April is Esophageal Cancer Awareness Month. According to the American Cancer Society, about 22,000 new cases of esophageal cancer will be diagnosed in the United States this year. We’ve asked Arizona Oncology medical oncologist and hematologist, Dr. Suresh Mukkamala, to answer a few questions about this relatively rare cancer that affects more men than women.
Q: What are the first signs of esophageal cancer?
Dr. Mukkamala: “Sticking” of solid food, chest discomfort or burning could be the earliest symptoms of esophageal cancer. This is typically followed by difficulty swallowing (dysphagia) and painful swallowing (odynophagia). This difficulty swallowing can slowly progress from solids to even with liquids, due to reduction in esophageal lumen diameter. The dysphagia and odynophagia can lead to significant weight loss.
Q: Who is most at risk?
Dr. Mukkamala: Most esophageal cancers are either squamous cell carcinomas or adenocarcinomas (based on histology). The risk factors for squamous cell carcinoma are smoking, alcohol consumption, and human papillomavirus (HPV). The risk factors for adenocarcinoma are Barrett’s Esophagus, gastroesophageal reflux disease (GERD), smoking, and a high BMI/obesity.
Note: Barrett’s Esophagus is a condition where the tissue lining the esophagus changes. Normally, the lining of the esophagus is composed of squamous cells, but in Barrett’s esophagus, these cells are replaced by cells similar to those found in the intestine. This change, known as dysplasia, is believed to occur as a result of chronic gastroesophageal reflux disease (GERD), where stomach acid regularly flows back into the esophagus. Barrett’s esophagus itself usually doesn’t cause symptoms, but it is considered a precancerous condition because it increases the risk of developing esophageal adenocarcinoma.
Q: According to research, while esophageal cancer is considered rare in the U.S. cases are increasing. Can you speak to this and perhaps why this might be happening?
Dr. Mukkamala: In the United States, over 22,000 cases of esophageal cancer are diagnosed annually, with over 16,000 deaths from the disease. In the United States, smoking and excessive alcohol consumption account for approximately 90 percent of the total cases of squamous cell carcinomas. However, rates for squamous cell carcinomas are steadily decreasing because of long-term reductions in tobacco use and alcohol consumption. Incidence rates for adenocarcinomas of the esophagus have increased dramatically, due to increases in certain risk factors such as higher BMI/obesity.
Q: What is the prognosis for the average patient with esophageal cancer?
Dr. Mukkamala: The prognosis of esophageal cancer is mainly associated with the stage of the disease at diagnosis. People with early stage disease and locoregional disease are generally treated with surgery, chemotherapy and radiation (multimodality management). These patients tend to have a good prognosis. However people with distant metastases are typically treated with systemic therapy (chemo-immunotherapy), and the goal here is to control the disease and to prolong life.
Q: Many people have GERD or get heartburn. Should they be worried about esophageal cancer?
Dr. Mukkamala: Patients with gastroesophageal reflux disease (GERD) may be at increased risk for esophageal adenocarcinoma. Reflux symptoms were associated with esophageal cancer in a large case control study from Sweden. The risk was greatest among patients with long-standing (>20 years) and severe symptoms. A meta-analysis concluded that at least weekly symptoms of GERD increased the odds of esophageal cancer fivefold, whereas daily symptoms increased the odds sevenfold.
Q: Can you speak a little about Barrett’s esophagus and how that relates to esophageal cancer?
Dr. Mukkamala: For patients who have Barrett’s esophagus, the risk of developing esophageal cancer is increased at least 30-fold above that of the general population. We recommend that all patients with Barrett’s esophagus receive treatment with a proton pump inhibitor (PPI) and start on a PPI once daily. Also, endoscopic screening to detect dysplasia is recommended for patients with Barrett’s esophagus.
Note: Proton pump inhibitors (PPIs) are a class of medications commonly used to reduce the production of stomach acid. They work by inhibiting the action of proton pumps, which are enzymes found in the stomach’s lining that produce acid. By blocking these pumps, PPIs effectively decrease the amount of acid produced, thereby alleviating symptoms associated with conditions such as gastroesophageal reflux disease (GERD), peptic ulcers, and gastritis. PPIs are often prescribed to treat heartburn, acid reflux, and related symptoms by providing relief and promoting healing of the esophagus and stomach lining. They are available both over-the-counter and by prescription, and while generally considered safe when used as directed, long-term use or misuse of PPIs may be associated with certain risks and side effects, so it’s important to use them under medical supervision.
For more information about esophageal cancer, visit the American Cancer Society.