GERD and Esophageal Cancer Risk: 2 RCCA Oncologists
Discuss What to Know – and What to Do


Living with gastroesophageal reflux disease, or GERD, can mean living with worries. Will the limited-choice menu at that important business dinner have something ‘safe’ for me to eat? Is this chest pain that has me up at 3 a.m. just a bad episode of reflux or could it be a cardiac issue? And will the long-term effects of GERD increase my risk for developing cancer of the esophagus?

Two medical oncologists with Regional Cancer Care Associates (RCCA), one of the nation’s largest networks of oncology specialists serving patients in New Jersey, Connecticut, Massachusetts, and the Washington, D.C., area, addressed that last question in a recent interview.

Jumana Chatiwala, MD, said, “About 70% of people with GERD have the non-erosive form of the condition. This means that even though they have chronic acid reflux, there are no visible erosions, ulcers, or inflammation when a physician examines their esophagus – the tube that connects the throat to the stomach – during an upper endoscopy procedure. People with non-erosive GERD have a risk of esophageal cancer that is the same as or only slightly higher than that of the general population. However, esophageal cancer risk is modestly elevated in the 30% or so of people who have the less-common form of GERD – erosive esophagitis. And the risk is increased further in people who progress from GERD to a condition called Barrett’s esophagus, in which the lining of the esophagus becomes damaged by long-term acid reflux. Even in those cases, however, the great majority of people with erosive esophagitis or Barrett’s esophagus will not develop esophageal cancer, which is fairly uncommon in the United States.”

Joel Silver, MD, a board-certified medical oncologist and hematologist who practices at RCCA’s West Hartford, CT, office, noted that these differences in risk reflect the role that chronic inflammation plays in the development of cancer. “More than 160 years ago, a German pathologist named Rudolf Virchow noted the presence of white blood cells in cancerous tissues. Because white blood cells are a component of the inflammatory response that the immune system initiates to fight pathogens such as bacteria or viruses and to heal damaged tissue, Virchow theorized that some tumors may develop at sites of persistent inflammation and tissue damage. Subsequent decades have seen his theory validated and refined, with chronic inflammation and tissue damage in the colon, cervix, and esophagus, among other sites, now known to increase cancer risk. This explains why risk is elevated when there is erosion or ulceration – forms of tissue damage and triggers for an inflammatory response – in the esophagus. It also is the reason for the increased risk associated with Barrett’s esophagus, in which the flat pink lining of the esophagus thickens and becomes red due to sustained damage from acid reflux,” he said.

Esophageal Cancer: What to Know

Dr. Silver explained that erosive esophagitis and Barrett’s esophagus are only two of several risk factors for cancer of the esophagus. He said, “Other risk factors include drinking alcohol, tobacco use, excess body weight, certain inherited conditions, being older, and being male. In terms of those last two, the average age at diagnosis is 69 years, and the lifetime risk in the US is about 1 in 132 for men versus 1 in 437 for women.”

The oncologist said that esophageal cancer makes up about 1% of cancers diagnosed in the US each year and added that the American Cancer Society estimates 22,530 new cases and 16,290 deaths from the disease nationwide this year.

Signs and Symptoms of Esophageal Cancer

The signs and symptoms of esophageal cancer include heartburn, hoarseness, chronic cough, trouble swallowing, weight loss, and vomiting after eating. “Many of these potential indicators of esophageal cancer, such as chronic cough or weight loss, are what doctors call ‘non-specific’ symptoms. That means they can be attributable to a wide variety of conditions, some relatively minor and others quite serious,” said Dr. Silver. The oncologist added that it is important to see a physician promptly for evaluation of such symptoms so that their cause can be identified and treated.