Esophageal Cancer: Signs and Symptoms

Trouble swallowing is the symptom doctors see most with esophageal cancer. It's often the symptom that leads to a diagnosis.

But there's a problem. Swallowing tends to change only once the passage has narrowed, so this symptom often appears later rather than early. That is a pattern across the group of people diagnosed, not a reading of any one person's stage. Only tests can say how far a cancer has gone.

About 22,530 people in the U.S. get this diagnosis each year. Most are 55 or older. It's about three times more common in men than women.

Doctors call trouble swallowing "dysphagia." It's the top symptom of esophageal cancer.

It often starts small. Solid food — meat or bread — feels stuck. It moves slowly going down. You might start eating slower. You might chew more. You might switch to softer foods. At first, this may not feel serious.

As the tumor grows, the esophagus narrows more. Solid foods get harder to swallow. Later, even liquids can be hard to get down. This pattern — solids first, then liquids — is a real warning sign. Tell your doctor if this happens to you.

Weight loss is common. It's often not on purpose. It can be a lot of weight.

Weight loss ties closely to swallowing trouble. If swallowing hurts, you eat less. Eating less means losing weight. The cancer itself can also change your appetite.

Other symptoms can show up too, before or along with swallowing trouble:

• Pain behind the breastbone. It can feel like burning or pressure.
• A hoarse voice or a cough that won't quit. This can happen if the tumor presses on nearby nerves.
• Heartburn or indigestion. This might be long-standing reflux, or something new.
• A lump you can feel, often in the neck or above the collarbone. Lumps have many causes; a swollen lymph node is one of them, and it needs looking at rather than guessing about.

Each of these symptoms has many other, harmless causes. Plain heartburn, a cold, or a strained muscle can all cause these too. What matters more is the pattern — especially swallowing trouble that keeps getting worse.

Early esophageal cancer often causes nothing at all. Swallowing usually stays comfortable until the passage is narrowed, and reflux or indigestion is easy to put down to something else. That is one reason this cancer is often found later than people expect, and the reason a swallowing change that keeps returning is worth reporting instead of adapting to.

Risk is not the same for both main types of this cancer. Long-standing reflux and Barrett's esophagus are linked mainly to adenocarcinoma, the type that forms low down near the stomach. Heavy smoking and heavy drinking weigh more on squamous cell carcinoma, which forms higher up. If any of that describes you, new swallowing trouble needs a prompt check. Don't assume it's just worse reflux.

If you have Barrett's esophagus, you likely already get regular endoscopy exams. But report new symptoms right away. Don't wait for your next scheduled exam.

Call a doctor right away for new or worsening trouble swallowing. Get it checked within days, not weeks. This matters even more if solids are getting harder to swallow, or if liquids are too. It matters even more if you're also losing weight without trying. Don't just try to manage it by eating carefully.

A hoarse voice or cough that won't go away needs prompt attention too. So does new chest pain that doesn't have a clear cause. Don't wait to see if these go away on their own.

• National Cancer Institute — Esophageal Cancer Symptoms.
• American Cancer Society — Risk Factors for Esophageal Cancer.
• American Cancer Society — Key Statistics for Esophageal Cancer.