When Heartburn Signals Cancer Risk

Older man talking with a doctor about esophageal cancer.

People who have had reflux disease for a long time should talk to their doctors about their risk for esophageal cancer.

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 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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