In 2014 there were approximately 18,170 new cases of esophageal cancer in the United States. Nearly 60% of these cases were of a type of esophageal cancer that has been on the rise in this country since the 1970s. The medical term for this type of cancer is esophageal adenocarcinoma (EAC). Although uncommon compared to other types of cancer in the U.S., such as colon, lung, prostate, and breast cancers, EAC is a highly lethal cancer associated with a poor 5-year survival, which is often less than one year in cases of advanced disease.
The only known risk factor for development of EAC is a condition known as Barrett Esophagus, which is associated with gastroesophageal reflux disease (commonly known as “acid reflux”). How does the stomach acid get into the esophagus? The esophagus is a tubular organ that connects the mouth to the stomach. There is a circular band of muscle around the bottom of the esophagus, and when you swallow, this muscle relaxes to allow food and liquid to flow into your stomach. Then, normally the muscle closes again, preventing stomach contents from entering the esophagus. If the muscle relaxes abnormally or is weak, stomach acid can flow back up into your esophagus. This constant backwash of acid irritates the esophagus lining, often causing it to become inflamed. When the esophagus is repeatedly exposed to stomach acid, a reaction occurs in the cells that line the esophagus to protect it from the acid.
Factors that are associated with acid reflux include:
- Male gender
- Caucasian race
- Age over 50
- Hiatal hernia (bulging of the top of the stomach into or through the diaphragm)
- Connective tissue disorders, such as scleroderma
- Delayed stomach emptying
Factors that can aggravate acid reflux include:
- Eating large meals or eating late at night
- Eating certain foods (triggers), such as fatty or fried foods
- Drinking certain beverages, such as alcohol or coffee
- Taking certain medications, such as aspirin
Symptoms of acid reflux include:
- An acid taste in your mouth
- Chronic cough
- Difficulty swallowing food
- Chest pain
When Barrett Esophagus develops from acid reflux, the lining of the esophagus is replaced by a lining similar to that seen in the intestines. Barrett esophagus is seen in 10% to 15% of people who have long-term acid reflux. A small percentage of these people develop a precancerous change (called ‘dysplasia’) in the cells that line the esophagus. If these precancerous changes are discovered early enough, they can be stopped, thus preventing development of EAC. Advances in therapy, such as endoscopic eradication therapy (EET), allow a minimally invasive treatment approach that avoids the hazards of surgically removing the esophagus. EET has been shown to be effective and safe in achieving complete eradication of Barrett Esophagus and dysplasia, and preventing progression to EAC.
Why is EAC so lethal? Unfortunately, the microscopic changes of Barrett Esophagus, along with the precancerous changes, and even early cancerous changes do not cause any symptoms in most cases. Sadly, by the time the first symptoms of EAC are noticeable to the patient, the cancer is often advanced, and may have already invaded into the deeper tissue surrounding the esophagus, or spread to other organs where it is much more difficult to treat.
If you have had trouble with heartburn and acid reflux for more than five years, ask your doctor about your risk for Barrett Esophagus and about an examination by a gastroenterologist using an endoscope to visualize the esophagus, and biopsy of any abnormal area. If you are diagnosed with Barrett Esophagus, your gastroenterologist should examine your esophagus every three to five years. If you have precancerous changes in Barrett Esophagus, you will need more frequent surveillance by your gastroenterologist, generally every one to two years. You should seek immediate help if you have chest pain, which may also be a symptom of a heart attack, if you have difficulty swallowing, if you are vomiting blood, coffee ground material, or if you are passing black, tarry, or bloody stools.