No Laughing Matter — What to Know About Esophageal Cancer
While April is celebrated as National Humor Month, it is also National Esophageal Cancer Awareness Month. On a serious note, esophageal cancer results in more than 15,000 deaths each year according to the National Cancer Institute. Because this type of cancer is uncommon, two faculty physicians from the Digestive Health Center at Keck Medicine of University of Southern California (USC) in Los Angeles, and members of the American Gastroenterological Association (AGA), with extensive experience treating this disease review the warning signs and behavioral risks of esophageal cancer.
What is esophageal cancer?
Your esophagus is the muscular organ that moves food from your mouth to your stomach. And like many other parts of your body, it can become cancerous. There are two kinds of esophageal cancer. While squamous cell cancer is the most common esophageal cancer in the world, adenocarcinoma is the most common form of the disease in the United States. But while most cancers in the U.S. have seen a decline in recent years, the number of Americans with esophageal cancer has been steadily increasing.
What are the symptoms?
As a tumor grows in your esophagus, it will become increasingly difficult to swallow. Early signs include difficulty swallowing bulky food like bread. Later signs include difficulty swallowing even soft foods and liquids. When you tell your doctor about these symptoms, you will be directed to have an X-ray, an endoscopy or both. Endoscopy is a test during which your doctor inserts a flexible tube with a camera and light on the end into your esophagus to look for and biopsy the tumor. This video from the AGA describes the procedure in greater detail. You are sedated for this examination and most people do not find it uncomfortable. If a tumor is discovered, the next most important step is to determine the stage of the tumor—as early stage tumors are treated differently than more advanced tumors.
Can I prevent esophageal cancer?
Most patients with esophageal cancer are over the age of 60 years. The disease is slightly more common in men. Tobacco and alcohol increase the risk for squamous cell cancer. Chronic gastroesophageal reflux disease, or GERD, is associated with an increased risk of adenocarcinoma, or cancer. GERD can lead to a condition known as Barrett’s esophagus, which is easily detected by endoscopy and can be treated before a cancer develops. While there are no outward signs of Barrett’s esophagus, symptoms of reflux, such as heartburn, will alert your doctor to the possibility of this precancerous condition. Obesity increases the risk of cancer as much as four fold. A diet rich in fruits and green and yellow vegetables is associated with a decreased risk of cancer.
How is esophageal cancer treated?
Because esophageal cancer is uncommon, it is best treated at centers and by specialists with experience. The earliest forms of the disease can be treated without surgery. Your doctor can remove or destroy small esophageal tumors or precursors of the disease through the same endoscope used to detect them. Later forms of the disease require removal of the esophagus either before or after treatment with radiation and chemotherapy.
When esophageal cancer has advanced beyond the point where it can safely be removed, nutrition becomes difficult because food is no longer able to reach the stomach. In such cases, an expandable mesh called a stent can be inserted into the esophagus to permit the passage of food into the stomach. If a stent is not possible, nutrition can be delivered directly into the stomach via a feeding tube inserted through the skin of the abdomen.
With additional research into the causes of esophageal cancer, we’re confident that detection and treatment methods will continue to advance. AGA, as a member of the Deadliest Cancers Coalition, advocates for increased funding of the National Institutes of Health to ensure research into esophageal cancer is supported.
This article was written by Jeffrey A. Hagen, MD, and Jacques Van Dam, MD, PhD