Esophageal Cancer Awareness

“Never overlook the simplest of symptoms...” – Dr. Pineau

Specialists at the Borland Groover know that easy-to-treat heartburn symptoms may seem like just another case of acid reflux but a closer look at these symptoms can be a sign of something much more serious.

Esophageal cancer is a cancer that occurs in your esophagus, which carries the food you swallow to your stomach to be digested. This type of cancer usually begins in the cells that line the inside of the esophagus then travels to other areas. It can occur anywhere along the esophagus, but is found most often in the lower portion of the esophagus.

The American Cancer Society estimates that there will be almost 18,000 new cases of esophageal cancer in 2013. It is expected to cause more than 15,000 deaths this year alone. Although this disease is three to four times more common among men than among women, Ben Pineau, M.D., F.R.C.P., a gastroenterologist with the Borland Groover, says there are many risk factors that women should be familiar with and aim to avoid.

“Not every case of esophageal cancer can be prevented but the risk of developing this disease can be reduced by avoiding certain risk factors,” says Dr. Pineau. “The most apparent risk factors for this cancer are the use of tobacco and alcohol. These factors increase the risk of esophageal cancer multiple times, especially if you partake in both.”

Avoiding tobacco and alcohol are the simplest ways a person can limit their risk of esophageal cancer. Another preventable measure is monitoring a daily diet. A healthy diet rich in fruits and vegetables and maintaining a healthy weight helps in preventing esophageal cancer, especially since obesity has been directly linked with this disease.

When reflux of stomach acid into the lower esophagus continues for a long time, it damages the lining of the esophagus and is known as Barrett’s esophagus. This causes the cells that line the esophagus to be replaced with cells that are more resistant to stomach acid. Most with Barrett’s esophagus have symptoms of “heartburn”, but many patients may not feel symptoms at all. Those with Barrett’s esophagus are more likely than people without this condition to develop esophageal cancer and the risk of cancer is highest if abnormal cells (dysplasia) are is present or if Barrett’s is found in the setting of a family history of esophageal cancer.

In many cases esophageal cancer is found because of the symptoms it causes, but unfortunately, most esophageal cancers do not cause symptoms until they have reached an advanced stage and require advanced treatment.

One of the most common symptoms of esophageal cancer is having difficulties swallowing creating the sensation that food is stuck in the throat or chest. This is usually mild in early stages but progresses and gets worse over time as the opening inside the esophagus becomes narrower.

“Without realizing it, patients change their diet when swallowing becomes difficult. They take smaller bites and chew their food more slowly. As the cancer grows larger, the problem gets worse,” said Dr. Pineau. “When these symptoms occur it is important to listen to your body and see a gastroenterologist rather than assume it will dissipate.”

Alarm symptoms that warrant urgent evaluation from your primary care physician or gastroenterologist include dysphagia, or food getting trapped in your throat, weight loss and black stool which indicates blood loss from the upper gastrointestinal tract. Treatment may be necessary if you have any of the alarm symptoms, or if you experience reflux that affects your quality of life, daily or nightly symptoms.

Various new studies are testing innovative ways to combine established drugs to act against esophageal cancer to improve effectiveness. There are also studies testing the effectiveness of combining chemotherapy with radiation to best treat this disease. Targeted drugs, which attack certain substances in cancer cells, have been successful in some other cancers and are now being tested in esophageal cancer.

If you are over the age of 55 and have GERD, Barrett’s esophagus or commonly smoke and drink, the first step to prevent esophageal cancer is to visit a gastroenterologist to measure your risk. There are multiple ways that doctors can check your esophagus, the best being an upper endoscopy to directly visualize the lining of the esophagus. Other methods include imaging tests, such as barium swallow X-ray as well as various scanning methods (CT, MRI, PET-CT).

If esophageal cancer is found it is important that you take time to consider all of the options your doctor has suggested. Depending on the stage of the cancer the main options for treatment are surgery, radiation, chemotherapy or endoscopic treatments such as endoscopic mucosal resection, radio frequency ablation and photodynamic therapy. Some of these treatments or a combination can also be used if all the cancer is unable to be removed. As well, if pre-cancerous Barrett’s esophagus is found, there are various options available to prevent the development of esophageal cancer.

“Never overlook the simplest of symptoms because it can undoubtedly save your life,” says Dr. Pineau.