Esophageal cancer: difficulty swallowing may signal something serious

J. Rob Headrick, M.D., thoracic surgeon, CHI Memorial Chest and Lung Cancer Center

J. Rob Headrick, M.D., thoracic surgeon, CHI Memorial Chest and Lung Cancer Center

We all know someone who lives with constant heartburn and indigestion. More than just the irritation that acid reflux or gastroesophageal reflux disease (GERD) can cause, these conditions may lead to a much more serious health issue – esophageal cancer. An estimated 150 million people have acid reflux, which puts a large portion of the population at risk for eventually developing the disease. That’s why controlling the effects of acid reflux or GERD is about more than alleviating pain and discomfort – it’s about cancer prevention, too. 

Many people ignore the symptoms of acid reflux or think it’s something they just have to live with. Since there is no recommended screening for esophageal cancer, the discovery of disease is led by symptoms. There’s one sign in particular that shouldn’t be ignored – difficulty swallowing.

Food getting stuck in your esophagus doesn’t necessarily mean cancer – you may be experiencing a stricture or narrowing due to another cause. As the condition worsens, people often change their eating habits without realizing it. Any change in your ability to swallow is a preliminary sign warning sign for esophageal cancer that should be evaluated right away. 

Why is this kind of cancer on the rise?

When you go back 50 years, most esophageal cancers were a different type and in a different location than we are seeing today. Squamous cell carcinoma, which usually occurs in the middle of the esophagus, was due in part to nitrates in meats and preservatives in other foods. Excessive alcohol use and smoking were almost always associated.

Today, nearly all the esophageal cancers are adenocarcinomas – located at the bottom of the esophagus and directly related to acid reflux and the rise of obesity. There’s a been change in the last 30 years in the number of people who are obese and in the way people eat. Along with an increase in caffeine, chocolate, alcohol, and fatty food consumption, people are eating food in larger quantities. These factors could be leading to an evolutionary change that’s having an impact on the number of people diagnosed.  

Digging a little deeper, there’s a valve at the bottom of the esophagus that connects to the stomach and keeps the acid inside contained. It’s called the lower esophageal sphincter. When this valve doesn’t function properly, it stays open and allows acid reflux to occur. People feel this when they eat a huge meal, burp or have indigestion. It usually feels even worse when you lie down because gravity is working in the wrong direction, letting acid move upward.

Some people are born with a dysfunctional esophageal sphincter, which also allows the stomach acid to creep up – and we don’t know what causes it to happen. But no matter the reason – a deformity or as a result of poor eating habits – we do know when acid comes from the stomach into the esophagus and throat repeatedly, you’re more like to develop a condition called Barrett’s Esophagus. This precancerous condition causes the normal lining of the esophagus to change – resembling more closely the lining of the intestines. When you have Barrett’s Esophagus, you’re at increased risk of developing esophageal adenocarcinoma.

When should I see a specialist?

If you have a sore throat, you know something isn’t right. When you twist an ankle, you know it needs attention. But if you wait for those typical warning signs of pain in the lungs or esophagus, it’s going to be too late for effective treatment. No one can feel those types of sensations in their chest, and that’s what makes early detection so difficult.

It’s important to see a gastrointestinal specialist immediately for further evaluation if you:

  • have a history of cancer, especially cancers of the chest, and are living with constant heart burn or GERD.
  • have heart burn and food isn’t going down like it should. Trouble swallowing is never normal and should evaluated.
  • experience discomfort or pressure in your chest or worsening heartburn and indigestion that isn’t helped by a change in diet or medication.
  • are constantly hoarse or have a chronic cough in combination with acid reflux.

Most of the time, esophageal cancers don’t cause symptoms until they are in an advanced stage – when they are more difficult to treat. Paying more attention to subtle changes is the first step in finding – and beating – this disease.  

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