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== Childhood Esophageal Cancer Treatment (PDQ®)–Patient Version ==

=== General Information About Childhood Esophageal Cancer ===

'''KEY POINTS'''

*Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus.

*Having gastroesophageal reflux or Barrett esophagus may increase the risk of esophageal cancer.

*Signs and symptoms of esophageal cancer include trouble swallowing and weight loss.

*Tests that examine the esophagus are used to help diagnose esophageal cancer.

*Certain factors affect prognosis (chance of recovery).

'''Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus.'''

The esophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach. The wall of the esophagus is made up of several layers of tissue, including mucous membrane, muscle, and connective tissue. Most esophageal tumors in children begin in the thin, flat cells that line the inside of the esophagus (called squamous cell carcinoma of the esophagus) and spread outward through the other layers as it grows. Some esophageal tumors begin in the mucus-secreting glands of the esophagus (called adenocarcinoma of the esophagus).

Esophageal tumors may be benign (not cancer) or malignant (cancer).

[[File:428446-750.jpg|600px|thumb|center|The esophagus and stomach are part of the upper gastrointestinal (digestive) system.]]

'''Having gastroesophageal reflux or Barrett esophagus may increase the risk of esophageal cancer.'''

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your child's doctor if you think your child may be at risk.

Risk factors for esophageal cancer include the following:

*Having gastroesophageal reflux.

*Having Barrett esophagus.

*Swallowing chemicals, which may burn the esophagus.

'''Signs and symptoms of esophageal cancer include trouble swallowing and weight loss.'''

These and other signs and symptoms may be caused by esophageal cancer or by other conditions.

Check with your child's doctor if your child has any of the following:

*Trouble swallowing.

*Weight loss.

*Hoarseness and cough.

*Indigestion and heartburn.

*Vomiting with streaks of blood.

*Streaks of blood in sputum (mucus coughed up from the lungs).

'''Tests that examine the esophagus are used to help diagnose esophageal cancer.'''

The following tests and procedures may be used:

*'''Physical exam and health history:''' An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

*'''Chest x-ray:''' An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

*'''CT scan (CAT scan):''' A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

*'''PET scan (positron emission tomography scan):''' A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

[[File:775456-750.jpg|600px|thumb|center|Positron emission tomography (PET) scan. The child lies on a table that slides through the PET scanner. The head rest and white strap help the child lie still. A small amount of radioactive glucose (sugar) is injected into the child's vein, and a scanner makes a picture of where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells do.]]

*'''MRI (magnetic resonance imaging):''' A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the esophagus. This procedure is also called nuclear magnetic resonance imaging (NMRI).

*'''Ultrasound exam:''' A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.

*'''Barium swallow:''' A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.

*'''Esophagoscopy:''' A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope is inserted through the mouth or nose and down the throat into the esophagus. 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 samples, which are checked under a microscope for signs of cancer. A biopsy is usually done during an esophagoscopy. Sometimes a biopsy shows changes in the esophagus that are not cancer but may lead to cancer.

*'''Bronchoscopy:''' A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

*'''Thoracoscopy:''' A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. Sometimes this procedure is used to remove part of the esophagus or lung.

'''Certain factors affect prognosis (chance of recovery).'''

Prognosis depends on the following:

*The type of esophageal cancer (squamous cell or adenocarcinoma).

*Whether the cancer was completely removed by surgery.

*Whether the cancer has just been diagnosed or has recurred (come back).

Esophageal cancer is hard to cure because it usually cannot be completely removed by surgery.

=== Stages of Childhood Esophageal Cancer ===

'''KEY POINTS'''

*There is no standard staging system for childhood esophageal cancer.

*There are three ways that cancer spreads in the body.

*Cancer may spread from where it began to other parts of the body.

'''There is no standard staging system for childhood esophageal cancer.'''

The process used to find out if cancer has spread from the esophagus to nearby areas or to other parts of the body is called staging. There is no standard system for staging childhood esophageal cancer. The results of tests and procedures done to diagnose esophageal cancer are used to help make decisions about treatment.

Sometimes esophageal cancer recurs (comes back) after treatment. The cancer may come back in the esophagus or in other parts of the body after it has been treated.

'''There are three ways that cancer spreads in the body.'''

Cancer can spread through tissue, the lymph system, and the blood:

*Tissue. The cancer spreads from where it began by growing into nearby areas.

*Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.

*Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

'''Cancer may spread from where it began to other parts of the body.'''

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

*Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.

*Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if esophageal cancer spreads to the lung, the cancer cells in the lung are actually esophageal cancer cells. The disease is metastatic esophageal cancer, not lung cancer.

=== Treatment Option Overview ===

'''KEY POINTS'''

*There are different types of treatment for children with esophageal cancer.
*Children with esophageal cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.

*Three types of standard treatment are used:

:*Surgery

:*Radiation therapy

:*Chemotherapy

*New types of treatment are being tested in clinical trials.

:*Targeted therapy

*Treatment for childhood esophageal cancer may cause side effects.

*Patients may want to think about taking part in a clinical trial.

*Patients can enter clinical trials before, during, or after starting their cancer treatment.

*Follow-up tests may be needed.

'''There are different types of treatment for children with esophageal cancer.'''

Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

'''Children with esophageal cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.'''

Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health professionals who are experts in treating children with cancer and who specialize in certain areas of medicine. This may include the following specialists and others:

*Pediatrician.

*Pediatric surgeon.

*Radiation oncologist.

*Pathologist.

*Pediatric nurse specialist.

*Social worker.

*Rehabilitation specialist.

*Psychologist.

*Child-life specialist.

'''Three types of standard treatment are used:'''

'''Surgery'''

Surgery to remove as much of the tumor as possible is done.

'''Radiation therapy'''

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. In esophageal cancer, a plastic or metal tube is passed through the mouth and into the esophagus. A machine that is outside the body has a special tool that is placed in the tube to send radiation toward the cancer.

'''Chemotherapy'''

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).

'''New types of treatment are being tested in clinical trials.'''

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

'''Targeted therapy'''

Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.

Targeted therapy is being studied for the treatment of childhood esophageal cancer that has recurred (come back).

'''Treatment for childhood esophageal cancer may cause side effects.'''

For information about side effects that begin during treatment for cancer, see our Side Effects page.

Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include:

*Physical problems, such as narrowing of the esophagus.

*Changes in mood, feelings, thinking, learning, or memory.

*Second cancers (new types of cancer) or other conditions.

Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.

'''Patients may want to think about taking part in a clinical trial.'''

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

'''Patients can enter clinical trials before, during, or after starting their cancer treatment.'''

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

'''Follow-up tests may be needed.'''

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

=== Treatment of Childhood Esophageal Cancer ===

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of newly diagnosed esophageal cancer in children may include the following:

*Surgery to remove all or part of the tumor.

*Radiation therapy given through a plastic or metal tube placed through the mouth into the esophagus.

*Chemotherapy.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

=== Treatment of Recurrent Childhood Esophageal Cancer ===

For information about the treatment listed below, see the Treatment Option Overview section.

Treatment of recurrent esophageal cancer in children may include the following:

*A clinical trial that checks a sample of the patient's tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

=== To Learn More About Childhood Esophageal Cancer ===

For more information from the National Cancer Institute about esophageal cancer, see the following:

*Esophageal Cancer Home Page

*Computed Tomography (CT) Scans and Cancer

*Targeted Cancer Therapies

*Nutrition in Cancer Care

For more childhood cancer information and other general cancer resources, see the following:

*About Cancer

*Childhood Cancers

*CureSearch for Children's CancerExit Disclaimer

*Late Effects of Treatment for Childhood Cancer

*Adolescents and Young Adults with Cancer

*Children with Cancer: A Guide for Parents

*Cancer in Children and Adolescents

*Staging

*Coping with Cancer

*Questions to Ask Your Doctor about Cancer

*For Survivors and Caregivers

=== About This PDQ Summary ===

'''About PDQ'''

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

'''Purpose of This Summary'''

This PDQ cancer information summary has current information about the treatment of childhood esophageal cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

'''Reviewers and Updates'''

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.

'''Clinical Trial Information'''

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

'''Permission to Use This Summary'''

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

The best way to cite this PDQ summary is:

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

'''Disclaimer'''

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

'''Contact Us'''

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

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