April is designated Esophageal Cancer Awareness Month. The esophagus is a long hollow organ that connects mouth/throat to the stomach. Cancer can develop from the lining of the esophagus inside the lumen. There are 2 common types of cancer that can develop in the esophagus - squamous cell cancer which occurs in the upper or middle parts of the esophagus, and adenocarcinoma, which commonly develops in the lower part of the esophagus. Adenocarcinoma is the most common esophageal cancer type in the United States. In recent years, cases of esophageal cancer have increased 4- fold. The lifetime risk of esophageal cancer in the United States is about 1 in 125 in men and about 1 in 435 in women. Approximately 17,000 new esophageal cancer cases are diagnosed each year in United States. 
Patients often ask why they got cancer or what they can do differently to prevent cancer. Diet always comes up during the discussion. The causal connection between diet and cancer is difficult to determine because people do not eat only one food item and there are lot of compounding factors. The exact cause of esophageal cancer is not known, but we do know patients with certain risk factors have an increased risk of developing the condition. Risk factors such as age (over55), gender (men have higher prevalence than women), smoking, alcohol use, obesity, chronic acid reflux disease, presence of pre-cancerous condition called Barrett’s esophagus, unknown dietary factors and rare causes such as Tylosis, caustic damage, Achalasia, Plummer-Vinson syndrome, HPV, and work place exposure.
Prevention of esophageal cancer involves modifying these risk factors. Note that not all the risk factors are subject to modification. The risk factors we can modify are not smoking, limiting alcohol use, treatment of acid reflux and surveillance of Barrett’s esophagus. Barrett’s esophagus is a pre-cancerous condition of the esophagus that can slowly develop into esophageal cancer. By modifying some of these risk factors, esophageal cancer can be prevented at some level.
Esophageal cancer is one cancer where tests can detect pre-cancerous conditions or cancer at an early stage. But it is not recommended everyone get checked for esophageal cancer. Instead, patients with symptoms such as trouble swallowing or dysphagia, chest pain, weight loss, hoarseness, chronic cough, vomiting, hiccups, pneumonia, bone pain, and esophageal bleeding or patients with acid reflux for several years are recommended to undergo testing to screen for Barrett’s esophagus or cancer. Upper endoscopy is the best test available for diagnosis of Barrett’s esophagus and cancer. The crucial step of prevention or early detection of the progression of Barrett’s esophagus to esophageal cancer can be accomplished with an upper endoscopy and by following a surveillance program. Early detection is always important as there are effective treatment options available.
Once Barrett’s esophagus is detected, surveillance is necessary to ensure that cancer is not developing. As a result, patients with Barrett’s esophagus are recommended to undergo upper endoscopy every 3 months to 3 years depending on the degree of dysplasia. Dysplasia within Barrett’s esophagus measures the stage of progression towards cancer (high grade dysplasia is one step away from cancer). For the patient with dysplasia, it is important to undergo close endoscopic surveillance to detect cancer early on. Fortunately, dysplasia often can be treated effectively with a newer technique called radiofrequency ablation at the time of endoscopy. Even early cancer or cancerous lesions within the esophagus can be safely treated with endoscopic methods. Once cancer is detected, a team of doctors such as thoracic surgeon, oncologist, gastroenterologist and a radiation oncologist may be needed to treat the cancer with surgery, chemotherapy, radiation or a combination of modalities. For some patients with advanced cancers, treatment can be more harmful. In those situations, palliative care such as feeding tube placement or esophageal stent placement, along with pain control, is the most appropriate treatment.
Remember April is Esophageal Cancer Awareness Month Esophageal cancer is serious, but it is treatable, so do not ignore warning symptoms that allow for early diagnosis of cancer. For more information, discuss with your doctor or visit www.cancer.org or www.nccn.org.
