Cancer of Esophagus Rates Up – a Lot

Obesity has been linked with a small increase in some cancers – breast, uterus, colon, gall bladder, and kidney – for various reasons. For instance, increased body fat can act as a source of estrogen, helping to promote breast cancer. In the case of the esophagus, however, the increase is major – to about 3½ times what it was 30 years ago. The reason here is the epidemic rise in gastro-esophageal reflux disease (GERD) associated with overweight and obesity. According to Mark Orringer MD, speaking at the Society of Thoracic Surgeons Annual Meeting, the commonest type of esophageal cancer has changed, too. Twenty years ago it was usually a squamous cell carcinoma seen in heavy drinkers and smokers, with rarely a few adenocarcinomas. Now these ’glandular’ tumors, which are derived from stomach-lining cells, make up 85% of esophageal cancers.

People with long-standing GERD may develop Barrett’s esophagus, which is replacement of the normal squamous (‘pavement’) cell layer at the lower end of the esophagus by gland-containing mucosa. This represents a stage in the response to reflux that can, rarely (~1%), continue to become adenocarcinoma.

At this surgeons’ conference Dr Orringer described a new technique for removal of the cancer – which doesn’t concern us here. The best way to react to this information is to fight overweight, and GERD, and, if advised by your physician, to have an endoscopy to see if you have Barrett ’s. If you have, it can be fairly easily treated without major surgery.