April is esophageal cancer awareness month. It is a deadly cancer because it is most often found at late stages. There are two main types of esophageal cancers. Squamous cell cancer historically was more prevalent and linked to alcohol and smoking. However, esophageal adenocarcinoma is now on the rise and is more common than squamous cell cancer, in the United States. Esophageal adenocarcinoma usually arises in the setting of Barrett’s esophagus, which is characterized by a change in the lining of the esophagus that occurs due to acid reflux. Unfortunately, many people with Barrett’s esophagus may not experience typical acid reflux symptoms such as heartburn and acid regurgitation. Others may experience less recognizable symptoms of acid reflux including cough, hoarse voice, upper abdominal pain, nausea, chest pain and the sensation of “choking” when laying down. Smoking and obesity are additional risk factors for esophageal adenocarcinoma. Barrett’s esophagus is more common in Caucasians and men.
Current guidelines for screening for Barrett’s esophagus include those with multiple risk factors for esophageal adenocarcinoma. The American College of Gastroenterology recommends screening for Barrett’s esophagus in those with acid reflux for >5 years and/or frequent (≥weekly) GERD symptoms and ≥2 of the following risk factors:
Age ≥ 50
Male
Caucasian/White race
Central obesity
History of smoking
History of Barrett’s esophagus or esophageal adenocarcinoma in a first degree relative
Screening for Barrett’s esophagus is accomplished with a procedure called Esophagogastroduodenoscopy also known as EGD or upper endoscopy. Patients are sleeping during the procedure, which generally takes about 10 minutes, and usually do not experience any discomfort during the procedure. The procedure requires fasting.
If you have certain symptoms, including trouble swallowing, weight loss, black stools, or iron deficiency anemia, you should consult your doctor or gastroenterologist immediately as you may need a more urgent endoscopy.
Barrett’s esophagus needs to be monitored closely for the development of pre-cancerous cells. If this develops, it can often be treated endoscopically, which helps prevent the progression to esophageal cancer, a rising and deadly cancer.
For more information on acid reflux and the acid reflux diet, click on the links below:
https://www.asge.org/docs/default-source/about-asge/newsroom/doc-gerd_infographic_final.pdf
https://patients.gi.org/topics/acid-reflux/
References:
Saltzman, J., & Gibson, M. (2018). Clinical manifestations, diagnosis, and staging of esophageal cancer. In D Savarese (ed.), UpToDate. Retrieved April 30, 2019, from
https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-staging-of-esophageal-cancer
Spechler, S. (2018). Barrett's esophagus: Epidemiology, clinical manifestations, and diagnosis. In S. Grover (ed.), UpToDate. Retrieved April 30, 2019, from