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GRAY MATTERS: Esophageal Cancer

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.

This is how bad things got when the economy and Wall Street tanked: Sales of antacids topped $10 billion for the year. And the people who figure such things say that 100 million Americans suffered from heartburn once a month and 15 million battle it at least once a day.

That could strike you as amusing, but it’s not. For as a longtime chewer of Tums or Rolaids, I can tell you that what we call “heartburn,” or “acid indigestion” is not only a literal pain. It is also potentially dangerous, especially when the discomfort is relieved repeatedly with one of the many over-the-counter antacids that are heavily advertised — without including a warning.

Anyone remember that Alka-Seltzer commercial? “You ate the whole thing? I ate the whole thing!” The Alka-Seltzer provided relief from the indigestion, but the guy we laughed at may have been killing himself with each heavy meal and a burp.

One large reason for my concern right now is the approaching fifth anniversary next month of the thunderous, life-changing discovery – through a routine endoscopy – that I had cancer of the esophagus. The fifth anniversary means I have survived. Not cured, mind you, survived, as in so far, so good. For whether you know it or not, cancer can be arrested but there is no cure yet.

The other reason is a new website which caught my attention with this: “I want you to know that heartburn can cause cancer.” Based in Maryland, the website belongs to the new Esophageal Cancer Action Network founded by Mindy Mintz Mordecai who lost her husband, Monte, to the disease two years ago. And she has enlisted her two daughters to appeal to those of you who may be in danger without knowing it.

I understood their appeal, for I have two daughters and narrowly escaped this damned disease because of sheer luck. As Mindy Mordecai wrote, she discovered during her husband’s struggle, as I did during my ordeal, that

“...the cancer that was consuming my husband was caused by acid reflux, something we often call persistent heartburn. And I was angry that I had never been told that heartburn could cause cancer. Angry that, because we didn’t know, we never took any steps to try to catch my husband’s disease.”

When I began my research on the disease following that diagnosis – on St. Valentine’s Day, 2005 – what I learned was not encouraging. The incidence of esophageal cancer was rising faster than any other cancer, and the survival rate was (and is) only 15 percent.

It’s three or for times more common in men, especially if they smoke cigarettes, are overweight and eat too much or irregularly, all of which describe the lifestyles of busy men with stressful jobs. And that was me. Eating too much, chewing an antacid, getting relief and forgetting about until the next time – a potentially deadly cycle.

The incidence of esophageal cancer increases with age; eight of ten people diagnosed with this cancer are between 55 and 85. About 17,000 new cases are diagnosed each year. And most victims die because the cancer is usually caught at the too-late stage. Why? In large part because antacids mask what’s going on when your body is trying to warn you with heartburn or acid reflux.

The medical name for this condition is “gastroesophageal reflux disease,” or GERD. Heartburn, or acid reflux, occurs when digestive acids - that may accompany certain foods, over-eating, along with smoking – splash up from the stomach into the esophagus, the muscular tube that sends food to the stomach.

The cells in the walls of the stomach are tough and acid resistant. But the acid battering of the esophagus changes its cells into the type found in the stomach. That condition is called Barrett’s Esophagus which affects about ten percent of people with GERD and which increases the chance of developing a cancer by 30 to 125 times.

It’s good news when the cancer is spotted very early, when it’s confined to the esophagus. Even so, as it was with me and two friends, treatment involved weeks of chemotherapy, radiation and radical surgery in which most of the esophagus is removed and what remains is attached to the stomach.

Depending on the stage at which the cancer is discovered, there are other, less invasive treatments which can be found at the American Cancer Society site. Unfortunately there are few warning symptoms beyond persistent heartburn. By the time you have difficulty swallowing, as Mindy Mordecai’s husband’s learned, the cancer had spread beyond the esophagus. Even now, I’m subject to periodic checkups.

Despite the rapid growth in the incidence of esophageal cancer, it gets about only $23 million in research funds from the National Cancer Institute. That’s about ten percent or, $1,500 per death, compared to $14,000 per breast cancer death. Indeed, lung and esophageal cancers are shortchanged on research funds, I believe, because there are not too many survivors to lobby for more money and they are considered diseases in which the lifestyle of the victims – smoking and obesity – are blamed.

And it’s true that the increase in cancers of the esophagus seems to have coincided with the increase in obesity.

That suggests some obvious ways to prevent this cancer, according to the American Cancer Society, including cutting down on over-eating, especially spicy or fatty fast foods before bed time or before plunking yourself down on the couch, which increases the chance of acid reflux. If you tend to have acid reflux after meals, don’t lie down. Prop yourself up in bed. I shouldn’t need to tell you that smoking is also strongly linked to esophageal cancer as well as other nasty illnesses.

Beyond this, instead of chewing or swallowing those too-well advertised, over-the-counter remedies to relive the discomfort from GERD, which may mask the development of Barrett’s esophagus, take the antacid before the onset of reflux. Or better, ask your physician for the several prescription drugs available to prevent or control reflux.

And whether or not they work, if you have a history of heartburn, you should ask for an upper endoscopy – a probe of the esophagus and the upper stomach to determine if you’re one of an estimated 3 million Americans with Barrett’s Esophagus – which should be watched closely. Medicare and most insurance companies will cover an endoscopy if it’s prescribed by your primary care physician.

The Esophageal Cancer Action Network has on its board several distinguished physicians including the surgeon who operated on me. And Mindy Mordecai is selling for $2.50 blue wristbands, one of which says, “Heartburn can cause cancer.”

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I hope your 5th anniversary passes without a hitch. One of my kids has GERD, and I will pass this on to her.

I'm happy that you are celebrating an anniversary! Cancer is not a joke. I just celebrated eighteen years from breast cancer. My brother is in the throes of stage 4 lung cancer. The suffering is heartbreaking. Oh for the day of a cure.
Even more sad is that it is preventable. Sometimes it's all about choices.

Thanks for the good information, Saul.

I'm doing research to start my own Blog on what it's like to be aging in today's society and I stumbled across this site.

Here on the front page, I read your article. I want to first say that I've suffered since I was young with this acid indigestion. As the years went by, it got worse.

Then my friends and relatives began to die from Esophageal Cancer. My acid reflux was so bad that after an incident (during which vomit always got to my lungs) I suffered for days. I was scared.

I was so scared that I paid good money for an online natural cure. And it works! I've not had an incident in over a year. The cure: a fresh apple after a meal.

I freely share this with you and your readers, not trying to get you to ignore your doctors, but just as another tool.

Thank you!!!! I learned a lot!!!!

If the heartburn is caused by low stomach acid, as it has been for me, digestive enzymes taken just before or at the start of a meal do the trick really well. If it is caused by a slack valve, which in some cases it is, there's a surgical procedure (Nissan fundoplacation)that can fix it. So yes, it is very important to figure out the cause of heartburn, rather than simply reaching for the antacids. Thanks for this useful post.

Echo my predecesor: "Thanks for this (extremely)useful post." Covers all bases, including my use of Protonix. Very thoughtful!

Natural enzymes before meals is my solution as well. Also avoid to much spicy stuff (yum)if you can:)Thanks again, Saul & I thank goodness you're doing so well. Dee

Thank you for the information, it's been very enlightening.

Congratulations on your upcoming anniversary! May you be celebrating many more

Mindy Mordecai is nothing short of a hero. I "met" her when we connected through a support Web site. My father was diagnosed at the age of 57 -- by that time he could barely swallow, but they hadn't yet been able to locate the tumor. At first, they thought he was just having a muscle spasm at the bottom of his esophagus; they even assured him it wasn't cancer. Twelve weeks later, they figured out they were wrong. Doctors need as much as education about this disease as we do. And yes, my father took over the counter antacids for as long as I can remember; no doctor ever gave him a warning. We had never heard of EC!
Seven months after diagnosis, my father was dead. It was ugly and painful. The cancer seeped into his bones and debilitated his body. And every day my heart breaks when I look into my daughter's eyes -- a baby girl he never even got to hold in his arms. And when my four year old tells me with tears in his eyes that he "wishes Grampy would come back," I am horrified again at my loss and my family's loss. And I cannot understand why the cancer with the fastest growing diagnosis in the country receives nearly the least amount of research funding. Thank you for helping to raise awareness.

Our family, like many others, wish we had known acid reflux causes cancer. My husband was diagnosed with esophageal cancer 7 months ago. I don't understand why his doctors weren't more forthcoming with what Barrett's Esphagus could mean to us. It is the mission of our family to get the word out and raise awareness about this silent killer. Thank you for your article. You bring encouragement to our family.

Thank you for raising awareness! My husband was diagnosed in Dec. 09 with stage IV EC. He died on Feb 18. I am making it my mission to get the word out so others do not have to experience what my three girls and I did.

wonderful site. my husband was diagnosed with EC aug.o9. stage 3, he also took tums forever. never smoked,nor drank and is not over weight. since that time he has been through 6 weeks of chemo/radiation and on dec.7th had his surgery after his tumor was greatly reduced by his treatment. he is doing very well and eating (small amounts) any thing he wants to. he is now taking chemo pills as a clean up to make sure if there is a floater it will get caught.
now his brother is fighting the same thing. and a sister has been doctoring for gerd for several years.
keep putting out the good word and we will keep telling people about it too.

Thanks so much for this excellent information. I wish I had read it sooner. My husband was diagnosed in April 2010 and 10 months later February 2011 he passed away. Cancer is a very cruel disease for both the patient and the family members who care for them.. I just hope that anyone who is suffering from any of the symptoms mentioned gets checked out quickly and has a better chance of surviving. Thanks again.

as a stage 3 EC with nodes perihilar and intraabdominal but no organ mets I am in a strange category not a candidate for surgery yet responding well to flofox I am a physcian and have a good grip on things but I am very conflicted this is a bad disease and I have hospiced my fahter in bladder cancer to death and both my mother and sister in breast cancer to death it IS NOT PLEASANT and I have resolved to concentrate on QUALITY of life not quantity give me a good weeek vs a bad year any day so that is my goal I do not want to be unrealistic I would like to see my youngest finish college but that may be asking too much but at least the girls are happy and established in their lives life goes on as it did when their father died instantly of a cerebral aneursym I would love to hear other stories of what they did or are doing I am not game for unrealistic heroics I just want the best that could happen to close this Meg Mac

My brother was diagnosed with esophageal cancer in August...he was put on chemo pills and radiation for five weeks.which made him deathly ill...then left alone for three weeks expecting surgery to remove the tumor. Instead the pet scan showed new cancers in the intestine and hip, put on a new type of chemo for three weeks and a new scan showed the cancer ws now in the liver and had taken over most of his body...he has now been given three weeks to three months to live....this is so heartbreaking to see this fine man desolve into a skeleton....yes, he had reflux problems, but, no other symptoms until a nurse found a small amount of blood in his stool, after a slight stroke.

I had lung cancer three years ago and no idea why. I have never smoked. However, shortly after, I was diagnosed with acid reflux. It was so severe my vocal cords were affected and I have been taking meds ever since. I recently allowed myself to run out of meds and didn't reorder immediately and now I am finding myself hoarse but also coughing continuously. It feels like I have food, water, flem, etc. in my lungs and cannot cough it out. Do you think there is a possibility that acid reflux could be linked to the lung cancer I had before and is there a chance of it coming back again? I had never considered the two being linked together before. I have a dr. appt. tomorrow to see what can be done to make the cough go away and get the "junk" out of my lungs.

I was put on prevacid after a diagnosis of barrets esophogus.
Going to stop becaude I now have diareah,and am assuming that I am not getting all of my nutrients.
Going to go the natural way wiyh accupuncture and chineese herbs.
If that does'tvwork,oh well I have lived a good life. 61 now. Did not think that I would make this far.

David, strong urge you to consult with your doctor about your concerns/plans. Also, you might want to consult with another Otolaryngologist. You're too young at 61 to be giving up too easily.

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