Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
What about the cancer that occurs in Barrett's esophagus?
Adenocarcinoma of the esophagus
The type of cancer that occurs with Barrett's esophagus is adenocarcinoma. Cancer arising from the squamous lining of the esophagus is called squamous cancer or carcinoma. Among Caucasians, the rate (frequency over time) of squamous cancer is decreasing relative to Barrett's-associated adenocarcinoma. Other racial groups (for
example, African Americans) however, have not experienced the same rate of decline in squamous cancer relative to adenocarcinoma.
Smoking and excessive alcohol ingestion are definite risk factors for squamous cancers. They also are risk factors for adenocarcinoma seen in Barrett's esophagus. In this situation, however, it is not clear if smoking and alcohol increase the risk for adenocarcinoma by making GERD more severe or if smoking and alcohol have a more direct cancer-causing effect, as occurs in squamous cancer.
Forty years ago, when a patient was diagnosed with cancer of the lower esophagus, it was almost always of the squamous type. Now, in white males, the chances are that 50% or more of the lower esophageal cancers are adenocarcinomas of the esophagus or gastroesophageal junction.
Throughout the remainder of this section, the term
esophageal cancer will refer to adenocarcinoma arising from the Barrett's esophagus.
Connection with cancer of the gastroesophageal junction (cardia)
Cancer of the gastroesophageal junction is also called cardia cancer because the region where the esophagus meets the stomach is called the cardia. This cancer, like Barrett's-associated adenocarcinoma, is found predominantly in white males, is apparently increasing in frequency at the same rate as esophageal cancer, and is associated with chronic GERD. Therefore, it has been speculated that cardia cancer starts from short segments (for
example, 1-2 cm) of Barrett's. By the time the diagnosis of cancer is made, however, the
tumor may have spread beyond the short segment of Barrett's and may appear to be in the cardia. This speculation about the origin of cancer of the cardia, however, remains to be proven.
Increasing cases of Barrett's-associated cancer and cancer of the cardia
An increase in the frequency of esophageal
adenocarcinoma has been observed for at least 20 years, primarily in white
males. One clue to the reason for this trend may be related to a decrease in the
frequency of H. pylori infection of the stomach. In other words, people with Barrett's cancer, including cardia cancer, seem to have lower rates of
H. pylori infection than others of the same age and sex in the same population.
H. pylori is the bacterium that is a
major cause of ulcers. It is a very common infection worldwide and causes no
symptoms in the vast majority of affected people. However, about 10% of persons
with H. pylori develop peptic ulcer of the stomach and duodenum. These ulcers
are treated by eliminating the bacteria, which in turn, prevents relapse of the ulcers.
If H. pylori goes untreated, it causes progressive inflammation of the stomach (gastritis) which is associated with reduction in acid secretion and possibly less reflux of acid into the esophagus. In many areas of the world, however, this infection is decreasing in frequency, presumably because of better public health measures. Therefore, it is possible that the protective effect (such
as decreased acid production) of chronic H. pylori infection has decreased. In other words, with less
H. pylori gastritis, the stomach produces more acid and there is more acid to reflux into the esophagus. At the same time, we are more predisposed to reflux in our senior years. So, although this is not a settled issue, the decreasing frequency of
H. pylori infection may be one reason for the increasing frequency of Barrett's-associated adenocarcinoma.
Most sore throats are caused by viruses or mechanical causes (such as mouth breathing) and can be treated successfully at home. However, a person should be seen by a health care professional if they have a sore throat that has a rapid onset, and is associated with a fever or tenderness of the front of the neck; a sore throat that causes the person to have difficulty swallowing (not just pain swallowing) or breathing; or if a sore throat lasts for more than a week.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Bronchitis is a disease of the respiratory system in which the bronchial passages become inflamed. There are two types of bronchitis, acute and chronic. Symptoms of acute bronchitis include frequent cough with mucus, lack of energy, wheezing, and possible fever. Treatment may require medication such as bronchial inhalers and predinsone. Supportive treatment is focused on relieving the symptoms with fever reducers, cough suppressants, and rest. Treatment may be more aggressive in patients with pre-existing conditions such as empyema, COPD, or cigarette smoking.
A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Causes of hiatal hernia are a larger than normal esophageal hiatus. There are two types of hiatal hernias, sliding, or para-esophageal. When symptoms of hiatal hernia appear, they are similar to GERD symptoms. Hiatal hernia treatment is generally surgery.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Esophageal cancer is a disease in which malignant cells form in the esophagus. Risk factors of cancer of the esophagus include smoking, heavy alcohol use, Barrett's esophagus, being male and being over age 60. Severe weight loss, vomiting, hoarseness, coughing up blood, painful swallowing, and pain in the throat or back are symptoms. Treatment depends upon the size, location and staging of the cancer and the health of the patient.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation (gastritis) of the inner lining of the stomach in humans. This bacteria also is the most common cause of ulcers worldwide.
Eosinophilic esophagitis is an inflammation of the esophagus. Eosinophilic esophagitis has many causes including acid reflux, heartburn, viruses, medications that become stuck in the esophagus, allergy, asthma, hay fever, allergic rhinitis, and atopic dermatitis. Eosinophilic esophagitis symptoms include difficulty swallowing food, abdominal pain, chest pain, and heartburn.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Gastritis is an inflammation of the stomach lining. Causes of gastritis include drinking too much alcohol, medications such as NSAIDs, ibuprofen, aspirin, H. pylori infection, severe infections, burns, anemia, and autoimmune disorders. Gastritis is diagnosed with endoscopy, blood tests, or stool tests. Treatment depends upon the cause of gastritis.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Hoarseness (abnormal deep, harsh, raspy voice) is caused by a variety of conditions in which the larynx (voice box and vocal chords) are irritated or injured. Examples of causes of hoarseness include: laryngitis, straining the vocal cords by yelling or screaming, infections, GERD, allergies, and more. Treatment of hoarseness depends on the cause.
Schatzki (Schatzki's) ring, is a narrow ring of tissue located just above the junction of the esophagus and stomach. The cause of Schatzki ring is not clearly known, however, some doctors believe they are caused by long term acid reflux. The symptoms of a Schatzki ring is primarily poorly chewed food that stays in chunks becoming stuck in the esophagus. Diagnosis of Schatzki's ring is barium x-ray or endoscopy. Treatment is generally a procedure to stretch or fracture the rings.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Heartburn is a burning sensation experienced from acid reflux (GERD). Symptoms of heartburn include chest pain, burning in the throat, difficulty swallowing, the feeling of food sticking in the throat, and a burning feeling in the chest. Causes of heartburn include dietary habits, lifestyle habits, and medical causes. Treatments for heartburn include lifestyle changes, OTC medication, prescription medication, and surgery.
Acid backing up into the larynx (voice box), it causes reflux laryngitis. Irritation of the lining of the esophagus, larynx, and throat can lead to esophagitis, sinusitis, strictures, hoarseness, throat clearing, swallowing problems, asthma, chronic cough, and more. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat. Reflux laryngitis can be treated with OTC medication, prescription medication, and lifestyle changes.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
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