Esophageal Cancer On the Rise
Barrett's Esophagus: More Serious Than Heartburn
Acid regurgitation from the stomach into the esophagus causes heartburn and
indigestion. Nearly everyone experiences this uncomfortable sensation at some
time in life. Surveys suggest that tens of millions of Americans feel reflux
symptoms at least once a week. Doctors call this "gastroesophageal reflux
disease," or GERD.
When acid reflux occurs frequently, though, the chronic irritation
(esophagitis) can cause problems:
- The cells at the bottom of the esophagus can change form in response to the
- The new abnormal cell pattern is called Barrett's esophagus.
- People with Barrett's esophagus have a 1 in 200 chance of developing
adenocarcinoma each year, far higher than the general population.
Is a rising rate of Barrett's esophagus causing the increase in the
adenocarcinoma form of esophageal cancer? No one can say, because we can't
accurately estimate how many people have Barrett's esophagus.
Barrett's esophagus is both common and elusive:
- Approximately five to eight percent of people with GERD also have Barrett's
- However, as many as 95 percent of people with Barrett's esophagus don't
know they have it.
- About one-quarter of people with Barrett's have no reflux symptoms.
- Although well-associated with adenocarcinoma, 90 percent of people with
Barrett's esophagus will never develop esophageal cancer.
A physician can only diagnose Barrett's esophagus through upper
endoscopy. While generally safe, this procedure requires sedation,
expense, and some risk.
According to the American College of Gastroenterology, "patients with
chronic GERD symptoms are those most likely to have Barrett's esophagus and
should undergo upper endoscopy."
Bains agrees: "Clearly a certain group with chronic reflux disease are at
higher risk," and should be screened with upper endoscopy.
However, the National Cancer Institute recommends against screening
asymptomatic people with endoscopy.
Esophageal Cancer Symptoms
Symptoms of esophageal cancer include:
- Difficulty or pain with swallowing
- Pain behind the breastbone
- Coughing (sometimes blood is seen in sputum produced by cough)
- Weight loss, which can be severe
- Frequent heartburn or indigestion
These symptoms should trigger an immediate call to your doctor, particularly
in someone with frequent reflux symptoms
Treatment for Esophageal Cancer
Doctors use a variety of approaches to cure or control esophageal
- Surgery (esophagectomy, or removal of the esophagus)
- Radiation therapy
- Photodynamic therapy (using a light-activated chemical to attack the
Most patients will undergo esophagectomy. This major surgery requires
opening the chest or abdomen. Further treatment depends on what physicians find
during the surgery.
Unfortunately, esophageal cancer usually spreads microscopically (called
metastasis) before patients feel any symptoms. Even after successful surgery,
these undetectable cancer deposits eventually grow larger and cause more
For this reason, many cancer centers use chemotherapy and radiation therapy
as well as surgery. These methods attempt to kill any cancer that has already
spread from the esophagus to the rest of the body.
To try to improve cure rates, the National Cancer Institute is recruiting
patients for clinical trials in esophageal cancer. You can find details at
www.cancer.gov or by calling (800) 4-CANCER.