Esophageal Cancer

Symptoms such as heartburn and acid reflux are common in most cases of gastroesophageal reflux disease (GERD). However, chronic acid reflux can result in long-term complications and serious health problems if left untreated. One such problem is increased risk for developing esophageal cancer.

According to the University of Michigan Health System (UMHS), esophageal cancer is often considered a “silent cancer.” This is because its symptoms are sometimes overlooked or mistaken for other conditions. As a result, the prognosis is often life-threatening.

There are two common types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma usually occurs in the upper and middle parts of the esophagus. Adenocarcinoma affects the cells in the lower portion of the esophagus, near the stomach. Adenocarcinoma can’t begin unless acid reflux deforms the squamous cells, according to the MetroHealth System in affiliation with Case Western University School of Medicine.

Causes

Columbia University identifies GERD as one of the primary risk factors for esophageal cancer amongst smokers and those with heavy alcohol use. Mark B. Orringer, professor and head of thoracic surgery at the UMHS, reports a dramatic change in the last few decades in the type of patient who develops esophageal cancer.

While this type of cancer primarily affected heavy smokers and drinkers with squamous cell carcinoma, Orringer documented a 350 percent increase of adenocarcinoma alongside the climbing obesity rate. Orringer attributes this connection to GERD, as one of the primary causes of reflux is excessive weight.

But how does acid reflux lead to cancer? The Cleveland Clinic explains that repeated reflux causes prolonged irritation of the lower part of the esophagus. This continuous exposure to stomach acid can lead to changes in cells lining the esophagus. In turn, this can cause the pre-cancerous condition called “Barrett’s esophagus.” According to Ohio State University Medical Center (OSUMC), Barrett’s esophagus is estimated to affect approximately 700,000 adults in the United States.

Normally, the tissue lining the esophagus is similar to the lining in your mouth. However, in Barrett’s esophagus, the body replaces the normal esophageal lining with one similar to that found in the intestines. While OSUMC notes that Barrett’s esophagus may not cause symptoms itself, the resulting abnormal cells may progress to cancer. In fact, between 2 and 15 percent of those with Barrett’s esophagus develop esophageal cancer.

Symptoms

Esophageal cancer often shows no symptoms until it reaches a more advanced stage. However, some of the primary signs and symptoms include:

  • trouble swallowing
  • chest pain
  • decreased appetite
  • weight loss
  • constant cough or hoarseness
  • hiccups
  • pneumonia
  • bone pain
  • esophageal bleeding, resulting in black stool

The American Cancer Society emphasizes that the presence of one or more of these symptoms doesn’t mean that you have esophageal cancer. Many of these signs are likely to be caused by other, less serious conditions. However, if you notice these symptoms—especially trouble swallowing—it’s important to have them checked by a doctor as soon as possible.

Prevention and Treatment

You can help prevent the possibility of developing esophageal cancer by addressing seemingly harmless symptoms like heartburn. Harvard Medical School recommends these tips to manage GERD:

  • Maintain a healthy weight. If your doctor determines that you need to lose weight, make that a priority. Being overweight or obese can lead to reflux, which increases your chance of developing esophageal cancer. Sticking to a low-fat diet and exercising regularly can help you lose weight.
  • Avoid lying down after eating. When you have acid reflux, the valve between your stomach and esophagus malfunctions, which causes your stomach’s contents to back up into your esophagus. Wait a few hours after eating before lying down to give your stomach sufficient time to empty and help prevent acid reflux.
  • Elevate the head of your bed. Lying down flat can exacerbate acid reflux. One way to counteract this is to use four to six-inch blocks or bricks under the bedposts at the head of your bed, so that you elevate the bed several inches above the floor. Alternatively, you can try using a wedge-shaped pillow to elevate your head and upper chest while in bed. Wedge pillows are available in many maternity stores.

The National Cancer Institute (NCI) notes that primary treatments for esophageal cancer include surgery or chemotherapy with radiation therapy. Researchers are currently evaluating the effectiveness of other types of treatment combination—for example, chemotherapy plus surgery, or chemotherapy and radiation therapy plus surgery.

According to The Merck Manual, the pre-cancerous condition, Barrett’s esophagus, doesn’t disappear even when treatment relieves more general GERD symptoms. Even if your acid reflux symptoms are under control, you could still be at risk for developing cancer.

Your doctor may ask you to undergo a diagnostic procedure called an endoscopic examination every two to three years if you’re diagnosed with Barrett’s esophagus. This is to ensure that the condition isn’t progressing to esophageal cancer.

Visit your doctor early and often if you have a history of severe heartburn or acid indigestion. Discuss the possibility of screening for Barrett’s esophagus, as your risk of developing cancer is higher if you have this pre-cancerous condition. Esophageal cancer is curable—but early diagnosis is critical.