Digestion & GI health
Esophageal cancer — could you be at risk?
You may be aware of the high numbers of American who suffer acid reflux, where the contents of the stomach can splash up past a leaky esophageal sphincter into the throat, causing the acrid taste we associate with heartburn. But did you know that many people experience “silent acid reflux,” and don’t notice an unpleasant taste or any other symptoms?
This can be a problem for some because up to one in ten people who suffer acid reflux may develop a condition known as Barrett’s esophagus, which can lead to esophageal cancer. In fact, a history of reflux is the third most established risk factor for this type of cancer. So even though it’s likely you would notice symptoms of GERD before developing esophageal cancer, it’s important to be aware of the association and that it can begin to develop without overt symptoms.
In Barrett’s esophagitis, the cells lining the throat respond to frequent exposure to acid by becoming more like the cells lining the stomach and intestines. And whenever there are cellular changes taking place that are not natural for our bodies to make, it increases the opportunity for mutations to occur. This can be a set-up for esophageal cancer, first because it increases the chances that mutations will occur in those cells, and second because the inflammation that arises as a result of acid irritation can cause oxidative stress and free radical damage. Taken together, the twin insult of irritation and inflammation are known to be carcinogenic in throat tissue.
Other risk factors for esophageal cancer
It is worth noting here that there are two major types of cancer of the esophagus, squamous cell and adenocarcinoma, and that the risk factors most closely associated with them differ because the structure of the tissues involved differs. So the changes that bring about cancer development in those cells involve slightly different mechanisms. Esophageal adenocarcinoma is the type most associated with acid reflux.
Recently published research has shown that there are certain genetic abnormalities that are strongly linked with likelihood for developing esophageal adenocarcinoma from Barrett’s. Scientists think additional studies along these lines may help single out which Barrett’s patients need the closest monitoring. But keep in mind that even in people who have genes placing them at higher risk, there may be simple ways to prevent cellular changes from progressing to cancer.
Beyond genetic factors, the number-one and number-two risk factors are within our ability to change:
- Cigarette smoking
- High BMI (obesity)
Up to 80% of cases of esophageal cancer are attributable to these top three risk factors: a history of acid reflux, smoking, and being overweight.
Other factors that appear to contribute include the following:
- Consumption of fruits and vegetables less than twice per day
- Use of medications that weaken the lower esophageal sphincter
These factors reveal that this is a largely preventable disease that can be avoided through diet and lifestyle choices.
Esophageal cancer and soft drinks
One dietary habit believed for years to be associated with risk of esophageal cancer was a high intake of carbonated soft drinks. This association was made because of the parallel increase in soft drink consumption with esophageal adenocarcinoma in the US. Interestingly enough, however, researchers centered at Yale School of Medicine claim to have debunked this as a myth. The US study was fairly large, and similar results from a smaller 2006 study were reported by researchers in Sweden as well.
Nonetheless, subjects in the US study who drank greater amounts of diet and regular soda self-reported more frequent reflux symptoms than those who consumed it less often, so it’s still clearly a habit that bears watching. And either way, carbonated soft drinks will never make it to our list of favorite drinks. We continue to advise moderation, if not overt caution, when it comes to drinking soda. There are plenty of reasons to avoid it — not just because of its disruptive effect on your digestive system!
Symptoms of gastroesophageal cancer
So there’s much more to acid reflux than its unpleasant taste and harmful effects on our digestion. As with all health matters, prevention and early detection are key! The following are symptoms often associated with cancerous changes in the esophagus:
- Heartburn
- Regurgitation of undigested food
- Pain or difficulty with swallowing
- Food getting caught during swallowing
- Unexplained weight loss
- Vomiting blood
- Dark or tarry stools (indicating bleeding higher in GI tract)
Most Barrett’s esophagus patients never develop cancer, but it’s important to know where you stand so any malignant changes can be caught early. If you notice any of the above symptoms of esophageal cancer, be on the safe side and call your healthcare practitioner for evaluation and follow-up.
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Related to this article:
References & further reading on esophageal cancer
Original Publication Date: 04/06/2007
Last Modified: 03/27/2008
Principal Author: Marcella Sweet