Esophageal Cancer: Common Acid Reflux Can Also Be An Underlying Cause Of This Killer Disease
Due to GERD or common reflux, our esophagus develops a lining similar to our stomach, which leads to metaplasia.

In addition to smoking and alcohol intake, GERD is a significant risk factor for esophageal cancer. Read on.

Esophageal cancer develops in the esophagus or food pipe, a tube that carries food from the mouth to the stomach. What makes this cancer deadly is its lack of visible symptoms till a later stage. If screened in time, esophageal cancer can be treated through multiple modalities, including robotic-assisted surgery, radiation therapy, chemotherapy and immunotherapy. There are two types of esophageal cancer based on their histology, squamous cell carcinoma and adenocarcinoma.

Squamous cell carcinoma is the most common type of esophageal cancer worldwide and is often linked to smoking and alcohol consumption. Adenocarcinoma, on the other hand, is more common in Western countries and is often linked to obesity, gastroesophageal reflux disease (GERD), and Barrett’s esophagus, a condition in which the lining of the esophagus changes.

Symptoms and risk factors

The most important symptom of esophageal cancer is dysphagia or difficulty in swallowing, which starts with solid food and later progresses to liquids. Other symptoms of esophageal cancer include pain while swallowing, weight loss, chest pain, hoarseness, and coughing.

Beware of acid reflux

In addition to smoking and alcohol intake, GERD is a significant risk factor for esophageal cancer. GERD is characterized by acid reflux, heartburn, and regurgitation. Our stomach is usually exposed to digestive acids and has the tolerance to manage the acidic level; however, our esophagus is not. Due to GERD or common reflux, our esophagus develops a lining similar to our stomach, which leads to metaplasia.

The lower esophageal sphincter (LES) at the bottom of the esophagus prevents acid and food from flowing back up into the esophagus. GERD happens when LES doesn’t close properly or relaxes too often, causing acid reflux into the esophagus. GERD can also have multiple causes, including a weak LES, certain medications, obesity, and hiatal hernia, characterized by part of the stomach protruding into the chest through the diaphragm.

The importance of screening

Due to the lessened awareness of these kinds of cancers, people often don’t get screened till it is extremely delayed and cancer has reached a later stage. If a patient suffers from GERD for a longer period, they should undergo an endoscopy and get screened for esophageal cancer. If screened early, the cancer can be detected and treated in time. There is a significant improvement in survival if the cancer is diagnosed and treated early compared to the dismal survival rate with advanced-stage tumors

Treatment

Treatment for esophageal cancer depends on the stage of the disease, the location of the tumour, and the overall health of the patient. Treatment options can include surgery, radiation therapy, chemotherapy, and immunotherapy. Often, a combination of these treatment modalities are used (multimodality therapy). When it comes to surgery, robotic-assisted surgery is recommended as one of the viable options, especially when the cancer is in the thoracic region, as there is a requirement for lymph node dissection along the nerves, which is extremely challenging. Robotic-assisted surgical devices like da Vinci provide magnified vision and precise movements, which helps to improve lymph node yield along the recurrent laryngeal nerves. It also reduces the nerve palsy rate.

With newer surgical technologies like robotic-assisted surgery, conditions like esophageal cancer can be treated effectively. However, laying emphasis and spreading awareness on the importance of screening is the current need of the hour.

(This article is authored by Dr Kalayarasan Raja, Additional Professor & Head, Department of surgical gastroenterology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry)

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