When Heartburn Signals Cancer Risk

By Julie Grisham,

Tuesday, April 26, 2016

Older man talking with a doctor about esophageal cancer.
Summary

Gastroesophageal reflux disease (GERD) is a potentially serious condition that, untreated, can ultimately lead to cancer of the esophagus. MSK surgeon Daniela Molena discusses what you should know about GERD, a related condition called Barrett’s esophagus, and esophageal cancer.

Highlights
  • Although it’s still considered rare, adenocarcinoma of the esophagus is one of the fastest growing cancers.
  • Middle-aged and older white men who are overweight are at greatest risk of developing the disease.
  • MSK offers screening programs for those most likely to develop adenocarcinoma of the esophagus.

You’ve probably seen TV commercials for over-the-counter heartburn medications that feature diners clutching at their chests after eating a big meal. But you may not know that heartburn can be a symptom of something called gastroesophageal reflux disease (GERD), a potentially serious condition that — if left untreated — can ultimately lead to esophageal cancer.

Although still considered rare, adenocarcinoma of the esophagus, the most common form of esophageal cancer, is one of the fastest growing cancers in terms of incidence. It’s most frequent in middle-aged and older white men, especially those who are overweight.

“When patients come to me after they find out they have esophageal cancer, the number-one thing they say to me is, ‘I wish I had known that GERD is related to cancer,’” says Memorial Sloan Kettering surgeon Daniela Molena, who specializes in treating esophageal cancer and other cancers of the chest. “Most of them have had GERD for a long time, sometimes decades.”

When GERD Progresses to Esophageal Cancer

GERD develops when acid that digests food in the stomach washes up into the esophagus. Often it occurs in people who overeat or who lie down too soon after eating. It may also be caused by defects in the valve that connects the esophagus to the stomach or by a condition called hiatal hernia, which is when the upper part of the stomach pushes up through the diaphragm and into the chest.

After someone has had GERD for many years, it can advance to a condition called Barrett’s esophagus. “Barrett’s is a defensive mechanism of your esophagus,” Dr. Molena explains. “When the esophagus is bathed in acid all the time, it wants to protect itself, and so the cells in the lining begin to change. These changes can advance to become cancer.”

Barrett's is a defensive mechanism of your esophagus … [and] can advance to become cancer.
Daniela Molena
Daniela Molena thoracic surgeon

When patients develop Barrett’s esophagus, their GERD symptoms often disappear. “It’s typical for patients with esophageal cancer to tell me that they suffered from GERD for years, but then it went away and they stopped taking their GERD medications, which would have actually reduced their cancer risk,” Dr. Molena says.

Not everyone with GERD has the typical symptoms, which are heartburn and regurgitation soon after eating. Up to 20% may have different symptoms, such as coughing or chest pain, a sore throat or hoarse voice, or even frequent sinus infections. It’s important to talk to your doctor about any of these.

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Should We Screen for Esophageal Cancer in Everyone with GERD?

Experts say no. Even in people with GERD, esophageal cancer is still considered a rare disease. It occurs in about 17,000 people in the United States each year. (This number takes into account all kinds of esophageal cancer, including the other main one, squamous cell disease. This type is strongly linked to smoking and heavy alcohol consumption, making many of these cancers preventable as well.)

Not everyone who has GERD knows that they have it, because they may have atypical symptoms.

However, Dr. Molena says, some people should talk with their doctor about having an endoscopy — a test in which a scope is inserted into the mouth and down the esophagus — to look for Barrett’s esophagus. This includes people who have had GERD for more than ten years, especially those whose reflux disease started when they were very young, white males over 50, and those who have a hiatal hernia or are overweight.

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MSK’s Barrett’s Esophagus Screening Program

Only a small number of people with Barrett’s esophagus will ultimately develop cancer. But for people who have Barrett’s with no dysplasia (precancerous cells), MSK experts recommend undergoing screening with endoscopy every three to five years. We offer a screening program for these patients, who are monitored by our multidisciplinary team of experts. We may also provide surgery to eliminate GERD, especially for patients who have a large hiatal hernia or can’t take medication due to side effects.

MSK offers screening programs for people at high risk for esophageal cancer.

“Barrett’s esophagus progresses in a very methodical way,” Dr. Molena explains. “If we monitor patients with Barrett’s, we can remove precancerous lesions using an endoscope before they become more serious. Ninety percent of patients who have these procedures are able to avoid cancer, and they don’t even need to have invasive surgery.”

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Treatment Options for Those with Cancer of the Esophagus

For those who do have esophageal cancer, MSK uses treatments that are tailored to each individual patient. Most patients eventually require surgery, and 99% are able to have it through minimally invasive techniques such as laparoscopy or robotic surgery. These approaches result in shorter recovery times and fewer side effects.

Our researchers are developing more precise radiation therapy, which shrinks tumors, makes them easier to remove, and reduces the risk that the cancer will spread elsewhere in the body. MSK medical oncologists are also using genetic testing to identify which patients may benefit from clinical trials with targeted therapies.

“Treatment for esophageal cancer has improved dramatically in the past few years,” Dr. Molena says. “It’s important for patients to know that we have a lot to offer, and we are committed to helping them in their fight, from diagnosis to cure.”

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Comments

I am a 56 yr old female who has been suffering with GERD for over 20 yrs. I have taken all but one of the many acid blockers and proton inhibitors for probably too long. 2 yrs ago I began to have side effects including breathing issues, rashes and stomach upset. I gave up the meds, and watched the diet and I had GERD symptoms on and off. My gastroentorologist did an endoscopy last year and discovered I have some Barrett's cells, but couldn't be certain of their location. He wanted me to go back to acid blockers, and I did for a short while, but ended up with a rash and stomach upset. I am now seeing a Naturepath who has me on a low FODMAP diet and has me taking L-Glutamine and other supplements. The doctor also discovered I have an overgrowth of bacteria in the small intestines. I'm feeling better but still concerned about the Barrett's cells. Would I be able to be seen by one of your doctors there and would you be able to do the endoscopy to determine the state of my stomach/esophagus? Please let me know. Thank you.

I have been taking Proton Pump inhibitors and now I read that this causes boken bones due to not absorbing calcium. Also it has shown that it leads to kidney disease.
What should I do?

Dear John, it's best to discuss these specific questions with your physician to see if these possible risks outweigh the benefits of continuing with your current treatment plan. Thank you for reaching out to us.

I recently found out I may esaphagus cancer. I am being screened Friday by a specialist. I have suffered with gerd and acid reflux bad for 14 years. I was screened for acid reflux disease 14 years ago but recently it got so bad I started vomiting and sharp pains in chest and stomach. I was put on a different medication to help but it didn't so my doctor put me on a really strong pill that calmed down vomiting but I still am having acid regurgitation with other symptoms. I never knew gerd could lead to cancer until my doctor told me recently. I am already a survivor of cancer from another medical problem and Friday I will find out if I have cancer of my esaphagus or stomach when they do endoscopy of my upper GI.

Dear Chris, we are sorry to hear about your health issues. We wish you well with your appointment on Friday. If you do receive a diagnosis of esophageal cancer and would like to make an appointment with one of our specialists, please call our Physician Referral Service at 800-525-2225 and they can help you make the necessary arrangements. Thank you for reaching out to us.

I'm a 70 year old woman who was diagnosed with Barrett's Esophagus 6 yrs ago. I had no earlier history of reflux. This condition developed quickly with the first symptom being pain when swallowing meat. I never had heartburn either. My exam showed I have a hiatal hernia and I had slowly gained weight over 5 yrs but the first sign of trouble was the swallowing pain. I had recently moved to a location that became a landfill emitting continuous high numbers of hydrogen sulfide. I contended that this was a factor in my problems, including the sudden onset of a bad sounding cough with wheezing. Why would I suddenly develop these problems? I had been constipated for many years and had a colonoscopy with a diagnosis of diverticulosis. Thank you for your help.

Dear Maureen, we're sorry to hear that you're experiencing these problems. Unfortunately we are not able to offer medical advice on our blog. We recommend that you discuss your concerns with your healthcare team. Thank you for your comment, and best wishes to you.

I have been treated at MSK for esophageal cancer and by Dr Molina specifically and can tell you that they are world class. Do yourself a favor and contact them, you will be happy you did.

My boyfriend has very bad heartburn, his symptom include constantly vomiting, chest pain and shortness of breath, over the countervmefs are not helping him anymore, he recently told me when he was in jail he was seen by a Dr, they took xrays and found a black spot on his lungs, could this possibly be cancer ?

Dear Florence, we're sorry to hear that your boyfriend is going through this. We recommend that he consult with his doctor. If he's interested in arranging a consultation at MSK, he can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment.

My daughter was 5 weeks premature, she is now 20 and has had terrible acid reflux since birth. Colic every night with projectile vomiting. She has had awful stomachaches causing even greater vomiting as she grew up. Over the years she has been prescribed multiple medications but they all make her sick and cause migraines. I always felt our doctors (about 4 different doctors) didn't take it seriously because of how young she was. She just saw a new doctor today who found a lump while performing her initial exam, and has her scheduled for a biopsy the beginning of next week. He says it's definitely not a lymph node. He is concerned because of her history of acid reflux and the location of the lump is common with cancer related to it. Is there a connection between premature births and acid reflux? I cannot find much information on the internet that relates to children and young women who suffer this condition.

Dear Kristi, we're very sorry to hear that your daughter has been through all this. We hope that everything goes well with her biopsy next week. We recommend you discuss your concerns with her gastroenterologist. Thank you for your comment, and best wishes to both of you.

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