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Esophageal Cancer 101 — and why you shouldn’t ignore that nagging heartburn

  • 04.27.2018

Marty got popcorn caught in his throat, then developed sudden, terrible heartburn.

While dining, Bart choked on meat several times over the course of a month.

Marc started having chronic problems swallowing food and even liquid.

These three men were all eventually diagnosed with esophageal cancer. While they survived to tell their stories, many do not. In 2018, it is estimated that 17,290 new cases will be diagnosed and 15,850 people will die from esophageal cancer – 81% of those people will be men.

April is Esophageal Cancer Awareness month, so we are taking the opportunity to shine a light on this somewhat rare cancer.

What is esophageal cancer?

The esophagus is the hollow, muscular tube located behind your windpipe and in front of your spine. It serves to transport food and liquid from your throat to your stomach. Esophageal cancer begins when abnormal cancer cells develop in the lining of the esophagus. It starts in the inner layer (the mucosa) and grows outward, making it hard to diagnose early. Cancer of the esophagus is both rare – accounting for 1% of all cancers in the United States – and challenging to treat effectively.

Symptoms of esophageal cancer

While not all esophageal problems are related to cancer, these problems can indicate serious conditions, many of which can contribute to the development of esophageal cancer if left untreated.

Those diagnosed with esophageal cancer often report several of the following symptoms:

  • Difficulty and pain with swallowing, particularly when eating meat, bread or raw vegetables
  • Chronic pressure or burning in the chest
  • Chronic indigestion or heartburn
  • Frequent vomiting
  • Frequent choking on food
  • Unexplained weight loss
  • Chronic coughing or hoarseness
  • Consistent pain behind the breastbone or in the throat

As screening is pretty intrusive — a flexible lighted tube is inserted into the esophagus — and the disease is quite rare, experts recommend that only people at high risk, or those with symptoms, get screened. As general screening is not advised, it is important to report any of the above symptoms to your doctor. Swallowing problems, called dysphagia, may result from a number of conditions that are not cancer. For example, chronic heartburn, medically called gastroesophageal reflux disease (GERD), could be caused by diet, alcohol consumption, even pregnancy.

Yet, these conditions could still pose a cancer risk, according to Dr. Jorge Perez of Sierra Nevada Cancer Center. He advises patients to take these symptoms seriously. “While a symptom like acid reflux may not be related to an existing cancer, having acid in the esophagus chronically can contribute to the development of cancer,” he explains. “Don’t take risks with your health, consult with your doctor.”

Who gets esophageal cancer and why?

Esophageal cancer is more common in men and there are certain risk factors that increase the probability of developing the disease, among them:

  • Age – most cases occur in those over 55
  • GERD – Those with gastroesophageal reflux disease (when acid escapes from the stomach into the lower esophagus) have a slightly higher risk of developing esophageal cancer
  • Barrett’s Esophagus – When acid remains in the esophagus over time, it can damage the lining and lead to normal cells being replaced by gland cells. This condition, called Barrett’s, greatly increases the risk of developing esophageal cancer.
  • Tobacco use – The more a person uses tobacco (cigarettes, cigars, pipes, and chewing tobacco), and the longer it is used, the higher the cancer risk. Smoking a pack a day more than doubles your risk. Quitting reduces it. 
  • Alcohol use – The more alcohol someone drinks, the higher their chance of getting esophageal cancer.
  • Obesity – Obese people often have GERD, which increases their esophageal cancer risk.
  • Diet – While not conclusive, a diet high in processed meat may increase the chance of developing esophageal cancer.
  • Achalasia – With this condition, food does not easily pass into the stomach and collects in the esophagus.
  • Tylosis – This inherited disease causes small growths to develop in the esophagus.
  • Plummer-Vinson syndrome – With this condition, membranes in the esophagus cause narrowing of the passage.

Treatment options for esophageal cancer

As is the case with many cancers, treatment is often a combination of different therapies, not a single approach. Below are the most common treatment options:

  • Surgery — Surgery to remove some or most of the esophagus is called an esophagectomy. The upper part of the esophagus is then connected to the remaining part of the stomach, which is pulled up into the chest or neck to become the new esophagus.
  • Radiation Therapy – RT is often used in conjunction with chemotherapy, or before surgery, to shrink the cancer.
  • Chemotherapy – Chemo is typically used in conjunction with radiation before surgery.
  • Targeted Therapy – TT are drugs that can be used either with chemo or by themselves if chemo is no longer working.
  • Immunotherapy – Immunotherapy is the use of medicines that help a person’s own immune system find and destroy cancer cells.
  • Endoscopic Treatments – Several types of treatment for esophageal cancer can be done by passing an endoscope down the throat and into the esophagus. They’re typically used for small and very early-stage cancers to help open a narrowed esophagus to aid with swallowing.

According to Dr. Perez, treating esophageal cancer is particularly challenging because we use our esophagus constantly to swallow and eat, without thinking about it. “Treating cancer of the esophagus requires aggressive treatment,” he explains. “But these treatments can drastically impact quality of life. We have to find the right balance.”

The 5-year survival rate for those with esophageal cancer is 19%, but there are mitigating factors that affect this statistic. For those with cancer located only in the esophagus, the rate is 43%. For those whose disease has spread to surrounding tissues or organs and/or the lymph nodes, it’s 23%. And for those with cancer in distant parts of the body, 5-year survival is 5%. While the survival rate seems low, it is improving. During the 1960s and 1970s, only about 5% of patients survived five years after being diagnosed.

If you are facing an esophageal cancer diagnosis, exceptional treatment is available in Carson City, South Lake Tahoe, Fallon or Gardnerville, through Sierra Nevada Cancer Center. Same week or sooner appointments are available by calling 775-883-3336.

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