Am I At Risk For Esophageal Cancer?

Many people have occasional heartburn or acid reflux. But when reflux lasts for years, it can increase the risk of a condition called Barrett’s esophagus and, in some people, esophageal cancer.

Gastroenterologist Paul Haynes, MD, explains the risk factors for esophageal cancer, what symptoms deserve attention and when to ask about esophageal cancer screening. Dr. Haynes is an independent physician who chooses to practice at Franciscan Health Indianapolis.

Key Takeaways: Esophageal Cancer Risk

• Long-term acid reflux can raise the risk of Barrett’s esophagus and esophageal cancer.
• Esophageal cancer often develops without early warning signs.
• You need medical attention if you have trouble swallowing, especially if it feels like food gets stuck.
• Talk with your doctor if you have longstanding reflux and have never had an upper endoscopy.

Barrett’s Esophagus And Your Cancer Risk

The vast majority of esophageal cancer cases are esophageal adenocarcinoma. According to the American Cancer Society, about 22,000 people in the United States are diagnosed with esophageal cancer each year.

“The risk factors of esophageal adenocarcinoma are largely due to Barrett’s esophagus, which is a consequence of longstanding acid reflux,” Dr. Haynes explained.

Long-term acid reflux is also known as gastroesophageal reflux disease (GERD). GERD happens in the esophagus, the tube that moves food and liquids from your throat to your stomach.

Over time, repeated acid exposure can change the lining of the lower esophagus. Cells similar to those of the stomach lining begin to replace normal esophageal cells. Doctors call that Barrett’s esophagus.

Barrett’s esophagus is not cancer. Most people with Barrett’s will never develop esophageal cancer. But Barrett’s can signal a higher risk, which is why doctors may recommend monitoring with upper endoscopy.

What Else Raises Your Risk For Esophageal Cancer?

Long-term GERD and Barrett’s esophagus can significantly raise the risk of esophageal cancer. Other risk factors include:

• A diet low in fruits and vegetables
• Alcohol use
• Older age
• Overweight or obesity
• Smoking

Men are at higher risk of esophageal cancer. About 75 percent of people diagnosed with the disease are men.

Why Reflux Symptoms Don’t Tell The Whole Story

Some people think severe reflux means a higher cancer risk. Dr. Haynes said symptoms don’t always work that way.

“Symptoms don’t really predict which patients are going to be at a higher risk for esophageal cancer,” Dr. Haynes said. “It’s kind of a challenge from that standpoint.”

If you have had GERD for a long time, talk to your doctor about your cancer risk, even if you manage your acid reflux symptoms well.

Symptoms You Should Not Ignore

Most people recognize common GERD symptoms such as heartburn, acid reflux or a bitter taste in the mouth. But one symptom deserves immediate attention: trouble swallowing.

If you feel like food gets stuck when you swallow, make an appointment with your primary care provider. “That’s something you really should not ignore,” Dr. Haynes added. 

Other concerning symptoms include:

• Blood in the stool
• Iron deficiency anemia
• Ongoing abdominal pain despite treatment
• Reflux that continues despite medication
• Unexplained weight loss
• Vomiting blood

When Should You Ask About Esophageal Cancer Screening?

If you have had longstanding reflux and have never had an upper endoscopy, talk with your doctor about whether you need one. Upper endoscopy is the “gold standard” screening test for Barrett’s esophagus and esophageal cancer.

During an upper endoscopy, a gastroenterologist uses a thin, flexible tube with a camera to look at the esophagus, stomach and upper part of the small intestine. The doctor may take small tissue samples, called biopsies, to check for Barrett’s esophagus or abnormal cells.

“If you have a colonoscopy appointment, tell your gastroenterologist that you also want an endoscopy added to your schedule,” Dr. Haynes said. “That’s a convenient and more cost-effective way to go about it.”

What If The Screening Shows No Signs Of Barrett’s?

If your first endoscopy is negative for Barrett’s, there’s no need for subsequent follow-up endoscopies. Dr. Haynes said patients usually either develop Barrett’s esophagus early in the course of reflux disease or they do not develop it at all.

That does not mean you should ignore new symptoms later on. But it offers reassurance for those whose screening did not show Barrett’s esophagus or concerning changes in the esophagus.

What If I Have Barrett’s Esophagus?

If you do have Barrett’s esophagus but no sign of cancer, your doctor will usually recommend regular monitoring with upper endoscopy.

During those follow-up visits, your gastroenterologist checks the Barrett’s tissue for dysplasia, or abnormal cells that can raise the risk of cancer over time.

“Barrett’s is a significant risk factor for esophageal cancer, but it doesn’t mean you are destined to develop the disease,” said Dr. Haynes.

If biopsies show dysplasia, treatment may include radiofrequency ablation to remove the abnormal tissue. Your doctor will recommend a schedule of follow-up endoscopies to monitor your condition.

Care For Reflux, Barrett’s Esophagus And Esophageal Cancer Risk

Franciscan Health offers care for reflux, Barrett’s esophagus and related esophageal concerns. Dr. Haynes said patients can receive screening and treatment, including radiofrequency ablation when needed, through Franciscan Health.

Talk with your primary care provider if you have longstanding acid reflux, trouble swallowing or other symptoms that concern you.