Most of us think of heartburn as just a nuisance. It’s that uncomfortable feeling we experience after a meal or at bedtime. Most don’t give much concern to their occasional heartburn, but this and other symptoms are signs of Gastroesophageal Reflux Disease (GERD). Many people don’t realize the fact that longstanding GERD has esophagus cancer risks.
GERD is caused when the valve between the swallowing tube (esophagus) and stomach malfunctions. The malfunctioning valve allows acid and stomach contents to back up into the esophagus causing the typical symptoms of burning and regurgitation. GERD can even cause chronic cough, hoarseness, damage to tooth enamel, worsening of asthma or emphysema, and sleep disturbances. Many patients do not even realize that GERD is the underlying cause of their symptoms. The damaging effects of reflux can also occur without any symptoms at all. Left untreated, GERD can lead to serious health problems, including esophagitis (inflammation of the lining of the esophagus), strictures (narrowing of the esophagus), swallowing difficulties and cancer.
Cancer of the lower esophagus is called adenocarcinoma and is caused by GERD. Its frequency is increasing at an alarming rate, faster that any solid tumor ever measured. In fact, this frequency has increased almost 800% since 1975, and some have referred to this as an epidemic.
The graph below illustrates the increase in the frequency of GERD-induced esophageal cancer compared to other cancers. The difference is dramatic. This year, there will be almost 25,000 cases of adenocarcinoma originating in the lower esophagus, and most will die of this disease.
Once discovered, the overall death rate within 5 years of a diagnosis of esophageal cancer is 85-90%, while it is only approximately 20% for colon cancer! Even in the face of this information, little is being done to address these GERD cancer risks. In a famous study done in 1999, the link between esophageal adenocarcinoma and GERD was established. In patients with GERD, the incidence of cancer was 8 times higher than those without GERD symptoms. It is undeniable that having GERD alone increases the risk of cancer significantly.
Facts about GERD Cancer Risks:
Over the years a lot has been learned. A pre-cancerous change in the cells lining the esophagus called Barrett’s esophagus is present in 10-15% of people with GERD. Barrett’s esophagus is diagnosed by endoscopy and taking biopsies (small tissue samples) of areas of abnormal appearing tissue from the lining of the esophagus. We also know that if Barrett’s esophagus is diagnosed and endoscopies are performed about every 3 years (time interval recommendations vary), if cancer develops it will be diagnosed very early with a cure rate of nearly 90% compared to the overall cure rate of 10-15%. Better yet, these early cancers can often be treated without surgery with the latest technological developments. It is the discovery of Barrett’s esophagus that identifies the population of people at risk for cancer.
There is no reason to expect this rise in GERD-induced esophageal cancer to abate. We know that the presence of GERD alone increases the chance of developing cancer, but Barrett’s esophagus is the particular condition “marking” cancer risk. If Barrett’s esophagus can be identified by endoscopy and biopsies, the likelihood is very high that a cancer will be found in an early stage, where a cure can be expected.
If you have GERD, particularly if your symptoms are longstanding and you have other risk factors noted above, discuss with your physician the possibility of getting an endoscopy performed. Although recommendations from various medical societies and physicians may differ, if you have GERD and are found to have Barrett’s esophagus and then go on to get cancer, the likelihood of cure from this otherwise lethal malignancy is good! Because of this, the DeKalb Medical Heartburn Solutions Center includes a cancer risk assessment as a component of our comprehensive evaluation. For more information call 404.501.RFLX (7359).