Esophageal cancer awareness: Q&A with Dr. Shawn Groth

In 2020, more than 18,000 people will develop esophageal cancer. It is the seventh most common cause of cancer-related deaths among men in the United States. Though it isn’t as common as lung, breast or colon cancer, the number of people who develop esophageal cancer is increasing faster than any other type of cancer.

Dr. Shawn Groth, a general thoracic surgeon with the General Thoracic Surgery Clinic at Baylor College of Medicine, discusses esophageal cancer, risk factors, and more.

Q: What is esophageal cancer?
A: The esophagus is a muscular tube that moves food and liquids from your mouth to your stomach. Esophageal cancer starts on the inner lining of the esophagus (called the mucosa) and spreads outwards through the muscular layers of the esophagus.

Q: Who needs to be screened for esophageal cancer?
A: Unlike colon cancer and breast cancer, there is no clear evidence supporting widespread screening of the general population for esophageal cancer. However, several medical societies have suggested screening people with two or more risk factors for developing esophageal cancer, such as male gender, being over 50 years of age, obesity, Caucasian race, chronic gastroesophageal reflux disease (GERD) symptoms, or a family history of Barrett’s esophagus or esophageal cancer.

Patients with a sensation of food sticking, weight loss or worsening reflux symptoms should also seek medical attention.

Q:  What is Barrett’s esophagus?
A: In Barrett’s esophagus, the lining of the esophagus is replaced by a lining that is similar to the intestine. It is the result of chronic reflux and regurgitation, which injures the esophagus. Rarely, Barrett’s esophagus can progress to precancerous changes (called dysplasia) or to esophageal cancer.

Q: Is there more than one type of esophageal cancer?
A: Yes. The most common types of esophageal cancer are squamous cell carcinoma and adenocarcinoma.  There are also several rare types. Squamous cell carcinoma is the result of chronic inflammation/irritation of the esophagus, which is largely related to alcohol and tobacco use in the United States. Other conditions associated with this type of cancer include achalasia, burns of the esophagus, or radiation for other chest cancers.

Adenocarcinoma is caused by uncontrolled reflux. Though GERD, often manifesting as heartburn, reflux, and regurgitation, is common, it is not a trivial health condition. The biology of each type of esophageal cancer is different, but both are usually treated with some combination of surgery, chemotherapy, or radiation therapy.

Early stage, small cancers may be removable through the mouth with an EGD scope. This is known as endoscopic mucosal resection or endoscopic submucosal dissection.

Q: Anything else people should know about esophageal cancer?
A: Stay proactive with your health. If you have chronic GERD symptoms, make sure that your healthcare provider is an expert in GERD to help treat you most effectively. You can reduce your risk through well-balanced nutrition and exercise. Consult with your provider prior to beginning a diet and exercise program. If you choose to drink alcohol, do so in moderation. If you smoke, see resources to quit.

Dr. Groth is an associate professor of surgery in the Division of General Thoracic Surgery and a member of the Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine.

-By Debbie Sugarbaker, editor in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine