Half a century ago, my grandmother died of esophageal cancer. For decades preceding her death, a bottle of milk of magnesia was her steady companion because she suffered daily from heartburn, now known as gastroesophageal reflux disease, or GERD. But many years passed before a link was clearly established between chronic irritation of the esophagus by stomach acid and this usually fatal cancer.
Now that the role of acid reflux is well known in cancer risk and unpleasant conditions like chronic cough and hoarseness, drug companies market several products, prescription and over the counter, that are far better able to control the backup of stomach acid than milk of magnesia. And gastroenterologists now know to be on the alert for early signs of trouble among patients who suffer from GERD.
The cancer that results from chronic reflux is preceded by a benign condition called Barrett’s esophagus, a cellular abnormality of the esophageal lining that can become precancerous. If untreated, about 10 percent of patients with Barrett’s esophagus eventually develop esophageal cancer, the US’ fastest-growing cancer. In the last four decades, the annual number of new cases has risen 300 percent to 500 percent.
The American Cancer Society estimates that 16,470 new cases of esophageal cancer will be diagnosed in the US this year and that more than 14,000 people will die from it.
Diagnosed early, well before patients develop swallowing problems, esophageal cancer is usually curable. A cure is most certain if the problem is detected and corrected before or during the advanced precancerous stage. But for about 90 percent of patients, early detection and treatment are missed, and the outcome is fatal.
Unfortunately, the esophagus, unlike more accessible body parts like the breast and skin, is not very easy to monitor. In the traditional exam, called gastrointestinal endoscopy, the patient is heavily sedated, usually in a hospital, and a scope the diameter of a garden hose is inserted through the mouth into the esophagus.
For patients with GERD who have already developed Barrett’s esophagus, annual endoscopy is recommended to check on the health of esophageal cells. If a biopsy indicates an impending or existing cancer, the usual treatment is a rather challenging operation in which all or part of the esophagus and the upper part of the stomach are removed and the remaining parts of the digestive tract are reattached.
Another technique uses light therapy to destroy the inner lining of the esophagus, which can result in scarring and strictures that impede swallowing.
After this treatment, patients must stay out of sunlight and direct artificial light for about six weeks to avoid severe sunburn on exposed skin.
But now there are simpler and safer alternatives for both detecting and treating an esophageal problem even before it becomes a serious precancer.
A colleague who suffers from chronic reflux recently underwent the new detection method, called TransNasal Esophagoscopy, or TNE. It can be done safely and effectively in a doctor’s office, and it does not require sedation or involve loss of a day’s work. Nor does it leave the patient with a sore throat.
“Surprisingly easy,” was how my colleague described it. “I had an exam that involved sending a tube, slim as a wire, with a camera, down through a nostril.”