How to Protect Yourself
With the incidence of some cancers (such as lung cancer) now declining, you might assume—or at least hope—that this promising trend applies to all malignancies. But this isn’t the case for a certain type of esophageal cancer. The rate of this malignancy has increased by nearly six-fold in recent decades, making it one of the fastest-growing cancers in the US.
THE NEW RISKS
A generation ago, most US patients with esophageal cancer had a type of malignancy known as squamous cell carcinoma. Largely due to smoking and drinking, it mainly affects the upper two-thirds of the esophagus and remains the predominant type worldwide. Now, as the incidence of esophageal squamous cell carcinoma has declined in the US, another form, known as adenocarcinoma, affecting primarily the lower third of the esophagus, has dramatically increased. Interestingly, there’s also a different set of risk factors for this cancer.
How anatomy plays a role: We all know that what we eat and drink passes through the esophagus, the tube that connects the throat to the stomach. What goes down, however, is less of a problem than what comes up. What to watch for…
• Heartburn. The upsurge of acid and other digestive juices into the esophagus from the stomach can cause tissue damage that can lead to cancer.
One in five American adults suffers from frequent heartburn and/or damage to the esophagus due to chronic reflux, also known as GERD (gastroesophageal reflux disease). The classic symptoms include heartburn and reflux (the sensation of food or fluid rising from the stomach into the chest). But the true number may be higher because many people have atypical GERD, where they have other symptoms—such as hoarseness, an unexplained cough or the feeling of a lump in the throat—but not the characteristic burn. Others have an even more dangerous form, silent GERD, which has no symptoms at all.
Even though GERD is a cancer risk factor, don’t worry too much if you have heartburn only once or twice a month (but be sure to mention it at your annual physical). Do consult a doctor if you have heartburn once or more a week…or if you have any of the other atypical symptoms mentioned above. You may be advised to have an endoscopy, in which a long flexible tube with a camera and light at one end is inserted through the mouth into the esophagus, stomach and upper part of the small intestine to look for signs of damage from GERD, such as scar tissue formation, or Barrett’s esophagus (see below), a precancerous condition.
What you can do: The foods that can trigger heartburn vary from person to person, so try to identify and avoid your food triggers. And don’t eat within two hours of lying down. For occasional relief, you can try an antacid such as Tums or Maalox or an acid-suppressing drug such as ranitidine (Zantac) or famotidine (Pepcid). But using these drugs more than once every few weeks is a sign that you need to see your doctor soon—before you do more damage to your esophagus.
• Barrett’s esophagus. If you have frequent or severe episodes of GERD, you could be at risk of developing Barrett’s esophagus. This precancerous condition, in which the chronic onslaught of digestive fluids causes tissue-damaging cell changes, increases risk for esophageal adenocarcinoma by 40 times. Barrett’s esophagus should be monitored closely by a physician.
What you can do: Even with the dietary advice above, you will likely need a strong acid-reducing drug called a proton-pump inhibitor (PPI). PPIs include omeprazole (Prilosec) and lansoprazole (Prevacid). Endoscopic ablation or even surgery may be required in advanced cases.
• Weight gain. This could be the main reason for the increase in esophageal cancer. Being overweight or obese adds intra-abdominal pressure, which increases the chance that stomach contents will be pushed up into the esophagus.
What you can do: Eat healthier foods. Also, you may have heard it before, but it really is helpful to eat smaller, more frequent meals—the less you put in the stomach at a time, the harder it is for the contents to back up into the esophagus and do damage. And try exercising regularly—even walking after dinner will help empty the stomach.
• Alcohol. You may assume that the “burn” of alcohol going down damages the esophagus. But small amounts of alcohol do not cause cell damage. The real problem is alcohol’s role in triggering GERD.
What happens: Alcohol relaxes the lower esophageal sphincter (LES), the ringlike muscle at the junction of the stomach and esophagus. This muscle keeps the bottom end of the esophagus closed, which helps prevent reflux. The more you drink, the more the LES relaxes—and the more likely you are to have an upsurge of stomach contents.
What you can do: If you’re prone to heartburn, limit your alcohol consumption. Women should have no more than one drink a day, and men should have no more than two. And don’t drink any alcohol within two hours of lying down.
• Coffee. Years ago, researchers noticed a high incidence of esophageal cancer in parts of the world where hot beverages are frequently consumed and speculated that this practice may be behind the high cancer rate. Subsequent research did not support this hypothesis—with a caveat. Coffee is usually served hot, and it can play a role in GERD…but heat isn’t the issue. Rather, the caffeine in coffee, like alcohol, relaxes the LES and makes reflux more likely.
What you can do: Limit coffee to two or three cups a day—or even less if you keep having reflux. Have it early in the day and not before bedtime. You might want to switch to decaf, although it too contains some caffeine and may affect those who are sensitive. Any caffeinated beverage can trigger reflux—and so can chocolate and peppermints!