Cancer rates are generally declining in the US, but the incidence of adenocarcinoma, the most common type of esophageal cancer, has increased more rapidly since the 1970s than any other cancer.
Until recently, cancer of the esophagus—the foot-long muscular tube that carries food from the mouth to the stomach—has been considered deadly, though relatively rare. Now both of these beliefs are being challenged.
At one time, people diagnosed with esophageal cancer who underwent surgery had a low chance of surviving for five years. That survival rate is now as high as 50%, most likely due to earlier screening and diagnosis.
Fortunately, healthy lifestyle changes can reduce your risk of developing esophageal cancer.
WHO IS AT RISK?
As with many cancers, the risk for esophageal cancer increases with age—nearly 80% of new cases are diagnosed in people ages 55 to 85.
There are two main types of esophageal cancer—squamous cell carcinoma, which develops in the cells that line the entire esophagus, and adenocarcinoma, which occurs in the part of the esophagus closest to the stomach.
More than half of all squamous cell carcinomas are linked to smoking. Risk of adenocarcinoma is doubled in people who smoke a pack of cigarettes or more per day. Carcinogens in tobacco are believed to enter the bloodstream and contribute to the development of esophageal cancer. Excessive alcohol consumption—more than two drinks daily—also increases the risk for the squamous cell type of cancer, although it is not known why.
Tobacco and alcohol are a potentially deadly combination. A person who drinks excessively and smokes one to two packs of cigarettes a day has a 44 times higher risk of getting esophageal cancer than someone who does neither.
A diet low in fruits and vegetables accounts for approximately 15% of esophageal cancer risk. To help avoid the disease, eat at least five daily servings. Some scientific evidence suggests that berries, particularly black raspberries, which are rich in cancer-fighting antioxidants, protect against esophageal cancer.
Body weight also is a factor. Obese men are twice as likely to die from adenocarcinoma of the esophagus as men of normal weight.
THE HEARTBURN CONNECTION
Frequent heartburn, known as gastroesophageal reflux disease (GERD), is caused by stomach acid backing up into the esophagus. Up to 14% of Americans experience heartburn at least weekly, while 44% suffer from it monthly. GERD is linked to nearly one-third of esophageal cancer cases.
An additional factor for esophageal adenocarcinoma is a condition called Barrett’s esophagus, in which cells of the esophagus begin to resemble those that line the stomach. People with Barrett's esophagus are about 50 times more likely to develop esophageal cancer than those without the condition.
People who suffer from chronic heartburn (three or more times per week for more than three months) should be screened for Barrett's esophagus. If they are found to have the condition, screenings every year may be recommended to detect esophageal cancer.
Screening involves the use of endoscopy, an invasive procedure that requires sedation. During the test, the doctor passes a thin, flexible tube (endoscope) through the mouth to view the entire length of the esophagus.
Prompt and effective treatment of GERD might reduce the risk for esophageal cancer, although this has never been proven. A number of effective prescription and over-the-counter GERD remedies, which block the production of stomach acid, are available. These include H2 blockers, such as ranitidine (Zantac) and famotidine (Pepcid), and proton pump inhibitors, such as omeprazole (Prilosec).
SYMPTOMS AND DIAGNOSIS
Difficulty swallowing is the most common symptom of esophageal cancer. If you notice that swallowing has become even slightly harder—you must swallow more firmly or food doesn't go down properly—see your doctor immediately. It could save your life.
Weight loss commonly occurs because of difficulty swallowing and loss of appetite. Frequent bouts of hiccups, another sign of esophageal cancer, may result when cancer irritates the nerves leading to the diaphragm. More advanced cancer may compress the nerves that control the vocal cords, which can lead to hoarseness.
If your doctor suspects cancer, endoscopy will be performed and a biopsy taken. Additional tests may be necessary—endoscopic ultrasound, a procedure that involves the use of high-frequency sound waves, to pinpoint the tumor thickness. ..and a computed tomography (CT) scan and a positron emission tomography (PET) scan to determine whether the tumor has spread to nearby lymph nodes.
TREATMENT
Surgery is the main treatment for esophageal cancer. Most often, the surgeon will perform esophagectomy, in which the cancerous part of the esophagus and nearby lymph nodes are removed, or esophagogastrostomy, in which the lower part of the esophagus and upper part of the stomach are removed. With both procedures, the remaining part of the esophagus is reconnected to the stomach, often with a segment of the large intestine.
These procedures are extremely complex and demand a high degree of surgical expertise, as well as a skilled team of nurses and other personnel to provide after-care. Choose a major cancer center that performs more than 10 esophageal cancer surgeries a year.
Chemotherapy and radiation before surgery have been shown to improve the outcome, possibly because they destroy microscopic tumor tissue before it can spread.
In one study of 802 patients, 42% of those who had two rounds of chemotherapy before surgery were still alive two years later, compared with 34% of those who had surgery alone.
New finding: A long-term clinical trial showed that esophageal cancer patients who received so-called "triple therapy"—treatment with two cancer drugs (5-fluorouracil and cisplatin) and daily radiation for five weeks before surgery—had a 39% chance of surviving for five years, compared with 16% of patients who received only surgery.
