Barrett’s Esophagus and the Risk of Esophageal Cancer

The American Cancer Society estimates that 17,650 new cases of esophageal cancer will be diagnosed in the United States in 2019. We spoke with Dr. Jose Pimiento, a surgical oncologist in the Gastrointestinal Oncology Program at Moffitt Cancer Center, about the risk factors, symptoms and treatment for esophageal cancer and Barrett’s Esophagus - a precursor to esophageal cancer.

1. What is Barrett’s Esophagus?
   Barrett’s Esophagus are changes that occur in the inner layer of the esophagus as a response to chronic reflux
   and the chronic acid injury at this level. These changes have different grades that can range from mild to severe.
   
   
2. What are the signs and symptoms of Barrett’s Esophagus? How can it be prevented?
   There are no symptoms specifically associated with Barrett’s Esophagus. This means that it can be silent. However, people with gastric reflux symptoms that persist after initial treatment should be checked for Barrett’s. Treatment of reflux can prevent the progression of Barrett’s Esophagus.
   
   
3. What are the risk factors for esophageal cancer?
   In the United States, the most common risk factor for esophageal cancer is gastro-esophageal reflux and its association with Barrett’s Esophagus. Additional risk factors include smoking and obesity. Worldwide, smoking and drinking are the most common risk factors.  
   
   
4. What are the signs and symptoms of esophageal cancer?
   Esophageal cancer can be silent. However, problems with eating (called dysphagia) are some of the most common symptoms. Usually this progresses from problems with eating solid foods to eventually problems with drinking fluids. Unexplained weight loss and pain associated with eating can be other symptoms of esophageal cancer.
   
   
5. When does heartburn become indicative of a greater underlying problem rather than just heartburn?
   Heartburn is one of the symptoms of gastro-esophageal reflux. However, persistence of heartburn may indicate a more significant problem. Many physicians will give a trial of anti-acid medication. If the symptoms persist, an upper endoscopy may be necessary.
   
   
6. When should I get an endoscopy?
   One should get an endoscopy for persistent symptoms of reflux, which may include heartburn. However, patients can manifest with atypical symptoms of reflux such as persistent hoarseness or recurrent respiratory infections that may require an endoscopy for evaluation as well. Additionally once you have a diagnosis of Barrett’s Esophagus you may need repeated endoscopic procedures to evaluate changes and progression of this condition (or endoscopic surveillance.)
   
   
7. What does treatment for esophageal cancer entail?
   Treatment for esophageal cancer depends on the stage of the cancer. It could include surgery, chemotherapy and radiation.
   
   
8. What are the advantages of the robotic approach for esophagectomy?
   The robotic approach has all the advantages of minimally invasive surgery, including decreased perioperative pain, decreased need for pain medication and early recovery to regular activities.
   
   
9. What steps can I take to prevent esophageal cancer?
   The steps one can take to prevent the onset or progression of esophageal cancer include first paying attention to symptoms such as persistent heartburn, unexplained weight loss or pain while eating, and seeking attention for these symptoms with an evaluation by a gastroenterologist. If a Barrett’s Esophagus diagnosis is made, one should continue regular follow-up or surveillance with his or her gastroenterologist to prevent progression of the disease. One also should also avoid heavy drinking and smoking in an effort to prevent esophageal cancer. 

Dr. Pimiento specializes in malignancies of the upper gastrointestinal tract and focuses on minimally invasive approaches including laparoscopic and robotic surgery. Dr. Pimiento has helped develop a comprehensive robotic program for the management of upper gastrointestinal and pancreatic tumors, making Moffitt Cancer Center one of the leaders in this field in the country. If you’d like to speak with one of our physicians about your symptoms, call 1-888-663-3488 or complete a new patient registration form.