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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 acid irritation.
  • 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 esophagus.
  • 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)
  • Hoarseness
  • 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 cancer:

  • Surgery (esophagectomy, or removal of the esophagus)
  • Chemotherapy
  • Radiation therapy
  • Photodynamic therapy (using a light-activated chemical to attack the cancer)

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 problems.

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.

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