Reviewed by: Deepak Agrawal, MD, MPH, Tripp Buckley, MD, and Stephanie Doggett, PA-C
Written by: Lauryn Gerard
Have you ever sized up a slice of pizza or a tasty looking cheeseburger, ready to dive in and devour every last piece, but hesitated by the thought of that uncomfortable fiery burn in your chest that may emerge soon after your blissful indulgence? Heartburn can affect people of all ages and is typically triggered by some of our favorite foods and drinks. Occasional heartburn is normal and can be controlled with over-the-counter medications. However, when heartburn becomes chronic, it not only can become detrimental to your quality of life, but may also become a progressive disease that leads to Barrett’s esophagus, and even, esophageal cancer.
Esophageal cancer is one of the deadliest cancers in relation to the estimated five-year survival rate following a diagnosis. The number of diagnosed cases per year has also skyrocketed by 600% since the 1970s, causing esophageal cancer to become the fastest growing cancer in the United States. UT Health Austin’s Heartburn and Esophageal Disorders clinical practice is a specialized team within Digestive Health, a clinical partnership between UT Health Austin and Ascension Seton, and includes surgical and non-surgical heartburn and esophageal disorder specialists who hope to bring awareness to esophageal cancer with the goal of diagnosing esophageal cancer at an earlier stage or preventing it altogether.
From heartburn to…cancer?
Heartburn occurs when the valve between your stomach and esophagus doesn’t function properly, allowing stomach acid or bile to flow back up the esophagus, which is the tube that connects your mouth and stomach. Since your esophagus does not have the same protective lining as your stomach, this can cause the walls of your esophagus to become irritated or inflamed, resulting in a burning sensation in your chest. This burning sensation typically occurs after eating and may increase at night while laying down. It is also common for some people to experience difficulty swallowing, regurgitation, cough, or a sensation of a lump in their throat as well as other discomforting symptoms.
Chronic heartburn, known as gastroesophageal reflux disease (GERD), occurs when you experience heartburn regularly (two times per week or more). 1 to 2 out of 10 patients with chronic GERD develop Barrett’s esophagus, a precancerous condition that can progress to esophageal adenocarcinoma, the most common form of esophageal cancer.
The cells of the esophagus are not designed to be frequently exposed to the acid and other stomach contents that backflow due to GERD, and over time, the cells that make up the inner lining of the esophagus can evolve to become more like stomach or intestinal cells that are better equipped to handle the acidic environment. The new lining changes from a white or light pink color to salmon pink, which can be easily identified during endoscopy. The diagnosis is confirmed by performing a biopsy, in which small pieces of tissue are removed with forceps from the cell lining and examined under a microscope to determine if the cells that make up the tissue are malignant (cancerous) or benign (noncancerous).
“Barrett’s esophagus is considered a premalignant condition that predisposes patients to esophageal adenocarcinoma,” says Tripp Buckley, MD, who is a board-certified surgeon and serves as both the Surgical Director of Digestive Health and Director of the Heartburn and Esophageal Disorders at the Dell Medical School. “Nearly 3.3 million people in the U.S. have Barrett’s esophagus, and while the risk of esophageal cancer is low in patients with Barrett’s esophagus overall, about 0.5% of people with the condition still go on to develop malignancies. That’s still a lot of people and actually oversimplifies the problem.” Dr. Buckley explains.
Certain patients are at higher risk for progression to cancer, such as white males over the age of 50, those with long-segment Barrett’s esophagus, and those with a family history. When weighing risk factors, the annual risk of progression can vary from as low as 0.13% to as high as 2.1% per year. Performing an appropriate risk stratification is key to prevention and treatment.
What is Esophageal Cancer?
“Esophageal cancer is a malignant tumor that can appear anywhere along the length of your esophagus and can affect the deep tissues and muscles of the esophagus. Most esophageal cancers can be categorized as one of two types. The most common type is esophageal adenocarcinoma, which is related to GERD. And the second type is squamous cell carcinoma, which is linked to smoking and excessive alcohol consumption. It’s a relatively uncommon cancer, but it’s often caught in later stages, making the five-year survival rate rather low,” explains Deepak Agrawal, MD, MPH, who is a board-certified gastroenterologist and serves as the Medical Director of Digestive Health as well as Chief of both Gastroenterology and Hepatology at the Dell Medical School.
During the early stages of esophageal cancer, you may not experience any signs of symptoms, but as the cancer progresses, new symptoms will likely appear.
Symptoms of esophageal cancer may include:
- Blood in stool
- Chest pain
- Chronic cough
- Food traveling back up the esophagus
- Pain or difficulty when swallowing
- Unintended weight loss
These symptoms often appear slowly, are not always specific to esophageal cancer, and are often ignored for some time, all of which allow the cancer to progress.
“Unfortunately, there isn’t a recommended screening program like there is for colorectal cancer, such as colonoscopies that are recommended every 5-10 years once you reach a certain age depending on your risk factors,” says Dr. Agrawal, “but if you have been experiencing GERD for at least 5 years and have never had an upper endoscopy, you should see a gastroenterologist to discuss if you are at high-risk for Barrett’s esophagus and if you would benefit from an upper endoscopy.”
How can you prevent esophageal cancer?
Not all cancers can be prevented. However, because there is evidence to support that irritation of the esophageal cells contributes to the development of esophageal cancer, there are certain habits you can avoid and conditions you can monitor or treat that may help lower your chance of developing esophageal cancer.
Potential ways to prevent esophageal cancer:
- Avoid smoking
- Drink alcohol in moderation
- Maintain a healthy weight
- Monitor Barrett’s esophagus with routine surveillance endoscopies
- Schedule an appointment with a provider if you are experiencing GERD symptoms
- Treat achalasia
Esophageal adenocarcinoma develops in a progressive manner, from GERD to Barrett’s esophagus followed by low- and high-grade dysplasia, and there are opportunities to treat the disease to prevent this progression from turning into cancer. Treatment options include endoscopic techniques, such as radio-frequency ablation or endoscopic mucosal resection, both of which are offered through the Heartburn and Esophageal Disorders clinical practice.
“Certainly, if you are experiencing heartburn on a regular basis, you’ll want to talk to your doctor about potential treatment options to address the root cause of your heartburn rather than continuously treating the symptoms without investigation,” says Dr. Buckley. “Getting screened for Barrett’s esophagus can also help determine if it would be beneficial to place you on a regular screening schedule to monitor your esophagus for dysplasia and other signs of cancer. We offer several novel techniques for the diagnosis of Barrett’s, such as optical biopsies, advanced brush biopsy techniques, and soon, even a small ‘pill’ that can be swallowed and retrieved without the use of endoscopy.”
Heartburn is a simple symptom, but the management can be complex depending on your history and risk factors. The Heartburn and Esophageal Disorders clinical team believes in taking an individualized and scientific approach to treating heartburn and other various gastrointestinal conditions. To make an appointment with the Heartburn and Esophageal Disorders clinical practice or to learn more about services offered at Digestive Health, call 1-844-GI-AUSTIN (1-844-442-8742) or visit here.