Esophageal Cancer and GERD

Esophageal Cancer and Acid Reflux

How Are Esophageal Cancer and Acid Reflux Related?

Acid reflux, also called heartburn, is the burning sensation you might feel in your chest or throat after you eat certain foods. Most people have probably experienced acid reflux at least once in their lives. However, if you experience chronic acid reflux — or acid reflux that occurs two or more times per week — you may be at risk of developing esophageal cancer.

The esophagus is the long tube that carries food from your throat down to your stomach. When you experience acid reflux, acid from your stomach comes up into your esophagus. Over time, this can damage your esophageal tissue and increase your risk of developing cancer in your esophagus. There are two main types of esophageal cancer: adenocarcinoma and squamous cell. Acid reflux disease slightly increases your risk of developing adenocarcinoma.

How Does Acid Reflux Lead to Esophageal Cancer?

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Acid reflux causes stomach acid to splash up and into the lower portion of your esophagus. While your stomach has a lining that protects it from the acid, your esophagus doesn’t. This means that the acid can cause damage to the tissue cells in your esophagus. Doctors aren’t sure why, but people who experience frequent acid reflux are at a slightly increased risk for esophageal cancer.

Sometimes the tissue damage from acid reflux can lead to a precancerous condition called Barrett’s esophagus. This condition causes the tissue in your esophagus to be replaced with tissue similar to what is found in the intestinal lining. Sometimes these cells develop into precancerous cells.

Even though Barrett’s esophagus is associated with a higher risk of esophageal cancer, the vast majority of people who have this condition will never develop esophageal cancer. However, people who have both GERD and Barrett’s esophagus are more likely to develop esophageal cancer than people who only have GERD.

What Are the Symptoms of Esophageal Cancer?

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The most common symptom of esophageal cancer is difficulty swallowing, which is also known as dysphasia. This difficulty tends to worsen as the tumor grows and obstructs more of the esophagus. Some people also experience pain when they swallow, typically when the lump of food, or bolus, passes the tumor.

Difficulty swallowing can also lead to unintentional weight loss. This is primarily because it is harder to eat, but some people also notice a decrease in appetite or an increase in metabolism because of the cancer.

Other possible symptoms of esophageal cancer include:

  • hoarseness
  • chronic cough
  • bleeding in the esophagus
  • an increase in indigestion or heartburn

Esophageal cancer usually does not cause any symptoms in its early stages. Typically, people only notice symptoms once the cancer has reached a more advanced stage. This is why it is important to talk to your doctor about esophageal cancer screening if you are at a higher risk of developing it.

What Are the Risk Factors for Esophageal Cancer?

Risk Factors

In addition to chronic acid reflux and Barrett’s esophagus, there are several other known risk factors for esophageal cancer.

  • Gender: Men are three times more likely than women to be diagnosed with esophageal cancer.
  • Age: Esophageal cancer is most common among people over the age of 55.
  • Tobacco: The use of tobacco products, including cigarettes, cigars, and chewing tobacco, increases the risk of esophageal cancer.
  • Alcohol: Drinking alcohol increases the risk of esophageal cancer, especially in combination with smoking.
  • Obesity: People who are very overweight or obese have a higher risk of esophageal cancer, partly because of the fact that they are more likely to experience chronic acid reflux.
  • Diet: Eating more fruits and vegetables has been shown to lower the risk of esophageal cancer, while some studies have linked eating processed meats to a higher risk. Overeating is also a risk factor.
  • Radiation: Previous radiation treatment to the chest or upper abdomen can increase your risk.

How Is Esophageal Cancer Diagnosed?

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If you have symptoms that could be caused by esophageal cancer, your doctor will do a physical exam and ask you about your medical history. If they still suspect esophageal cancer, you will likely undergo some tests.

This is likely to include an endoscopy, a test in which your doctor inserts a long, snake-like tube with a camera attachment down your throat to examine the esophageal tissue. Your doctor may take a biopsy of the tissue to send to a laboratory.

A barium swallow is another test your doctor might use to determine whether you have esophageal cancer. For a barium swallow, you will be asked to drink a chalky liquid that will line your esophagus. Your doctor will then take an X-ray of your esophagus.

If your doctor does find cancerous tissue, they may also want to do a computed tomography (CT) scan in order to see if the cancer has spread anywhere else in the body.

How Is Esophageal Cancer Treated?

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The main treatments for esophageal cancer are surgery, radiation, and chemotherapy, or a combination thereof. The treatment you receive will depend in part on the stage of your cancer.

Surgery

In early stages of cancer, your surgeon can remove the tumor completely. This sometimes can be done using an endoscope.

If the cancer has spread to deeper tissue layers, it may be necessary to remove the cancerous portion of your esophagus and reattach the remaining portions. In more serious cases, your surgeon may also remove the upper portion of your stomach.

Radiation

Radiation therapy is the use of high-energy beams to kill cancer cells. Radiation can either be directed at the cancerous area from outside of your body, or it can be administered from within your body.

Radiation can be used before or after surgery and is most commonly used in combination with chemotherapy among people with esophageal cancer.

Chemotherapy

Chemotherapy is the use of drug treatment to kill cancer cells. This is often administered either before or after surgery, or in combination with radiation.

You and your doctor will determine what treatment plan is best for you. You will likely be referred to a specialist to coordinate your treatment. This could be a gastroenterologist, a thoracic surgeon, a radiation oncologist, or a medical oncologist.

No matter what treatment you choose, you will also need to focus on controlling your acid reflux. This will likely include changes in your eating habits, or staying upright for a few hours after eating.

What is the Outlook for Someone with Acid Reflux and Esophageal Cancer?

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Your outlook will depend on the stage of your cancer. Because of the fact that esophageal cancer is typically diagnosed at a relatively late stage, it tends to have a relatively poor outlook.

According to the National Cancer Institute, the 5-year survival rate for localized esophageal cancer (cancer that has not spread to other parts of the body) is 40 percent. For regional esophageal cancer (cancer that has spread to nearby parts of the body, such as lymph nodes), the 5-year survival rate is 21 percent. For distant esophageal cancer (cancer that has spread to faraway parts of the body), the 5-year survival rate is 4 percent.

It is important to remember that these figures cannot help to predict the outcomes for any one patient. Your prognosis will depend on a number of factors, including your treatment, your cancer’s response to the treatment, and your overall health.

Is There a Way to Prevent Esophageal Cancer If You Have Chronic Acid Reflux?

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Controlling your acid reflux is the best way to reduce your risk of esophageal cancer. Talk to your doctor to try to figure out what steps you should take. These may include:

  • losing weight
  • not lying down after eating (lying down flat makes it easier for stomach contents to back up into the esophagus)
  • sleeping propped up so your head and chest are above your stomach
  • taking an antacid
  • quitting smoking
  • drinking alcohol only in moderation
  • eating more fruits and vegetables

If you have Barrett’s esophagus and GERD, you’re at a higher risk for developing esophageal cancer than people who only have GERD. People with both of these conditions should see their doctors for regular checkups, and report any concerning symptoms that develop. 

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