The Dangers of Esophageal Cancer

April is Esophageal Cancer Awareness Month. To raise awareness about the disease, here are a few prevention strategies and early detection methods.

Esophagus

The esophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach. The wall of the esophagus is made up of several layers of tissue, including mucous membrane (inner lining), muscle, and connective tissue.

Esophageal Cancer

Esophageal cancer is a highly aggressive form of cancer that originates in the inner lining of the esophagus and grows outward. There are two main types of esophageal cancer: adenocarcinoma and squamous cell carcinoma. In the US, it is estimated that over 19,000 people were diagnosed with esophageal cancer in 2021, and it claimed over 15,000 lives, highlighting the need for early detection and effective treatment options.

Symptoms of Esophageal Cancer

The most common way esophageal cancer is diagnosed is through investigating patients with alarm symptoms, including difficulty or painful swallowing, recurrent vomiting, unexplained weight loss, anemia, loss of appetite, or gastrointestinal bleeding, which are often associated with advanced adenocarcinoma. In fact, about 93% of diagnoses are made this way.

Risk Factors for Esophageal Cancer

Risk factors vary by type and geographic location. Major risk factors for esophageal cancer in the US include:

• Gender: Men are more likely to develop esophageal cancer.
• Race: White men have an increased risk of adenocarcinoma. Black men have a higher risk of squamous cell cancer.
• Age 50 or over
• Obesity
• Tobacco use
• Excessive alcohol use
• Gastroesophageal reflux disease (GERD)
• Barrett’s esophagus
• Family history of esophageal cancer or Barrett’s esophagus
• Other risk factors include drinking very hot liquids, caustic injury to the esophagus, achalasia of the esophagus, HPV infection, etc.

Gastroesophageal Reflux Disease (GERD):

Gastroesophageal reflux disease (GERD) is a condition where stomach contents go back up into the esophagus, which can cause irritation to the lining. The most common symptoms are heartburn (a burning feeling in the chest) and regurgitation (when acid and undigested food go back up into your throat or mouth).

People with GERD have a 5 to 7 times greater chance of developing esophageal adenocarcinoma, and 60% of those with this cancer have a history of GERD. However, most people with GERD do not develop esophageal cancer, and it can be difficult to predict who will.

Barrett’s Esophagus

Having gastroesophageal reflux disease for several years may result in a change in the lining of the esophagus, called Barrett’s esophagus. This condition increases the risk of developing esophageal cancer by at least 30 times, but the actual risk of developing cancer in people with Barrett’s esophagus is still low.

Preventing Esophageal Cancer

• Stay away from risk factors like smoking, heavy drinking, and being overweight.
• Eat a diet rich in fiber, beta-carotene, folate, and vitamins C and B6
• If you have Barrett’s esophagus, talk to your gastroenterologist about getting a procedure called ablation to remove abnormal cells. Ablation may not be appropriate for everyone. Your gastroenterologist can help you determine if this procedure is right for you.
• Using anti-inflammatory drugs might help lower the risk of esophageal cancer, but they can also have harmful side effects.
• Taking antacids or acid suppressants can improve your quality of life if you have acid reflux, but it’s not clear if they can prevent esophageal cancer.

Screening for Esophageal Cancer

Esophageal cancer often doesn’t show symptoms in its early stages, making it hard to detect. However, screening tests are available to detect Barrett’s esophagus and cancer earlier in people at high risk. A diagnosis of very early or early esophageal cancer may result in better survival rates and a better quality of life before and after treatment.

Esophagogastroduodenoscopy (EGD) is the most common test, which involves passing a small camera through the mouth down the throat into the esophagus to look for abnormalities. Other tests like a biopsy, brush cytology, and chromoendoscopy may also be performed at the time of EGD for the detection of Barrett’s esophagus or esophageal cancer.

Balloon cytology and fluorescence spectroscopy are newer tests that can also help detect early signs of cancer.

Not everyone with risk factors needs to undergo screening, but it should be discussed with a healthcare professional based on individual risk factors and preferences.

When to Consider Screening

According to recent guidelines, there isn’t enough evidence to recommend regular screening for esophageal cancer. However, if you have a family history of esophageal cancer or Barrett’s esophagus, or if you have acid reflux disease and at least one other risk factor, your doctor may suggest screening with an endoscopy. It’s important to talk to your doctor about your individual risk factors and screening options.