Am I At Risk For Esophageal Cancer?

If you’ve noticed yourself having trouble swallowing or experiencing indigestion, don’t ignore it. Even if it’s something that happens occasionally, it could be a sign of esophageal cancer.

Mary Maish, MD, thoracic surgeon with Franciscan Physician Network in Lafayette, Ind., discusses who’s at risk for esophageal cancer, its related symptoms and why it’s important to talk to a professional as soon as you notice them.

Key Takeaways: Esophageal Cancer

• Your esophagus helps your body squeeze food and liquids into your stomach.
• Symptoms of esophageal cancer can include coughing, chest pain, trouble swallowing, heartburn and weight loss.
• People at risk of esophageal cancer can have habits involving drinking frequent hot liquids, using alcohol and smoking. Additional risks can include obesity, a history of radiation treatment to the chest, bile reflux, GERD and Barrett’s esophagus.
• Do not ignore your symptoms, even if they’re subtle, as they can lead to esophageal cancer if they worsen.

What Role Does The Esophagus Play In My Body?

“The esophagus is a mobile tube that extends right in front of your spine from the back of your throat all the way down to your stomach,” Dr. Maish said. “It’s made out of muscle and has this ability to squeeze foods and liquids from the back of our mouth all the way down into our stomach.”

How Can I Spot Symptoms Of Esophageal Cancer?

From subtle to disruptive, symptoms of esophageal cancer can appear in many forms. The most common symptom is difficulty swallowing, which can be subtle at first, Dr. Maish said.

“You might notice a little bit of dry food sticking and assume that water will wash everything down,” Dr. Maish said. “Still, over time, it will progress to the point where swallowing anything is going to be difficult. Once it progresses, just swallowing a glass of water will take time with very small sips before you can get it down. So, it generally starts with a feeling of having something stuck at the bottom or the middle part of your esophagus.”

Other symptoms of esophageal cancer include:

• Swallowing difficulty
• Coughing
• Chest pain
• Heartburn
• Weight loss

“Sadly, esophageal cancer can become fairly advanced before people get any symptoms just because the esophagus is very pliable,” Dr. Maish said.

How Common is Esophageal Cancer?

According to the American Cancer Society, an estimated 22,530 people will be diagnosed with esophageal cancer this year. Of those, three-fourths will be men.

Who’s At The Highest Risk For Esophageal Cancer?

Like other cancer types, people with certain medical conditions or lifestyles can have a higher risk of being diagnosed with esophageal cancer.

Smoking and esophageal cancer risk

“Smoking may contribute to esophageal cancer, but there's no direct causality between smoking and esophageal cancer,” Dr. Maish said. Chewing tobacco can cause esophageal cancer at the top of the esophagus, even though it’s limited to the top.”

Heartburn and esophageal cancer risk

Dr. Maish explained that the most common reason why a person has esophageal cancer is likely due to longstanding reflux disease, such as heartburn, that has only been temporarily treated with medications.

“With ignored heartburn, the regurgitation into the esophagus continues and the chronic spillage of caustic material traveling in your esophagus can be one of the more common reasons for why esophageal cancer can occur,” Dr. Maish said.

Family history

She explained that family history can also play a role in a person’s esophageal cancer, such as patients who have a genetic predisposition for a pre-cancerous condition called Barrett's esophagus.

“Barrett's esophagus is something that can lead to esophageal cancer if unattended,” Dr. Maish said. “It’s a common genetic link that we have seen in a pre-cancerous condition, which we have seen in many patients with esophageal cancer.”

Are There Different Types Of Esophageal Cancer?

Dr. Maish explained that there are two major types of esophageal cancer.

Adenocarcinoma

“The most common in the United States is adenocarcinoma,” Dr. Maish said. “This type of esophageal cancer is the one that tends to come from conditions like Barrett's esophagus and reflux.”

Adenocarcinoma starts in the glands of the esophagus that build mucus. This type of cancer usually appears at the lower end of the esophagus.

Squamous cell carcinoma

Compared with adenocarcinoma, squamous cell carcinoma is more common worldwide, she explained.

Specifically, this type of esophageal cancer appears in the cells on the surface of the esophagus, with the cancer forming around the upper and middle parts of the tube.

“Squamous cell carcinomas can be caused by a variety of different reasons,” Dr. Maish said. “In some countries where scalding hot tea is common, such as the Middle East or China, we see high incidences of this condition.”

Dr. Maish explained that another common cause of squamous cell carcinoma is exposure to various chemicals used as preservatives, such as nitrosamines used to preserve pickled foods.

“For example, somebody who consumes a lot of mustard or pickles, or that pickled diet that we associate with some Japanese cultures, could be at risk for this condition,” Dr. Maish said. “In the U.S., the adenocarcinomas are understood to be caused mostly by reflux disease or the exposure of acid or bile acids to the bottom of the esophagus.”

How Important Is It To Get Tests Done For Esophageal Cancer?

“One of the critical things to remember is that some primary care physicians may downplay a symptom like swallowing difficulty for middle-aged people,” Dr. Maish said. “Many people at this age have difficulty swallowing for other reasons. As a result, a provider may wait until it progresses.”

Dr. Maish explained that if your symptoms are persistent or don’t resolve quickly, it’s crucial to get a second opinion.

“If you have had longstanding reflux and you have never had an endoscopy, you need to get it done,” Dr. Maish said. “If you have a colonoscopy appointment, tell your gastroenterologist that you also want an endoscopy added to your schedule. They can get that added on through the insurance company.”

She also explained that people should schedule an endoscopy appointment if they’ve ever taken any anti-acid medicine for reflux disease, even just once.

Barrett's esophagus, swallowing difficulty, and several other conditions can eventually lead to esophageal cancer if left unattended. Start a conversation with your doctor whether your symptoms are subtle or severe.