing and voice changes, most often hoarseness. The coughing occurs for several reasons, including damage caused by tumor growth. For some people, this may feel like a constant tickle that coughing may temporarily alleviate. For others, the damage is severe enough that they cough up mucus and even blood. Hoarseness usually occurs due to esophageal damage or when cancer spreads to the laryngeal nerves responsible for the larynx or voice box. Hoarseness can also develop after surgery for esophageal cancer due to irritation of the laryngeal nerves.
Individuals with esophageal cancer may expect the symptoms that occur in their throat but be less prepared for symptoms that present elsewhere. Notably, some people with the disease report black stools, caused by esophageal bleeding. The blood travels down the esophagus into the stomach and digestive tract. It eventually leaves the body with the waste, discoloring the stool. In some cases, blood loss is severe enough to cause anemia.
Occasionally, people with esophageal cancer develop pain that seems to ache from deep in the body. Usually, this is a sign that cancer has metastasized in the bones. The disease can also lead to hypercalcemia; this excess of calcium in the blood is drawn from the bones, which weakens them substantially, causing bone pain and other symptoms such as muscle weakness and depression.
Many people experience indigestion alongside esophageal cancer. The effects of the cancer combine to irritate the stomach and digestive tract, leading to digestive issues. For example, blood from the esophagus can irritate the stomach. Additionally, people who frequently experience acid reflux are more at risk of developing esophageal cancer, and the disease often substantially worsens symptoms of the former condition and makes it more painful.
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Though uncommon, back pain is a symptom of esophageal cancer. It most often occurs when tumors spread to the pericardium and the mediastinum. The pericardium sits around the heart, providing both protection and lubrication. It also connects the heart to the mediastinum, the central compartment that contains the organ. If cancer spreads to either of these structures, the pain can radiate laterally, presenting as back pain.
Fatigue is a common symptom of most cancers. Many of the effects of esophageal cancer take a huge toll on a person's life. An inability to swallow leads to poor nutrition, which results in fatigue. Add in the possible effects on the bones and other structures, and lethargy and exhaustion are easy to understand. Studies show individuals with esophageal cancer who have lower energy levels and greater fatigue have worse survival rates. It is unclear if this relationship is due to overall health or specific variations in the cancer.
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