December 17, 2014 | by Denise Heady
Too often, the symptoms of esophageal cancer are mistaken for those of more benign conditions. That's an easy mistake to make because many people do experience such symptoms every now and then, including trouble swallowing, hoarseness, coughing, frequent vomiting or hiccupping, even the more alarming chest pain or the feeling that food is getting struck in the throat.
Knowing whether such symptoms are caused by heartburn or esophageal cancer can be difficult. Here, Jae Kim, M.D., chief of the Division of Thoracic Surgery at City of Hope answers eight common questions about esophageal cancer and its treatment.
Can heartburn lead to esophageal cancer?
Heartburn is the most important risk factor for the most common type of esophageal cancer. Over time, gastroesophageal reflux disease can cause inflammation of the lining of the esophagus. If there is enough inflammation, the normal lining is replaced with an abnormal lining, called Barrett’s esophagus. In some cases, Barrett’s esophagus can then lead to esophageal cancer.
What are some other risk factors for esophageal cancer?
Aside from heartburn, the important risk factors are smoking, drinking alcohol, eating foods high in N-nitroso compounds (for example, smoked and cured meats) and obesity.
What are some of the symptoms of esophageal cancer?
The most important warning sign is difficulty swallowing or the sensation of food getting stuck on its way down. Commonly, it’s hard foods, like steak or dry bread. Other symptoms are weight loss, pain in the chest or hoarseness. Patients may also have some bleeding from the cancer, which usually manifests as mild anemia without any symptoms or as some dark stool.
How can someone control heartburn?
I recommend all patients try lifestyle modifications to help control heartburn. For patients who are overweight, losing weight is very effective in decreasing heartburn. Tobacco and alcohol cause relaxation of the sphincter muscle at the end of the esophagus, allowing acid and food to come up from the stomach.
Acid-suppressing medications, such as histamine 2 receptor antagonists (like famotidine and ranitidine), are relatively effective, but should be taken at least 30 minutes before a meal. Proton pump inhibitors (such as pantoprazole, omeprazole and lansoprazole) should be used for patients with frequent symptoms, signs of esophageal inflammation, or those patients whose symptoms are not controlled by the histamine antagonists. Various operations can also correct the weak sphincter muscle and are very effective, even for patients whose symptoms are not completely controlled by medications.
Are there certain foods people should stay away from if they tend to experience heartburn?
Alcohol and tobacco are the worse offenders, but caffeine, chocolate and carbonated beverages can also cause heartburn. For some people, spicy foods, fatty foods and peppermint can also cause heartburn.
Can people be screened for esophageal cancer?
Barrett’s esophagus can be found and treated before it becomes a cancer with a simple upper endoscopy, which is similar to a colonoscopy and can often be done in the same visit as a colonoscopy. Anyone with alarming symptoms, like food sticking on its way down, anemia, weight loss or blood in vomit should have an upper endoscopy. Patients who have symptoms despite a month of high dose anti-acid therapy, as well as men older than 50 who have had a history of reflux symptoms more than five years or who have had a previous abnormal upper endoscopy, should probably have an endoscopy.
Does taking omeprazole, which can prevent heartburn, decrease the odds of getting esophageal cancer?
There is not conclusive data that acid suppressing medications, such as omeprazole, can decrease the risk of esophageal cancer. There is probably some benefit for patients with inflammation and changes in the lining of the esophagus. However, none of the medications fix the underlying problem, which is mechanical. Stomach juices and food will still come back into the esophagus. The medication just makes those juices less acidic. The acidity plays some role in the development of cancer, but it’s not the only factor.
Does acid reflux in infants increase their risk of being diagnosed with esophageal cancer?
Gastroesophageal reflux is very common in healthy infants. Most children grow out of it by 18 months. Having reflux as an infant may increase the likelihood of developing heartburn as an adult. But most kids don’t require treatment for reflux once they’ve grown out of infancy.
Learn more about esophageal cancer treatment at City of Hope.
Learn more about becoming a patient or getting a second opinion at City of Hope by visiting our website or by calling 800-826-HOPE (4673). 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.