Esophageal cancer is one of the leading causes of cancer-related deaths in the United States, but early detection and minimally invasive procedures are dramatically increasing positive outcomes.
There are two main types of this malignancy: squamous cell cancer, related to smoking and tobacco use; and adenocarcinoma, related to chronic gastroesophageal reflux disease (GERD). While incidence rates of squamous cell carcinoma have remained stable, adenocarcinoma rates have steadily increased for decades.
The five-year survival rate for adenocarcinoma is less than 20%, primarily due to the late-stage diagnosis that is typical for this type of cancer. However, the survival rate can exceed 95% when the cancer is detected early.
Who is at risk?
Chronic GERD is the primary risk factor for esophageal adenocarcinoma, as it can lead to the precancerous condition called Barrett’s esophagus. The condition is diagnosed in 7-10% of patients with chronic GERD and is estimated to be present in 1%-2% of the general population.
Overweight white men who have a longstanding history of GERD are at the highest risk. Those with a family history of Barrett’s esophagus and/or esophageal adenocarcinoma, as well as those who smoke, are at an increased risk.
Gastroenterologists play a vital role in the screening and surveillance for Barrett’s esophagus. Higher-risk patients may undergo an upper endoscopy to screen for the condition.
What happens if Barrett’s esophagus develops?
When Barrett's is detected, biopsies are taken and reviewed by expert pathologists to determine the presence and degree of dysplasia, i.e., the presence of abnormal cells within a tissue or organ.
Patients with low- or high-grade dysplasia have an increased risk of developing esophageal cancer. Those without these cells can continue in a surveillance protocol.
What does treatment look like?
Fortunately, there is a treatment for dysplasia that is proven to be very effective in completely removing the abnormal tissue. The most common approach is called radiofrequency ablation (RFA), a minimally invasive procedure done during an endoscopy.
With RFA, a gastroenterologist applies targeted radio waves to heat and destroy the Barrett’s lining — the abnormal cells — so healthy tissue can grow back in its place. RFA is a safe procedure with extremely low complication rates and has proven to be highly successful in removing Barrett's tissue, greatly reducing the patient’s risk of developing esophageal cancer. Once the Barrett’s lining has been eradicated, patients can continue with routine surveillance and their prescribed anti-reflux medications.
What should you do?
Chronic GERD is more than a nuisance — it can lead to serious complications over time. If you have frequent or longstanding symptoms, especially alongside risk factors, don’t ignore them. Talk to your provider about whether screening is appropriate. Early detection can identify Barrett’s esophagus before it progresses, and it allows for treatment when outcomes are most favorable.
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