Until recently, cancer of the esophagus was relatively uncommon in the U.S., accounting for about 15,000 new cases of cancer per year. Now, the incidence of one type of esophageal cancer is on the rise.
What Is Esophageal Cancer?
The esophagus is a tube in your chest that moves food from your mouth to your stomach. It’s about 10 inches long and very muscular. Esophageal cancer starts in the inner most layer of the esophagus and spreads outward.
There are two main types of esophageal cancer: adenocarcinoma and squamous cell carcinoma, says Dr. Luis Herrera, medical director of the Rod Taylor Thoracic Care Center at UF Health Cancer Center — Orlando Health. Each develops in a different type of cell. Worldwide, squamous cell carcinomas are more common. However, in the U.S., adenocarcinomas (which develop in mucous-forming cells) are starting to become the predominant cancer type, Herrera says. “Adenocarcinomas were rare in the ’70s and ’80s. The incidence has increased 500 to 600 percent over the past few decades.”
Squamous cell carcinomas are heavily associated with smoking and alcohol, says Dr. Muhammad Beg, a medical oncologist at UT Southwestern Medical Center’s Simmons Cancer Center. Over the last couple decades, smoking and alcohol consumption rates have declined, and so has the incidence of squamous cell carcinomas.
However, this decline is offset by an even greater rate of increase of adenocarcinomas, which are associated with obesity and reflux disease. “It’s one of the few cancers with a rising incidence,” Beg says. Esophageal cancers in the upper third of the esophagus are equally split between squamous cell cancers and adenocarcinomas, while cancers lower in the esophagus are almost exclusively adenocarcinomas, he says.
[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]
Risk Factors for Esophageal Cancers
The biggest risk factors for esophageal cancer are smoking, drinking alcohol, obesity and gastroesophageal reflux disease, a chronic digestive condition. You likely recognize GERD by its more common name: heartburn (or acid indigestion). When acid from your stomach backs up into your esophagus, it causes a burning sensation in your chest. We all experience occasional bouts of reflux, but when it persists over time, it can irritate the lining of the esophagus and raise your risk for esophageal cancer.
GERD can also lead to Barrett’s esophagus, Herrera says, which is an abnormal tissue condition in the lower portion of the esophagus. “People with GERD and Barrett’s esophagus have a much higher risk of esophageal adenocarcinoma,” Herrera says. These individuals should be monitored closely for esophageal cancer with biopsies and routine endoscopy (a procedure in which your doctor inserts a scope down your throat).
Diagnosing Esophageal Cancer
Sometimes, Herrera says, doctors diagnose Barrett’s esophagus or esophageal cancer when a patient is having an endoscopy for another reason. However, the most common way it’s diagnosed is because the patient has difficulty swallowing and seeks medical attention.
Food becomes progressively stuck in your throat, Beg says. “It’s hard to swallow meat, then bread, then soup, then water. The food is not going through.” You may also lose weight, have chest or abdominal pain, or vomit and cough up undigested food.
“By then, you typically have a larger tumor blocking your esophagus,” Herrera says.” Eighty-five percent of esophageal cancers are diagnosed at stages 3 or 4 [advanced disease].”
An endoscope, or an endoscope with ultrasound, can help your oncologist determine how many layers of the esophagus wall the tumor has invaded and if lymph nodes are involved. This information helps plan treatment, Herrera says.
[See: 7 Innovations in Cancer Therapy.]
Treating Esophageal Cancer
In very early stage disease, Beg says it may be possible to scrape out the cancer using an endoscopic procedure. With stage 2 or stage 3 esophageal cancer, the treatment can be intensive and includes surgery with radiation therapy. If you have to have your esophagus removed, your surgeon will pull up the end of your stomach and connect it to the bottom of your throat. “Patients have to readjust to their new anatomy and learn how to eat again,” Beg says. This may involve eating smaller, more frequent meals and undergoing rehabilitation to re-learn how to swallow.
As a temporary measure, Beg says, doctors can “Roto-Rooter” through the tumor in the esophagus to keep the tube open while you undergo chemotherapy or radiation treatment. This may also be appropriate for patients who aren’t a good candidate for surgery. A PEG feeding tube from the abdomen into the stomach allows you to bypass the blockage in your esophagus. “You can get calories and nutrition [with a PEG tube], but you can’t swallow and taste food,” he says. “It negatively affects patients’ quality of life.”
Herrera says patients with early-stage disease (stage 1) have a 90 to 95 percent chance of being cured. In contrast, patients with stage 3 esophageal cancer have a long-term survival rate of 20 to 50 percent, depending on how they respond to chemotherapy and radiation and whether they have lymph node involvement or a lot of disease left after surgery. If the esophageal cancer spreads to the liver or bone, the five-year survival rate is only about 10 percent.
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
The best ways to prevent esophageal cancer are to not smoke or drink excessively, maintain a healthy weight and prevent (or treat) GERD or Barrett’s esophagus.
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What You Should Know About Esophageal Cancer originally appeared on usnews.com
