Driven by obesity and acid reflux, adenocarcinoma of the esophagus has become the fastest rising cancer in white men in the United States, said experts from Baylor College of Medicine and University of Pennsylvania Perelman School of Medicine in a review article published in New England Journal of Medicine. The review summarizes the latest developments in the risk factors, pathogenesis, diagnosis and treatment of the two major types of esophageal cancer.
“It’s important to remember that the risk factors (obesity and acid reflux) are potentially modifiable,” said Dr. Hashem El-Serag, senior author of the review and chief of gastroenterology and hepatology at Baylor.
Esophageal cancer is rare in young individuals but increases with age, peaking at ages 70 to 80. The cancer is three to four times as common in men as it is in women, the authors stated.
The review details how daily and weekly symptoms of acid reflux increase a person’s likelihood of developing this form of cancer. It also explains how abdominal obesity increases the risk of developing Barrett’s esophagus and cancer. Increased pressure causes the stomach to move upward, which can cause and exacerbate acid reflux symptoms.
Barrett’s esophagus, a precursor lesion to adenocarcinoma, can be detected through an endoscopy.
“People who are obese or have chronic acid reflux should consider having an endoscopy to be screened for Barrett’s or adenocarcinoma,” El-Serag stressed.
A technique called radiofrequency ablation can help prevent progression to cancer in those with Barrett’s esophagus who develop an abnormality called dysplasia.
“Radiofrequency ablation can be done endoscopically by a gastroenterologist,” El-Serag explained. “This reduces the risk of cancer and has proven safe and effective.”
He estimated that as many as 86 percent of dysplasia cases treated with radiofrequency do not go on to become cancer.
The other author in this review is Anil K. Rustgi, chief of gastroenterology at University of Pennsylvania Perelman School of Medicine, Philadelphia.