May 11, 2015 | by Sayeh Hirmand
Esophagheal cancer may not be on many people’s radar, but heartburn probably is. The latter can ultimately lead to the former.
More formally referred to as gastroesophageal reflux, heartburn occurs when stomach content makes its way back up into the esophagus, causing stomach acid to come into contact with the lining of the esophagus.
Many people experience heartburn every now and then, but for some people – especially those who are overweight, pregnant, taking certain medications or regularly exposed to smoke – the condition becomes a regular, even chronic, occurrence. Then, the condition becomes known as gastroesophageal reflux disease (GERD). That's the condition that can begin a progressive inflammation that ultimately becomes cancer.
GERD affects 20 percent of the U.S. population, experts say, with many experiencing symptoms on a weekly or daily basis. Although the most common symptom is the familiar heartburn feeling of pain or burning in the middle of the chest, not all people with the condition have heartburn. Other GERD symptoms include nausea, difficulty swallowing, vomiting, respiratory problems and bad breath.
Disruptive as GERD is, over time it can lead to a more severe condition known as Barrett’s esophagus, in which an abnormal lining – resembling the lining of the small intestine – replaces the normal lining of the esophagus.
Left untreated, Barrett's esophagus can lead to esophageal cancer. This year alone, experts predict almost 17,000 new cases of esophageal cancer will be diagnosed and nearly 16,000 people will die of the disease.
It’s time to educate ourselves about this quiet but deadly disease – and how to screen for it. Detecting Barrett's esophagus is key.
To detect Barrett’s esophagus, doctors perform a procedure called an upper endoscopy, in which a tiny camera is inserted into the esophagus via a long flexible tube. Doctors use the camera to look for changes in the esophageal lining, taking biopsies to confirm the diagnosis.
“Once the diagnosis of Barrett’s is established, what we want to know is if there’s any dysplasia," said James Lin, M.D., an assistant clinical professor of gastroenterology at City of Hope, referring to the presence of abnormal precancerous cells. "If there’s no dysplasia, then the recommendation is to repeat upper endoscopy every three to five years for checkup. If there is low-grade dysplasia, it already has some precancerous changes. My recommendation is to have a follow-up endoscopy in six to 12 months. With high-grade dysplasia, treatment is usually the norm.”
When it comes to treatment, patients with high-grade dysplasia have a new option: radiofrequency ablation.
“Radiofrequency ablation treatment is essentially a thermal-type ablation of the tissue. We destroy the Barrett’s esophagus and allow it to heal. This way, the patient has a new squamous lining,” Lin said. For patients with low-grade and nondysplasia, treatment includes “aggressive control of the reflux symptoms."
For patients with Barrett's esophagus, or at risk of the condition, Lin also recommends changes in behavior and lifestyle. “Certain foods can actually cause worsening of the reflux, such as coffee, tea, chocolate, alcohol and fatty foods," he said.
As with most cancers, early diagnosis and treatment are vital. If you suspect that you or a loved one may have an elevated risk of esophageal cancer, talk to your doctor about the potential need for screening.
April is Esophageal Cancer Awareness Month. Find about more about esophageal cancer treatment and research at City of Hope.
Learn more about becoming a patient or getting a second opinion by visiting our website or by calling 800-826-HOPE (4673). You may also request a new patient appointment online. City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.