The Facts About Cancer of the Lower Esophagus

Esophageal adenocarcinoma, or cancer of the lower esophagus, has risen by 450% in the U.S. since the 1970s. The risk of esophageal adenocarcinoma increases with obesity, smoking, and poor nutrition. Gastro esophageal reflux disease (GERD) , a condition that causes stomach acid to be regurgitated back into the esophagus, can also be a factor in the development of some cases of esophageal adenocarcinoma. GERD can lead to Barrett's Esophagus (BE), a condition where cells of the tissue lining the lower esophagus transform from normal squamous cell tissue into columnar epithelial cells, similar to cells typically found in the lower intestine, in a process called metaplasia. BE is considered to be a precursor to esophageal adenocarcinoma. Although having BE means an increased risk of lower esophageal cancer, only about one percent of BE patients actually develop esophageal adenocarcinoma, and only a small percentage of people with GERD develop BE. Still, getting GERD under control early on is an important step in cancer prevention.

The esophagus is the muscular tube where food passes from the mouth to the stomach. At the lower end, the esophageal sphincter opens to allow food to pass into the stomach, and then closes again. If the esophageal sphincter malfunctions, due to a weakness in nerve or muscle, the esophagus will not close completely. In the case of GERD, stomach acid backs up through the malfunctioning esophageal sphincter, into the esophagus, a condition known as acid reflux. Chronic GERD can lead to BE, because the esophageal lining is not designed to tolerate stomach acid. BE develops over time, in response to damage from stomach acid.

Being overweight and smoking are two of the most significant risk factors for both GERD and BE. Alcohol consumption, lack of exercise, and diet, are also important factors. Risk of GERD and BE increases with age, although BE can affect people of all ages. Medications, particularly non-steroidal anti-inflammatory drugs (NSAIDS), like aspirin, ibuprofen, and naproxen, can cause peptic ulcers, and long term users are twice as likely to develop GERD. Other drugs may play a role as well. Whites and Hispanics are at greater risk than blacks and Asians, and men are at greater risk for BE than women.

Heartburn and acid reflux are symptoms of GERD. More serious symptoms requiring immediate evaluation by a doctor include difficulty swallowing, vomiting blood, bloody stools, and unintentional weight loss. BE has no noticeable symptoms. A doctor can diagnose BE by examining throat tissue for changes in color.

Having GERD does not indicate a predisposal to cancer, but managing GERD can prevent BE, a pre-malignant condition. Incidence of adenocarcinoma in BE patients is higher than in the general population, and once cells have undergone metaplasia, they cannot be transformed back into normal squamous cells. Specific lifestyle changes can help to reduce occurrences of acid reflux, and therefore reduce the risk of developing BE. A physician may recommend weight loss, quitting smoking, avoiding foods that trigger heartburn, and taking antacids or other medications to block heartburn. Some GERD patients sleep with the upper body in an elevated position, in order to prevent reflux during sleep. A diagnosis of severe GERD or BE usually calls for aggressive treatment, including medications, non-surgical procedures, or in some cases surgery.

According to the Mayo Clinic, gastroesophageal reflux can be traced to about one third of esophageal cancers. Therefore, it is important to control GERD before it becomes BE. Common sense measures that promote good health in general are effective in controlling GERD, and preventing BE. We hear it over and over, but once again won't hurt. Following a healthy diet that includes plenty of fruits and vegetables, getting regular exercise, controlling weight, not smoking, and taking an active role in your own health maintenance will go a long way in preventing serious complications like BE, and a whole lot of others too.

http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/index.htm

http://www.mayoclinic.com/health/esophageal-cancer/DS00500