Find care now
If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.
Heartburn, a symptom of acid reflux, is annoying and uncomfortable. But when it doesn’t go away with medication and diet changes, it could be a sign of something serious: cancer of the esophagus.
The esophagus is the tube that connects the mouth and throat to the stomach. Cancer can form when cells in the lining of the esophagus grow out of control. The National Cancer Institute estimates that more than 22,000 people will be diagnosed with cancer of the esophagus in 2024, and more than 16,000 will die.
When detected early, esophageal cancer is treatable. Without proper treatment, it can progress quickly and become dangerous. Five years after diagnosis with esophageal cancer, 21.6% of people are still alive.
One of the reasons why esophageal cancer is dangerous is that it has few symptoms until it is advanced so catching it early can be tricky. When signs do appear, they include:
- Difficulty swallowing
- Indigestion and heartburn
- Weight loss
- Hoarse voice
- Chest pain
- Cough
Occasional heartburn doesn’t usually cause a problem. But chronic reflux can cause severe inflammation that can transform the cells of the lining of the esophagus, eventually leading to cancer.
Since esophageal cancer develops over time, knowing your personal risk for the disease will help us catch it early. Expert medical care and understanding your family and personal history of cancer—as well as lifestyle choices such as diet, exercise, and drinking—are key in determining your risk.
The good news is that there are changes you can make with help from a healthcare provider to reduce your risk of developing cancer of the esophagus. My colleagues and I in gastroenterology, medical oncology, and beyond work as a team to help each patient understand their risk, and to diagnose and treat the disease with advanced and minimally invasive techniques to provide a tailored treatment plan.
Understanding the types of esophageal cancer.
There are two main types of esophageal cancer: adenocarcinoma and squamous cell carcinoma. They tend to develop in different parts of the esophagus, occur more often in different types of people, and have different factors that contribute to your risk.
Adenocarcinoma
Adenocarcinoma is the most common form of esophageal cancer in the U.S. and other high-income Western nations. It is most often found in the lower portion of the esophagus.
Tobacco use, alcohol, and obesity all raise your risk of developing adenocarcinoma, but it is perhaps most closely associated with gastroesophageal reflux disease (GERD), or severe, chronic reflux.
The stomach’s acid helps digest food, but when it escapes into the lower portion of the esophagus during GERD it can sometimes cause symptoms like heartburn. Even without symptoms, people with reflux have a higher risk of developing adenocarcinoma of the esophagus. GERD is common, and most people do not develop cancer of the esophagus.
When reflux continues over time, the inner lining of the esophagus can become damaged, a condition known as Barrett’s esophagus. People with this condition are at a higher risk of developing esophageal cancer. Adenocarcinoma is most common among white men.
Squamous cell carcinoma
Once the most common type of esophageal cancer worldwide, squamous cell carcinoma is now most often found in China and India. It is increasingly rare in the U.S. It tends to occur in the middle and upper portion of the esophagus.
Lifestyle factors like tobacco and alcohol use increase your risk for developing squamous cell carcinoma. The human papilloma virus—a sexually transmitted disease behind cancers of the cervix, anus, penis, vagina, and mouth— has also been associated with this type of esophageal cancer.
Squamous cell carcinoma is more common in people with lower incomes and those from historically minoritized backgrounds.
Related reading: Early Signs of Esophageal Cancer
How to reduce your risk of esophageal cancer.
There are steps you can take to lower your risk of developing cancer, and they can help you lead an all around healthier life, too.
- If you use tobacco, quit. All forms of tobacco increase your risk for developing cancer of the esophagus, including vaping and chewing tobacco. Studies are ongoing, but alternatives like hookah and cannabis may also increase your risk—when it comes to the esophagus smoking is smoking.
- Limit alcohol. As a socially-accepted drug, alcohol can be difficult to avoid. Drink in moderation if you choose to drink, and don’t combine alcohol and tobacco.
- Maintain a healthy weight. Being overweight can increase your risk of esophageal adenocarcinoma, so talk with your doctor about how to achieve a weight that’s healthiest for you.
- Eat plenty of fresh foods and vegetables. It’s not clear yet if processed foods contribute to esophageal cancer. Anecdotally, patients with esophageal cancer tend to consume diets with a lot of processed foods and meats. Eating better can help you be healthier and reduce your overall risk. Studies have shown dark green or yellow fruits and vegetables help prevent some types of cancer.
- Exercise. Some studies have shown that regular exercisers have a lower risk of adenocarcinoma.
If you have reflux that doesn’t go away for two weeks, talk with a doctor about your family history and whether you should be checked for esophageal cancer. To examine your esophagus, we may insert a thin tube with a camera and a light called an esophagoscope into your esophagus.
Sometimes, we use the scope to remove a sample of tissue for testing. The procedure is performed under sedation. It takes 30-90 minutes, and patients return home to rest after the endoscopy.
Related reading: Esophageal Cancer: Know the Risks.
Treatment for esophageal cancer.
Early diagnosis is key to better outcomes. However, esophageal cancer is often diagnosed in the advanced stages, after symptoms begin and when treatment is more complicated.
Once we’ve diagnosed esophageal cancer, our teams use a number of tests to determine how advanced the cancer is and whether it has spread to other parts of the body through the lymphatic system. Cancer cells can break free and travel to other parts of the body through the series of tubes and nodes that function as a healthy body’s waste removal system.
Our specialist teams work together to develop a treatment plan that is tailored to each patient’s cancer. For the best outcomes, we may use a combination of chemotherapy, immunotherapy, and radiation therapy in addition to surgery.
Because surgery for esophageal cancer involves removing a portion of the esophagus, it can be complicated. I recommend that patients receive treatment at a high-volume cancer center like the MedStar Georgetown Cancer Institute at MedStar Washington Hospital Center. My colleagues are very experienced in these surgeries, offering the best chance at a positive outcome.
As many as 50% of patients will develop recurrence of esophageal cancer after treatment because tiny cancer cells can remain undetected and multiply over time. Routine follow-up endoscopy and imaging like a CT scan can help detect recurrence early.
A new immunotherapy drug recently approved by the FDA called tislelizumab could help patients with esophageal squamous cell carcinoma who were previously treated with chemotherapy. Additionally, an immune checkpoint inhibitor like nivolumab or pembrolizumab can provide benefit for some previously untreated patients when used in combination with chemotherapy.
Treatment at a high-volume center makes a difference.
Esophageal cancer specialists at MedStar Washington Hospital Center are specially trained to treat gastrointestinal cancers with advanced techniques in surgery, radiation, medication, and radiology. We see more patients than the average hospital, including the most complex cases that require specialized care.
Our treatments are backed by the latest research through the Georgetown Lombardi Comprehensive Cancer Center at MedStar Georgetown University Hospital, so our patients often have access to the latest clinical trials before the drugs are available to the public at large. What’s more, we provide holistic care that considers the whole patient, including and especially nutritional support that can be critically important to the best care for esophageal cancer.
If you have acid reflux that doesn’t go away, be sure to talk with your doctor. Sometimes it’s just heartburn, but sometimes it’s not. Knowing the difference could save your life.
