Only 1 percent of all cancers are of the esophagus, the tube that runs from your throat to your stomach. But esophageal cancer is a deadly disease. About 80 percent of people diagnosed with esophageal cancer live less than five years, according to the American Cancer Society.
The cancer is more common in men, and the risk increases with age. Lifestyle risk factors include smoking, alcohol and obesity. Eating processed meats and not enough fruits and vegetables also can put you at risk.
“There are patients who eat a lot of nitrates in processed foods or preserved foods that are at high risk for gastric cancer,” said Dr. Tolga Erim, a gastroenterologist at Cleveland Clinic in Weston. There is thought to be a link between gastric cancer and cancer of the very top part of the stomach and the esophagus, he said, but it’s difficult to prove, because there are so many variables in studies.
“I think as a general rule, we should really stay away from processed foods, those with chemical additives and preservatives,” Erim said.
Acid reflux also is a big risk factor. In fact, about 80-90 percent of esophageal cancer patients have had reflux, said Dr. Kfir Ben-David, chief of the Gastroesophageal Division at Mount Sinai Medical Center in Miami Beach. But not everyone who has reflux develops cancer.
Reflux happens when gastric acids back up into the esophagus. Over time, irritation to the esophageal lining can cause cellular changes, including cancer, he said. Obesity can contribute to reflux, Ben-David said, because when a patient overeats, his stomach distends, which causes an abnormal opening in the bottom part of the esophagus that allows acids to back up.
Reflux also can be diet-related. When people ingest a lot of caffeine, chocolate, spicy food, alcohol or carbonated drinks, it causes the stomach to be distended and acids to back up, Ben-David said.
With reflux, some people feel chest pain or heartburn while they are swallowing or after they have eaten a big meal, Ben-David said.
But not every patient with acid reflux has heartburn, Erim said. Those with silent reflux may cough, have asthma-like symptoms or feel like they are having allergy attacks. Those with nighttime reflux may wake up with hoarseness and a sore throat, he said.
The highest risk population for acid reflux and Barrett’s Esophagus, the precursor to esophageal cancer, in which chronic acid reflux changes the lining of the esophagus, are overweight white men ages 50 and older, Erim said.
If you are in this high-risk population and have long-term acid reflux symptoms, you should consider having an upper endoscopy to check for changes in the linking of your esophagus. Typically, the test is used for people who have had symptoms more than 10 years, Erim said.
“Some patients have had reflux for a very long time. Unfortunately, there’s no way to predict who will develop cancer and who won’t from reflux. We’re not that sophisticated yet,” Ben-David said. “If a patient is starting to take over-the-counter medicine for their reflux, and it’s not helping, or it’s an ongoing issue, they should seek medical attention.”
Esophageal cancer has very few early warning symptoms, Erim said. By the time you have symptoms, such as difficulty swallowing, the cancer may be advanced.
“About 17,000 patients are diagnosed each year, and about 16,000 die of the disease. It’s very deadly. A lot of patients get diagnosed when it’s too late,” Ben-David said.
Treatment depends on the grade of the cancer. “The deeper it goes into the tissue, the worse it is,” Ben-David said.
At an early stage, techniques that use an endoscope, a tiny camera inserted into the esophagus, can kill bad cells with radio waves or by freezing them with liquid nitrogen.
If it is very superficial, on the very top layers, it can sometimes be treated with endoscopic mucosal resection, when the top of the esophagus is shaved off, Erim said.
“Sometimes cancer in the early stages can be removed endoscopically. But those instances are rare,” Ben-David said. “Most esophageal cancers are diagnosed at later stages, which typically require chemotherapy, radiation and surgery.”
Ben-David, who joined Mount Sinai May 4, came from the University of Florida, where in 2007 he implemented a minimally invasive surgery to remove and rebuild the esophagus laparoscopically. He has performed about 400 procedures, and he has taught the procedure to surgeons from around the world.
“The recovery time is much better, and we’re not compromising the cancer operation. We’re not taking shortcuts,” Ben-David said. “We want to make sure the patient has the best chance for cure.”
Tips to prevent acid reflux
▪ Stop smoking.
▪ Limit intake of alcohol, spicy foods, carbonated drinks and caffeine. Watch for reflux triggers like fried or fatty food, chocolate, citrus, tomatoes, onion and garlic.
▪ Eat slowly, and only until you are full.
▪ Keep your weight down.
▪ After eating, stand up and walk around. Don’t lie down.
▪ When sleeping, prop your head up with pillows, or put books under the mattress to elevate your head.
▪ Wear comfortable clothing. Avoid tight fits around your mid-section.
Julie Landry Laviolette