The American Cancer Society estimates that esophagus cancer, technically known as esophageal adenocarcinoma, will cause over 15k – 18K deaths in 2014 in the U.S. alone. While esophagus cancer is rare, making up only 1% of all cancer diagnoses per year, the mortality rate is the fourth highest of all cancers, behind pancreatic, liver, and lung cancers. Though great strides have been made in the survival rate of this disease, it remains formidable cancer and one that should be taken seriously by everyone with chronic GERD.
What is Esophageal Adenocarcinoma?
Esophagus cancer is broadly defined as any malignant tumor that develops in the esophagus, although the term is usually used to describe a type of cancer called ‘carcinoma.’ Carcinomas arise from the surface cells of the esophagus and develop when chronic irritations spawn mutations in the cells resulting in DNA change. This DNA change can cause cells to grow abnormally large, as well as divide and multiply (tumors). If these cells are malignant, they can spread out of control into other parts of the body.
There are two main types of carcinoma of the esophagus: squamous carcinoma and adenocarcinoma. It’s important to understand that these are two completely different diseases. While we don’t fully understand what causes squamous carcinoma, we do know that smoking and alcohol consumption are risk factors and that this type of cancer is declining in incidence. On the other hand, we do know what causes adenocarcinoma – GERD! Unfortunately, the incidence of adenocarcinoma is rapidly increasing. In fact, there has been a six-fold increase in the incidence of the disease since 1975, which is why it’s so critical for people with GERD to take control of their health.
Learn more: Defining esophageal cancer
Symptoms of Esophagus Cancer
The signs of esophagus cancer can be very subtle and hard to detect. Furthermore, esophagus cancer symptoms are often confused as symptoms from less harmful conditions. In some cases, these early cancer symptoms do not cause great pain or alarm and can be easily dismissed, so people often don’t seek immediate medical attention for them. The most common symptoms include:
- Dysphagia: Swallowing difficulty
- Accidental weight-loss
- Persistent pressure or burning in the chest
- Progressing indigestion or heartburn, with symptoms growing in severity
- Chronic coughing, hoarseness, as well as chronic sinus irritations.
Tests and Diagnosis
Esophageal adenocarcinoma is diagnosed via endoscopy and biopsy. An endoscopy is a procedure that involves lowering a tube with a camera down into your esophagus. With the camera, your doctor can visually examine your esophagus for evidence of cancer.
Learn more: What to expect from an upper endoscopy
A biopsy is a procedure where tissue from your esophagus is examined in a laboratory. This procedure also requires a scope to attain the sample from the area where the skin irritation is discovered.
Learn more: The role of biopsies in the diagnosis of GERD
Once cancer is diagnosed
If cancerous cells are found in the esophagus, one of four stages will apply. As the stages progress in number, the survival rate lowers, and more aggressive procedures are needed to fight cancer.
This stage is diagnosed when cancer is found only in the surface/outer layer of the esophagus. If esophagus cancer is discovered early enough, resulting in Stage I diagnosis, an endoscopy could be performed to remove the threatening tumors, as well as the surrounding healthy tissue to ensure its complete eradication.
In this stage, the cancerous cells have spread deeper in into the esophageal tissue and possibly to nearby lymph nodes. Depending on the severity of cancer and how far it may have spread, two surgical options may are typically prescribed.
An esophagectomy aims to remove whole portions of the esophagus and if needed, the affected lymph nodes. The esophagus and stomach are surgically rejoined by pulling the stomach upward to reconnect the organs.
The other option is an esophagogastrostomy. Like the esophagectomy, this procedure removes a portion of the esophagus but also removes the higher portion of the stomach, as well. A reattachment process is also required to connect the stomach with the esophagus, and if needed, a portion of the colon can be used to help connect the two areas.
Stage III is a more severe condition where cancer has spread into the deepest layers of the esophagus, as well as lymph nodes and other areas. In this stage, depending on how far the cancer has spread, an esophagogastrostomy is a likely surgery combined with chemotherapy, radiation therapy, or both.
Chemotherapy is a medication therapy that uses drugs to kill cancer cells. Often performed post-surgery, chemotherapy can also be taken alone without surgery. Radiation therapy attempts to kill cancer cells with powerful energy rays.
This stage is diagnosed when cancer has entrenched itself in many nearby areas deep in the tissue. All surgeries and therapies are considered at this stage. This is the most severe stage with the lowest survival rate.
Learn more: Esophageal cancer survivor offers hope
What can you do to avoid disease progression
It’s important to understand that the risk of developing esophagus cancer is small, but very real. If you have chronic GERD, you must stay vigilant about your health. Early detection of esophageal cancer offers the best hope for successful treatment of the disease, so pay attention to any changes in your symptoms and be sure to see your doctor if you have any concerns about your cancer risk.
For more information on esophagus cancer, visit the National Cancer Institute’s Patient Website.