Warning signs of esophageal cancer

Editor’s Note: This store is part of our feature “Living With Cancer: Lessons and Advice from Kris Carr” which was originally printed in the Special Report “New Answers for Cancer” from Scientific American.

Rather than surrendering to despair and impersonal medical treatments, growing numbers of cancer patients are empowering themselves with information and control over their therapies. The trend is finding acceptance in mainstream medicine and helping people with cancer lead healthier lives.

The experiences of author and filmmaker Kris Carr, who was diagnosed with a rare, incurable malignancy, illustrate how successfully one can manage cancer as a chronic disease.

The following resource guides offer tips on developing a strategy for managing the illness, asking the right questions of physicians and getting the right professional and personal support.

1.You Have Cancer: Now What?
Diagnosis: cancer. Your head is spinning, and you feel like the wind has been sucked out of you. In a split second, life as you knew it is gone. “Getting diagnosed throws your entire universe into a free fall,” Carr writes in her 2007 book Crazy Sexy Cancer Tips. “There’s no sugarcoating it: cancer is a devastating blow, one that takes time to process.”

The first things you should do (after taking a deep breath and trying to chill):

  • Find the best doctor for your disease: Be willing to travel and always get second, third and even fourth opinions to make sure that you’re getting the best treatment.
  • Design a healing plan: Pull together a team of Western physicians as well as integrative doctors (to teach you how to build up your immunity and spiritual grit) to create the best get-healthy recipe. Ask family and friends to chip in and scour the Internet and bookshelves for information. “If you want to heal, you have to take initiative, have a voice and use it,” Carr says.
  • Focus on lifestyle changes: “The only thing that you can control is what you eat, what you drink and how you move,” Carr says. She recommends exploring healthy diets, exercise and alternative therapies such as massage, yoga and meditation to boost and maintain your physical and emotional well-being.
  • Create a support system: “Nobody understands you quite like another cancer survivor,” Carr says. “There is incredible strength in that.”
  • Live! “Don’t wait for permission to live. Just because you have cancer does not mean that your life is over,’’ Carr insists. “Start living. It’s that simple.”

2. Questions to Ask
Studies show that cancer (and other) patients who arm themselves with information typically fare better and experience fewer side effects than those who simply follow doctors’ orders, no questions asked. Being informed gives them some control over their disease—and that feeling of empowerment plays a role in the healing process. No. 1 rule: do not be cowed by your doctor. Ask him or her to explain anything and everything you don’t understand. Prepare questions in advance of appointments (to reduce stress and the odds of forgetting any)—and bring a notebook to jot down answers and other important info. Below are some questions you should ask:

  • What causes this type of cancer?
  • What are the risk factors? If it’s genetic, are other family members at risk?
  • What lifestyle changes (diet, exercise, rest) do you recommend?
  • What are my treatment options?
  • Are there activities that should be avoided because they might trigger or
    exacerbate symptoms?
  • What happens if new symptoms crop up or existing ones worsen?
  • What medical tests or procedures are necessary? How often?
  • What stage is my cancer? What does that mean?
  • What is my overall prognosis or chance of recovery?
  • What are the average survival and cure rates?
  • Could my disease go into remission?
  • What is the recommended treatment?
  • How often will I have to undergo treatment—and for how long?
  • What are the potential side effects?
  • What are the benefits versus the risks of each treatment option?
  • Are there alternative therapies? What are they?
  • What are the expected results of treatment?
  • Is the treatment painful? If so, is there a way to make it more bearable?
  • How long is the recovery? Will it require a hospital stay?
  • When can I resume my normal activity (if it’s been curtailed)?
  • Has my cancer spread? If so, how does this change treatment decisions?
  • Am I eligible for any clinical trials?
  • What happens if my disease progresses while I’m in a clinical trial?
  • Who foots the bills if I participate in a clinical trial?
  • Where can I find emotional, psychological and spiritual support?
  • Whom should I call with questions or concerns after office hours?
  • May I contact you or a nurse if I have questions or more symptoms? (If the
    answer is “no,” find another doctor.)

3. Your Odds of Beating Cancer
Success in the battle against cancer is often measured in terms of the “five-year relative survival rate.” That rate is the number of patients who are still alive five years after being diagnosed, relative to the number who would be expected to survive if they had not come down with the disease. Five years might not seem like a lot, but it is, considering that 67 is the median age for diagnosis.

Below is a sampling of five-year relative survival rates for common types of cancer diagnosed between 1996 and 2004. These rates are calculated by the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program, which collects survival data from state registries covering about 26 percent of the U.S. population.

Survival rates have increased dramatically over the years, thanks to earlier detection and better treatments. The five-year relative survival rate for patients diagnosed with any type of cancer in 1975 was 50 percent; the rate jumped to 67 percent in 2000.

Bear in mind that survival rates vary widely depending on the type of cancer and the patient’s age, gender, general health, lifestyle and ethnicity. You can find more detailed statistics at http://seer.cancer.gov

Five-Year Survival Rates
Melanoma (skin)91%
Urinary bladder80%
Non-Hodgkin’s lymphoma65%
Colon and rectum64%
Lung and bronchus15%

4. Getting Support: Tips, Tools and Tenderness
You’ve just been diagnosed with cancer. Now what? First and foremost, do not try to handle this on your own. Allow family and friends to help, and find others in your situation to lean on.
Online resources:

  • www.crazysexycancer.com: Carr’s Web site. Have questions? Want to dish? You can visit her online community, www.crazysexylife.com.
  • http://berniesiegelmd.com and www.ecap-online.org: These sites of physician Bernie Siegel, author of Love, Medicine & Miracles and Peace, Love & Healing (both from Harper Paperbacks, 1990), offer info and tools based on the science of mind-body-spirit medicine.
  • www.cancercare.org: Need a professional cancer assistant? Try the next best thing. This site is designed to help patients navigate their way through cancer—answering questions, finding help or just “listening” when they need to vent.
  • http://nccam.nih.gov: The National Center for Complementary and Alternative Medicine of the National Institutes of Health provides information here on alternative and complementary therapies, discoveries and clinical trials.
  • http://hippocrateshealthinstitute.com: Site of the Hippocrates Health Institute, a world-renowned healing center in Florida.
  • www.mercola.com: An alternative medicine and education site.
  • www.heardsupport.org: This site is specifically geared toward patients with hemangioendothelioma, the rare cancer that Carr has.
  • www.livestrong.org: Site of seven-time Tour de France winner and cancer survivor Lance Armstrong.
  • www.ulmanfund.org: Provides support programs and resources for patients and their families. Also helpful: a downloadable book penned by founders Doug and Diana Ulman.
  • www.thechinastudy.com: The China Study, by T. Colin Campbell, probes the relationship between diet and cancer and other diseases.
  • www.cancer.gov: This site of the National Cancer Institute is a comprehensive source of state-of-the-art treatments and clinical trials (including a database of open trials).
  • www.imtooyoungforthis.org: An invaluable source of support and research for survivors in their 20s and 30s and their families.
  • www.cancersurvivorsunite.org: Camps and support programs for young adults with cancer.
  • www.youngcancerspouses.org: A site designed to connect couples dealing with the ups and downs of cancer.
  • www.cancerconsultants.com: Contains detailed, consumer-friendly information on the latest treatment developments.
  • www.americancancersociety.com: This American Cancer Society site provides basic information, alternative therapies, ways to manage the disease, and support programs .
  • www.oncolink.com: This University of Pennsylvania site offers key cancer info and pointers.
  • www.cancerguide.org: A how-to on researching your disease, searching for clinical trials, and finding out about the latest traditional and alternative therapies.
  • www.cancer.net: American Society of Clinical Oncology site provides oncologist-approved information to help patients make informed decisions about their health care.
  • www.gildasclub.org: Named for Saturday Night Live comedian Gilda Radner, who died of ovarian cancer, this site provides a support network for patients and their families.
  • www.thewellnesscommunity.org: The Wellness Community provides support and education for cancer patients and caretakers—and hooks them up with others going through the same thing. It provides info on local wellness communities and even offersa virtual wellness community in Spanish.

5. Medical Resources
Finding a doctor who specializes in cancer care and choosing a treatment facility are essential steps in any patient’s recovery program. One good place to start is with the 63 cancer centers that the National Cancer Institute recognizes for “scientific excellence and the capability to integrate a diversity of research approaches” (http://cancercenters.cancer.gov/cancer_centers).

You can also check whether the American College of Surgeons’ Commission on Cancer (www.facs.org/­cancerprogram) approves of a given program. Some of the things to look for in a cancer center include a low mortality index, a high ratio of nurses to patients and opportunities to participate in clinical trials. For more tips, see www.cancer.gov/cancertopics/factsheet/Therapy/doctor-facility. Here is a selection of some of the most respected cancer treatment centers around the country:

Dana-Farber Cancer Institute

Memorial Sloan-Kettering Cancer Center
New York City

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Children’s Hospital of Philadelphia

Duke Comprehensive Cancer Center
Durham, N.C.

University of Texas M. D. Anderson
Cancer Center

University of Chicago Medical Center

Mayo Clinic
Rochester, Minn.
(facilities also in Arizona and Florida)

University of Washington Medical Center

UCLA Medical Center
Los Angeles

6. The 411 on Health Insurance
Worried that your health insurance won’t cover your treatment? Wondering if you’re entitled to disability benefits? These Web sites may help:

7. How to Stay Healthy
Patients undergoing treatment can shore up their physical (and emotional) reserves by eating well, exercising and cutting stress (which impairs the immune system). The American Institute for Cancer Research, which funds studies on the role of food and exercise in cancer prevention and treatment, recommends a diet that’s at least two-thirds vegetables, fruit, whole grains and beans. Below is a roundup of research related to staying healthy:

  • A study of 22,000 healthy Greeks showed their “Mediterranean diet,” rich in vegetables, whole grains, olive oil, fruit and fish, reduced their risk of dying from cancer by at least 25 percent. Other studies have found that nutrients in dark, leafy greens may inhibit the growth of tumor cells in breast, skin, lung and stomach cancers and that green tea may thwart cancer development in colon, liver, breast and prostate cells. (A leading theory: flavonoids in tea and carotenoids in leafy greens, which act as antioxidants, may protect against cancer by rooting out free radicals.)
  • A pair of 2006 studies showed that regular exercise reduced by up to 61 percent the odds of death in colorectal cancer patients. The findings held even in patients who did not start exercising until after diagnosis.
  • A 2005 study showed that 92 percent of nearly 3,000 women with breast cancer who walked or did other exercise three to five hours weekly were still alive 10 years after their diagnosis, compared with 86 percent of those who exercised less than an hour a week.
  • A 30-year review of the scientific literature, published in 2004, suggested that cancer patients who feel helpless or who suppress negative emotions may be at greater risk of having their cancer spread than those who play a role in their healing.

8. Looking Ahead: Start a Family?
Does a cancer diagnosis spell the end of your dreams to have a family? In a word—no. Note to readers: check your options before undertaking treatments that may cause infertility. In the event that you cannot become pregnant, there is always surrogacy and adoption. Despite what you’ve heard, it is possible to adopt if you’ve had cancer. The key: pick an agency and country that are open to working with cancer survivors.

For more, check out:

  • www.fertilehope.org: This site provides unvarnished facts about fertility risks associated with cancer treatment as well as fertility-preservation and parenthood alternatives before, during and after treatment. It outlines the success rates, costs and time requirements for a variety of fertility procedures and also addresses other possibilities, including egg and sperm donation, surrogacy and adoption.
  • www.pregnantwithcancer.org: This Web site links newly pregnant cancer patients with others with a similar cancer who have already been there, done that.

What Are the Warning Signs of Esophageal Cancer?

Do you constantly pop antacids? Is your heartburn so bad that it keeps you awake at night? Have you had acid reflux for more than 5 years?

If you do, you should speak with your doctor. You could have a condition called Barrett’s esophagus, a condition puts you at greater risk for esophageal cancer.

Your esophagus is the “tube” that transports food from your mouth and throat to your stomach and digestive system. In this post we review the signs of esophageal cancer and common risk factors.

Signs of Esophageal Cancer

Rampant heartburn isn’t the only sign that you may have cancer of the esophagus. Other signs include:

  • Unintended weight loss
  • A persistent cough or chronic hoarseness
  • Difficulty swallowing
  • Pain when you swallow
  • Indigestion
  • A lump underneath the skin
  • Heartburn and acid reflux that won’t go away with medicine

What Are the Risk Factors of Esophageal Cancer?


Smoking is a major risk factor. But that shouldn’t come as a surprise.

We really, really hope that you don’t smoke. If you do, then your first priority for your health should be to stop. Smoking places you at seriously high risk for multiple cancers and heart disease.

If you think vaping is a safer alternative, think again. Vaping has also been linked to diseases. There have been numerous cases of “vape lung,” an illness that causes severe respiratory distress and, in some cases, death.

We understand that quitting is difficult, and we want you to know that we’ll help you every step of the way.

There are also a lot of useful online resources for quitting.

Barrett’s esophagus

Ideally, your esophagus uses its muscles to push food down into your stomach.

However, in some cases, the part of the tube near the stomach is replaced by a different type of tissue. This different tissue is more similar to the kind found in your intestines. This condition is called Barrett’s esophagus.

Barrett’s esophagus is seen in people who have had GERD. That’s short for gastroesophageal reflux disease.

Think of GERD as chronic heartburn and regurgitations. It’s typically found in those with acid reflux that has been going on for more than 5 years.

Additional Risk Factors for Esophageal Cancer

Other risk factors include:

  • Using tobacco: This means much more than smoking. It means chewing tobacco, snuff, or any other similar tobacco product.
  • Excessive alcohol use
  • Age: Those who are older have a greater risk of developing esophageal cancer.

How Many Americans Are Affected by Esophageal Cancer?

First, the good news: Esophageal cancer rates in the United States are gradually declining.

However, thousands of Americans still die of esophageal cancer. According to the American Cancer Society there are about 17,650 new cases annually. Each year, around 16,080 Americans die from esophageal cancer.

Some Interesting Facts About Esophageal Cancer

Following are some interesting pieces of information about esophageal cancer:

  • It’s more common among men than women.
  • It makes up around 1 percent of the cancers diagnosed in the United States.
  • Your lifetime risk of getting it is around 1 in 132 for men and 1 in 455 for women.
  • There are two main types of esophageal cancer: adenocarcinoma and squamous cell carcinoma.
    • Adenocarcinoma is most commonly seen among whites.
    • Squamous cell carcinoma is more commonly seen among African-Americans.
  • Those who are Native American, Asian or Hispanic have lower rates of esophageal cancer.

Is There a Screening Test for Esophageal Cancer?

According to the National Cancer Institute there are no standard screening tests for esophageal cancer.

However, if you are in a high-risk group or if you have Barrett’s esophagus, your doctor may recommend having a regular endoscopy to look for problems.

During an endoscopy, a thin, lighted tube equipped with a tiny camera is gently placed down the throat. The doctor is able to see the inside of your esophagus.

Sometimes, the doctor may take a small piece of tissue to be closely examined. This process is called a biopsy.

If Barrett’s esophagus is found, your doctor will give you medicine to reduce acid reflux. Treatment does not usually cure Barrett’s esophagus, but it keeps it from getting worse.

If Barrett’s esophagus becomes more precancerous on subsequent endoscopies there is an endoscopic technique called ablation that allows removing Barrett’s esophagus and significantly reducing its risk of turning into esophageal cancer.

The Latest Treatments for Esophageal Cancer

Research has paved the way for many insights into treatment for esophageal cancer. The American Cancer Society outlines some discoveries that help the fight against cancer.

Genetic Screenings for Risks

Some genes are more common in people with Barrett’s esophagus. This means we can find those who may be more likely to get it, so we can implement preventative measures.

Genetic research also means better therapies that are targeted specifically to these problem genes.

Refined Screening Tests

Tests are being developed to help determine which people with Barrett’s are more likely to develop cancer. This enables doctors to know how often to schedule screening appointments and help find those patients who need close monitoring.

Imaging Tests

Advanced testing helps doctors determine who is more likely to be helped by surgery. Doctors are also constantly refining their surgical techniques to produce the best outcomes.

Protein Examination

Cancer cells contain protein. Researchers are hoping to learn a lot from these proteins—mainly whether or not the cancer cell will respond to chemotherapy. This helps doctors determine the best treatment.

Immunotherapy Drugs

Cancer cells are sneaky. They can often maneuver around your immune system’s “guards” to keep from being attacked. However, a new set of drugs called checkpoint inhibitors are now being used in fighting throat cancer.

These drugs help your body uncover cancer cells’ “disguises” and direct the immune system to attack them.

Do You Have Acid Reflux That Won’t Go Away with Medicine?

If you have acid reflux that won’t go away with medicine, you may have GERD. However, you should also be aware that severe acid reflux is also a potential sign of esophageal cancer.

Regardless, acid reflux that won’t go away with medicine is something that should be examined by one of our leading experts.

We welcome the opportunity to serve you. Simply contact us for more information.

A New Cancer Center Offers the Latest in Advanced Care

Inside Conway Medical Center, you’ll find our new DukeHealth affiliated Cancer Center. We’ve taken the time to create a treatment center that provides an environment that is both state-of-the-art and relaxing. We offer:

  • A variety of injections
  • Transfusions
  • Infusions
  • Blood draws

We invite you to learn more by exploring the features of our new, comprehensive Cancer Center.


American Cancer Society. “Esophageal Cancer.” Online.

National Cancer Institute. “Esophageal Cancer.” Online.

Esophageal Cancer: be aware of the early warning signs

According to the American Cancer Society (ACS), more than 16,000 new esophageal cancer cases are diagnosed each year in the U.S. Unfortunately the survival rate in these cases is only 10 percent. This alarming statistic is due largely to the fact that by the time the majority of cases are diagnosed, the cancerous tumors have grown to the point of inoperability. Raising patient awareness about potential conditions that, if left untreated, could progress into esophageal cancer, will encourage patients to seek the appropriate care through their physician.
Many people are aware that tobacco use increases the risk of developing esophageal cancer; however, there are several other common contributing risk factors including:

  • Excessive alcohol consumption;
  • Obesity;
  • Lye ingestion; and,
  • Gastroesophageal reflux disease (GERD), also known as acid reflux or heartburn.

A recent ACS Gallup poll revealed that 44 percent of adults in the U.S. have heartburn at least once per month and that approximately 30 percent of esophageal cancer cases can be linked to GERD. GERD is a condition in which acid (with some pepsin and bile) splashes up from the stomach into the esophagus. These three fluids are potentially dangerous to the sensitive esophageal tissue, as they can inflame and damage the lining of the esophagus, a condition known as esophagitis.
If GERD becomes a chronic condition, it can develop into Barrett’s esophagus, a precursor to esophageal cancer. Barrett’s esophagus is a condition in which the color and composition of the cells lining the lower esophagus change due to repeated exposure to stomach acid. Only a small percentage of people with GERD develop Barrett’s esophagus, but once it is diagnosed, patients should be sure to meet with their physician regularly as they are at a greater risk of developing esophageal cancer.

Symptoms of advanced GERD or the presence of Barrett’s esophagus include:

  • Frequent heartburn. A burning-type pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen.
  • Difficulty swallowing. Often, a narrowing of the esophagus (esophageal stricture) leads to trouble swallowing or dysphagia.
  • Bleeding. A person may vomit red blood or blood that looks like coffee grounds, or your stools may be black, tarry or bloody.
  • Weight loss and loss of appetite.

According to the ACS, prevention of Barrett’s esophagus can begin with controlling GERD by making some simple lifestyle changes, such as:

  • Losing weight. Obesity increases abdominal pressure, which can then push stomach contents up into the esophagus;
  • Eating a diet full of fruits and vegetables, eating smaller and more frequent meals and not eating two to three hours prior to bedtime;
  • Smoking cessation, as nicotine relaxes the esophageal sphincter and smoking also stimulates the production of stomach acid;
  • Discontinuing the consumption of alcohol.

People with severe GERD and Barrett’s esophagus often require aggressive treatment and prevention methods including medications, other nonsurgical medical procedures such as endoscopic therapies, or even laparoscopic and open surgeries. Often times, swallowing difficulty (known as dysphagia) and other symptoms can be treated if identified early.
However, due to the aggressive nature of the disease, the majority of patients who have esophageal cancer are not surgical candidates. In these situations, the primary focus becomes palliative care – providing comfort measures to help maintain quality of life. This includes treating the dysphagia and restoring the patient’s ability to swallow food and drink liquids by opening the stricture within the esophagus.
To open the barriers caused by tumor in-growth physicians use an esophageal metal stent. Prior to the stent placement the patient may require dilation of the stricture to allow room for the stent to be positioned, thereby expanding the lumen of the esophagus. Traditionally, the placement of the stent can be a painful process for the patient, yet new technologies are making this procedure easier on the patient and physician.
New, innovative delivery systems enable accurate deployment and recapturability of the stent. This reduces the stent from moving or migrating into the stomach and thus the need for repeat procedures to replace or reposition the stent, one of the more common complications in traditional esophageal stenting.
Raising awareness about the primary pre-cursors to esophageal cancer – GERD and Barrett’s esophagus – will encourage patients with these conditions to consult their physicians for the necessary screenings and treatment options. However, when palliative care becomes the primary option for patients with esophageal cancer, recent advancements in medical device technologies enable physicians to more easily implant an esophageal stent and in turn improve patients’ quality of life.
Written by Dr. Ali Fazel
Chief of Gastroenterology and Medical Director for Advanced Endoscopy
INOVA Fairfax Hospital, Fairfax, Virginia.

Detecting Esophageal Cancer

As with many cancers, survival rates for esophageal cancer are poor when the disease is diagnosed at a later stage. Being able to spot the warning signs, get a diagnosis, and begin treatment as early as possible can dramatically improve prognosis. However, it can be difficult to diagnose esophageal cancer early because it often doesn’t cause any symptoms until the cancer has become more advanced.

But if you know the warning signs of esophageal cancer, you’re more likely to notice them as soon as they start. And if you have risk factors for esophageal cancer, it is even more important to be aware of esophageal cancer symptoms so you can get to your doctor at the first sign of trouble.

Esophageal Cancer: Early Symptoms

There are a number of symptoms of esophageal cancer: Difficulty swallowing, feeling as if food gets stuck in your throat, sudden weight loss, and pain in the chest or throat are all common. These symptoms are caused by tumor growth in the esophagus, which can block the movement of food into the stomach, leading to pain and discomfort while eating. These symptoms often do not arise until the tumor has become large and the disease has advanced.

Being diagnosed with a precancerous condition known as Barrett’s esophagus is a definite warning sign that you’re at increased risk for esophageal cancer. This is a disorder that occurs when stomach acid damages the lower part of the esophagus, and it is a major risk factor for esophageal cancer. Barrett’s esophagus typically occurs when people experience acid reflux, or gastroesophageal reflux disease (GERD), over a long period.

Only a small percentage of people with Barrett’s esophagus or GERD will get esophageal cancer but many people with esophageal cancer start out with these conditions. GERD, which can cause Barrett’s esophagus, may be responsible for around 30 percent of all instances of esophageal cancer. In many cases of esophageal cancer, Barrett’s esophagus may be the earliest warning sign detected.

Esophageal Cancer: Know Your Risk, See Your Doctor

If you have frequent heartburn or have been told you have Barrett’s esophagus, you should take steps to get the acid reflux under control and monitor your symptoms closely with your doctor.

“The precursor to esophageal cancer — at least the adenocarcinoma type — is Barrett’s esophagus. If you have a long-term history of reflux disease or heartburn, then you should go talk to your doctor about it,” says Wayne Hofstetter, MD, director of the esophageal program at the University of Texas M.D. Anderson Cancer Center in Houston.

Chronic heartburn needs to be treated and followed closely by your doctor. It’s not something you should consider a mere annoyance — it can cause serious health problems, including esophageal cancer.

“If you have heartburn for longer than 10 years, or if you have bad heartburn that’s not well treated less than 10 years, you should have an endoscopy,” notes Dr. Hofstetter. During an endoscopy, your doctor will insert a scope that has a camera on it into your mouth, esophagus, and stomach. The doctor will look for abnormal areas in the esophagus and take pieces of esophageal tissue to examine more closely. Barrett’s esophagus is diagnosed when certain cellular changes are observed under a microscope.

If you suffer from persistent heartburn, have Barrett’s esophagus, or notice any difficulty swallowing, don’t wait to get checked out by your doctor. Close monitoring can lead to early diagnosis and treatment of esophageal cancer, which greatly increases your chances of surviving the disease.

Learn more in the Everyday Health Esophageal Cancer Center.

You’ve probably seen TV commercials for over-the-counter heartburn medications that feature diners clutching at their chests after eating a big meal. But you may not know that heartburn can be a symptom of something called gastroesophageal reflux disease (GERD), a potentially serious condition that — if left untreated — can ultimately lead to esophageal cancer.

Although still considered rare, adenocarcinoma of the esophagus, the most common form of esophageal cancer, is one of the fastest growing cancers in terms of incidence. It’s most frequent in middle-aged and older white men, especially those who are overweight.

“When patients come to me after they find out they have esophageal cancer, the number-one thing they say to me is, ‘I wish I had known that GERD is related to cancer,’” says Memorial Sloan Kettering surgeon Daniela Molena, who specializes in treating esophageal cancer and other cancers of the chest. “Most of them have had GERD for a long time, sometimes decades.”

When GERD Progresses to Esophageal Cancer

GERD develops when acid that digests food in the stomach washes up into the esophagus. Often it occurs in people who overeat or who lie down too soon after eating. It may also be caused by defects in the valve that connects the esophagus to the stomach or by a condition called hiatal hernia, which is when the upper part of the stomach pushes up through the diaphragm and into the chest.

After someone has had GERD for many years, it can advance to a condition called Barrett’s esophagus. “Barrett’s is a defensive mechanism of your esophagus,” Dr. Molena explains. “When the esophagus is bathed in acid all the time, it wants to protect itself, and so the cells in the lining begin to change. These changes can advance to become cancer.”

Barrett’s is a defensive mechanism of your esophagus … can advance to become cancer. Daniela Molena thoracic surgeon

When patients develop Barrett’s esophagus, their GERD symptoms often disappear. “It’s typical for patients with esophageal cancer to tell me that they suffered from GERD for years, but then it went away and they stopped taking their GERD medications, which would have actually reduced their cancer risk,” Dr. Molena says.

Not everyone with GERD has the typical symptoms, which are heartburn and regurgitation soon after eating. Up to 20% may have different symptoms, such as coughing or chest pain, a sore throat or hoarse voice, or even frequent sinus infections. It’s important to talk to your doctor about any of these.

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Should We Screen for Esophageal Cancer in Everyone with GERD?

Experts say no. Even in people with GERD, esophageal cancer is still considered a rare disease. It occurs in about 17,000 people in the United States each year. (This number takes into account all kinds of esophageal cancer, including the other main one, squamous cell disease. This type is strongly linked to smoking and heavy alcohol consumption, making many of these cancers preventable as well.)

Not everyone who has GERD knows that they have it, because they may have atypical symptoms.

However, Dr. Molena says, some people should talk with their doctor about having an endoscopy — a test in which a scope is inserted into the mouth and down the esophagus — to look for Barrett’s esophagus. This includes people who have had GERD for more than ten years, especially those whose reflux disease started when they were very young, white males over 50, and those who have a hiatal hernia or are overweight.

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MSK’s Barrett’s Esophagus Screening Program

Only a small number of people with Barrett’s esophagus will ultimately develop cancer. But for people who have Barrett’s with no dysplasia (precancerous cells), MSK experts recommend undergoing screening with endoscopy every three to five years. We offer a screening program for these patients, who are monitored by our multidisciplinary team of experts. We may also provide surgery to eliminate GERD, especially for patients who have a large hiatal hernia or can’t take medication due to side effects.

MSK offers screening programs for people at high risk for esophageal cancer.

“Barrett’s esophagus progresses in a very methodical way,” Dr. Molena explains. “If we monitor patients with Barrett’s, we can remove precancerous lesions using an endoscope before they become more serious. Ninety percent of patients who have these procedures are able to avoid cancer, and they don’t even need to have invasive surgery.”

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Treatment Options for Those with Cancer of the Esophagus

For those who do have esophageal cancer, MSK uses treatments that are tailored to each individual patient. Most patients eventually require surgery, and 99% are able to have it through minimally invasive techniques such as laparoscopy or robotic surgery. These approaches result in shorter recovery times and fewer side effects.

Our researchers are developing more precise radiation therapy, which shrinks tumors, makes them easier to remove, and reduces the risk that the cancer will spread elsewhere in the body. MSK medical oncologists are also using genetic testing to identify which patients may benefit from clinical trials with targeted therapies.

“Treatment for esophageal cancer has improved dramatically in the past few years,” Dr. Molena says. “It’s important for patients to know that we have a lot to offer, and we are committed to helping them in their fight, from diagnosis to cure.”

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Esophageal cancer facts

In the last decade, major strides have been made in the early diagnosis and treatment of esophageal cancer.

Seattle Cancer Care Alliance (SCCA) offers comprehensive treatment for this disease from a team of experts.

  • What is esophageal cancer?
  • Types of esophageal cancer
  • Symptoms
  • Diagnosis
  • Staging
  • Causes and risk factors
  • How common is esophageal cancer?
  • Next steps

What is esophageal cancer?

Esophageal cancer occurs when cells in the esophagus begin to grow abnormally.

They do not respond to regular cell growth, division and death signals like they are supposed to. They also don’t organize normally.

Instead they grow into a tumor, which may extend into the open space inside your esophagus or break through underlying layers of your esophageal wall.

Understanding your esophagus

Your esophagus is a 10-inch long, hollow, muscular tube that connects your throat to your stomach. The wall of your esophagus has several layers of tissue that work together to push food down into your stomach when you swallow.

  • Thin, flat squamous cells line the inside of most of your esophagus. Closer to your stomach, the lining is made up of glandular epithelial cells.
  • Under the lining are submucosal tissues, which keep your esophagus moist.
  • Thick muscles under the submucosal tissues contract in waves to push food down your esophagus.
  • Connective tissue forms the outer covering of your esophagus.

Types of esophageal cancer

Usually esophageal cancer starts in the squamous cells or glandular epithelial cells that line the esophagus. From there, cancer may spread into the esophageal wall and to nearby lymph nodes or other tissues or organs.

  • Adenocarcinoma — starts in the glandular epithelial cells, usually near the bottom of the esophagus, where the esophagus meets the stomach. Often these tumors arise in people with Barrett’s esophagus.
  • Squamous cell carcinoma — starts in squamous cells anywhere in the esophagus, most often in the upper and middle esophagus.

In the U.S., adenocarcinoma is more common than squamous cell carcinoma in the esophagus. The reverse is true in the rest of the world.

  • As the rates of gastroesophageal reflux disease (GERD) and obesity have risen in the U.S., so has the rate of adenocarcinoma.
  • As the use of cigarettes and tobacco has dropped, the rate of squamous cell cancer has dropped as well.

Symptoms of esophageal cancer

Esophageal cancer can be difficult to detect early on because it may not cause noticeable symptoms until a tumor gets big enough to interfere with swallowing.

See your doctor if you:

  • Have trouble swallowing
  • Have pain with swallowing
  • Frequently choke on food

Difficulty swallowing may start with foods like meat, bread or raw vegetables, but as a tumor grows, even liquids may be painful to swallow.

Other early warning signs may result from a variety of medical issues. See your doctor if you experience any of these other potential signs for a prolonged period:

  • Pressure or burning in your chest
  • Indigestion or heartburn
  • Unexplained weight loss
  • Pain behind your breastbone or in your throat

Diagnosing esophageal cancer

After your doctor has given you a thorough exam, you may need several tests to help diagnose esophageal cancer.

Flexible endoscopy

Endoscopy, including endoscopic ultrasound, gives the best information about the structure of your esophagus. It shows complications of reflux, such as esophagitis (irritation of the esophagus), and tissues that may have cancer. For this test:

  • You are sedated (given medicine to make you sleepy and relaxed).
  • The doctor inserts a thin, flexible tube (endoscope) into your mouth or nose and down into your esophagus.
  • The endoscope has a light and a tiny camera on the end to take close-up images, which show on a video monitor in the exam room.
  • The doctor can use instruments to take a tissue sample (biopsy) so a pathologist can check the cells under a microscope for cancer.

If you have a small, early-stage cancer that has not gone deeper than the lining of your esophagus, your doctor may be able to remove all of it during your endoscopy (endoscopic mucosal resection).

Imaging studies

If your doctor finds cancer or believes you may have cancer, you will likely have imaging tests to better understand your cancer and tell whether it has spread beyond your esophagus. These may include a computed tomography (CT) scan or positron emission tomography (PET) scan.

Blood tests

Your doctor may ask you to have a complete blood count to check the level of each type of blood cell in your bloodstream. Low red blood cells (anemia) may be a sign of internal bleeding, which sometimes happens with esophageal cancer (as well as other conditions).

Stages of esophageal cancer

The treatment that your doctors recommend for esophageal cancer will be based in part on the stage of your cancer. The stage depends on:

  • How far the cancer has spread through the wall of your esophagus
  • Whether the cancer has spread to nearby lymph nodes
  • Whether the cancer has spread to other parts of your body

There are different staging systems for adenocarcinoma and squamous cell carcinoma of the esophagus. Both systems use Roman numerals I, II, III and IV, with stage I being the least advanced and stage IV being the most advanced stage.

What causes esophageal cancer?

Doctors don’t know the precise causes of esophageal cancer, but studies have identified several risk factors.

SCCA’s Gastrointestinal Cancer Prevention Program offers a personalized approach to risk assessment, screening and prevention for people at high risk for esophageal cancer and other gastrointestinal cancers.

Risk factors

These factors may affect your risk for esophageal cancer:

  • Sex — Men are nearly three times more likely than women to develop esophageal cancer.
  • Race — The disease is three times more common among African-Americans than European Americans.
  • Age — The rate of esophageal cancer rises after age 50.
  • Tobacco and alcohol — These increase the risk of developing cancer, especially squamous cell carcinoma.
  • Weight — Obesity is linked with adenocarcinoma because it is linked with GERD, which can damage the esophagus.
  • Head or neck cancers — These increase esophageal cancer risk.
  • Human papillomavirus (HPV) — People who are infected with HPV are at greater risk.
  • Injury to the esophagus — This can cause scarring and damage cells in the area and is linked with higher esophageal cancer risk.

Barrett’s esophagus

When acid from the stomach repeatedly comes up into the esophagus — as it does in GERD — the acid may damage the cells of the esophageal lining. Over time this damage can cause the cells to mutate and become more like cells in the stomach and intestine, leading to a condition called Barrett’s esophagus.

In a small fraction of people, the mutated cells turn into cancer (esophageal adenocarcinoma).

Several options, including lifestyle changes, medication, radiofrequency ablation and surgery, are available to control reflux and to prevent or treat the problems that can develop as a result of reflux.

Read more about Barrett’s esophagus and treatment options for this condition at the UW Medicine Center for Esophageal & Gastric Surgery.

How common is esophageal cancer?

About 17,000 people are diagnosed with esophageal cancer in the United States each year.

Next steps

  • Request an appointment to see an SCCA esophageal cancer expert.
  • Learn about esophageal cancer treatment at SCCA.
  • Read stories of people who’ve had esophageal cancer.
  • Find resources and support for new SCCA patients.

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