You may have seen TV commercials for over-the-counter medications that make light of heartburn sufferers. They tend to portray a person in distress after eating an overly large or unhealthy meal. What often isn’t made clear in these commercials is that heartburn can be a symptom of gastroesophageal reflux disease (GERD), a severe form of acid reflux that — if left untreated — can lead to esophageal cancer.

Although still considered rare, adenocarcinoma of the esophagus is the most common form of esophageal cancer, and is one of the fastest-growing cancers in younger adults. The five-year survival rate for adenocarcinoma of the esophagus is less than 20 percent. Indigestion, a broad term defined by heartburn, trouble swallowing, acid reflux, abdominal pain and other gastrointestinal symptoms, can be a first sign.

The stomach normally makes strong acid and enzymes to help digest food. In some people, acid can escape from the stomach up into the lower part of the esophagus. This is how reflux occurs. People with GERD have a slightly higher risk of getting adenocarcinoma of the esophagus. This risk seems to be higher in people who have more frequent symptoms, according to the American Cancer Society.

“Heartburn, or reflux, is a risk factor for esophageal cancer but that doesn’t mean that if you experience acid reflux periodically you’re going to develop cancer,” says Prakash Gatta, M.D., FACS, a doctor on the medical staff of Texas Health Fort Worth and an esophageal surgeon with Texas Health Surgical Specialists, a Texas Health Physicians Group practice. “Step by step, reflux that goes on for a long time can damage the inner lining of the esophagus resulting in something called Barrett’s esophagus. Barrett’s esophagus is considered a precancerous condition, so people who have it are linked to a much higher risk of developing esophageal cancer than people without the condition.”

Gatta, whose areas of clinical focus include oncology of the esophagus and treatment of GERD, notes that Barrett’s esophagus represents long-term change or damage to the lining of the esophagus. “When the esophagus is continually bathed in acid it wants to protect itself, so the cells of the lining begin to change. It’s these changes that can advance to become cancer.”

“The problem is there aren’t currently good esophageal cancer screening guidelines, so this cancer often goes undetected and undiagnosed until it is in an advanced stage,” Gatta explains. “For this reason, patients who are diagnosed with late-stage esophageal cancer typically have poor outcomes and more so than those with early-stage disease.”

When To See a Doctor

Not everyone with GERD has the typical symptoms of heartburn and regurgitation soon after eating. Some report experiencing coughing or chest pain, difficulty swallowing, a sore throat or hoarse voice, or even frequent sinus infections. If a patient with long-term reflux begins noticing weight loss, trouble swallowing or symptoms that improve for no reason, Gatta says they should make a point to visit with their doctor.

Because esophageal cancer can have few warning signs and go undetected for many, Texas Health is helping lead the way in awareness, care and finding a cure.

If esophageal cancer is suspected, an upper endoscopic biopsy and additional advanced upper endoscopic procedures, such as ultrasound, may be done to evaluate the esophagus and collect a sample of esophagus cells. Upper endoscopy can provide information about the size and spread of a tumor if one is found. If the cancer is caught early and there is no sign of lymph node involvement, the tumor may be able to be removed with surgery. 

At Texas Health, patients diagnosed with esophageal cancer have access to a minimally invasive approach to tumor removal as well as access to the latest trials and radiation and chemotherapy treatments. Texas Health Fort Worth is one of only a few North Texas hospitals with the capability to treat esophageal cancer using a robot-guided esophagectomy.

“The complex procedure requires removal of the bottom part of the stomach and lower esophagus, but the patient benefits from a minimal hospital stay with less downtime and fewer side effects than an open surgery,” Gatta says.

Takeaways

The rate of adenocarcinoma esophageal cancer is on the rise, especially among younger adults. Chronic heartburn, or reflux, is a risk factor for Barrett’s esophagus and, ultimately, esophageal cancer. According to Gatta, a person may be considered high risk for the disease if they:

• are overweight and experience ongoing reflux,
• are male,
• have a family history of esophageal cancer,
• have a history of hiatal hernia,
• experience difficulty swallowing, or
• have new heartburn or heartburn that goes away after a good amount of time.

Most patients with early-stage cancer in the esophagus eventually require endoscopy and further surgery. If you have severe reflux and want to get off medications or medications are no longer working, Gatta recommends talking to a doctor about having an upper endoscopy.

“If there are no symptoms but something looks abnormal on imaging, or if food is getting stuck and you’re losing weight, an upper endoscopy may be in order. It’s so much better to be safe than sorry.”

Learn more or find a specialist to address your digestive health needs or provide advanced cancer care at TexasHealth.org.