Cancer of the esophagus — the tube that goes from your throat to your stomach — is on the rise in the U.S., and it's often diagnosed in later stages.
Adenocarcinoma mostly affects older white men, but other common risk factors include:
- Family history of esophageal cancer
- Use of tobacco products, including cigarettes, cigars, pipes and chewing tobacco
- Alcohol. Smoking and drinking combined increases risk of esophageal cancer more than either alone.
- Central obesity, which is fat distribution around the central part of the body (an apple-shaped body rather than pear-shaped)
Dr. Vani Konda, a gastroenterologist with the Baylor Scott White Center for Esophageal Diseases, says none of the risk factors cause esophageal cancer. However, those with multiple risk factors may want to consider screeening for esophageal cancer.
Adenocarcinoma is often caught in later stages. Early diagnosis often leads to more successful otucomes.
And then there's chronic acid reflex disease, or gastrointestinal reflux disease. Some call it GERD or heartburn.
"We know that those people who have a chronic reflux disease – symptoms on a more daily basis over a longer period of time – are a risk factor for esophageal cancer," Dr. Konda said. "People with well-controlled reflux who take PPIs or acid suppression medicines for several years are also at risk."
Dr. Konda spoke with us about changes in the esophagus and why detecting them early is important.
On Barrett's esophagus: "A screening upper endoscopy can see if there are any changes in the esophagus that might be a precursor lesion for esophageal. That change is called Barrett's esophagus, something that might occur after years of reflux. Instead of the esophagus healing as it's supposed to, it actually heals like the lining in the stomach or the lining in the intestine."
Why esophageal cancer's often diagnosed in later stages: "Most patients diagnosed with esophageal cancer don't know they have Barrett's esophagus. A very small subset of those patients will get esophageal cancer. An upper endoscopy may not benefit everyone in the population, so we have to actually choose who might benefit the most and, right now, we choose patients who have multiple risk factors. But not all those patients are getting screening endoscopies. And if they do, not all those patients benefit from that."
Efforts to improve screening: "We are looking at non-endoscopic screening devices and tools. So, it may be that one day we will go on to have a screening tool that could be used at a broader level, that might include a device like swallowing a capsule with a tissue collection device on it. It might include other markers for disease. All of those areas are being actively investigated."