Digestion & GI health

Esophageal cancer — could you be at risk?

You may be aware of the high numbers of Americans 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 most likely you would notice symptoms of GERD before developing esophageal cancer, it’s important to be aware of the association as well as the existence of silent acid reflux.

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.

Genetics. 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.

Factors we can control. Beyond genetic factors, here are the top two risk factors that we do have the power to change:

• Cigarette smoking
• High BMI (obesity)

Other daily habits 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
• Irritation to the esophagus caused by habitually drinking very hot liquids
• Alcohol intake (more than 3 alcoholic beverages a day)
• Low vitamin D

These factors reveal that this is a largely preventable disease that can be avoided through healthy 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 people noticed a 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. This US study was fairly large, and similar results have since been reported in a smaller 2006 Swedish study and a large 2008 Australian study.

Nonetheless, carbonated soft drinks are highly acidic (pH <4.0) and increase bloating, too. People 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 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 it can disrupt your digestion!

Esophageal health — you have a say

Simple daily habits can keep your throat healthy. As you think about your risk factors for esophageal cancer, you may want to consider adopting the following measures:

• Address any acid reflux symptoms or silent reflux you may be having.
• Increase the antioxidant and vitamin-rich fruits and vegetables you consume.
• Allow your hot beverages to cool for a few minutes before enjoying them.
• Give up smoking if you do.
• Maintain a healthy weight.
• Moderate alcohol intake.
• Enjoy healthy sun exposure or supplement with vitamin D.

As the all-important route to your digestive tract, your lungs, and the seat of your voice, you have a say in the health of your esophagus.

 

Return to our article on acid reflux.

Related to this article:

References & further reading on esophageal cancer

 

Last Modified Date: 05/09/2011
Principal Author: Marcella Sweet