Esophageal Cancer: Know the Risks

by John F. Lazar, MD, Thoracic Surgery
October 27, 2020

Are you a tea drinker, sometimes drinking multiple cups a day? It may be time to “cool things down.” A recent study suggests a significant link between hot tea and esophageal cancer.

Surprising? Don’t worry, there’s plenty you can do to minimize your risk of developing this cancer. Let’s look at the tea-drinkers’ study and explore other risk factors for esophageal cancer, then review the options for patients diagnosed with this cancer.

What is Cancer of the Esophagus?

Esophageal cancer occurs in your “food pipe,” also known as your gullet or esophagus, the long tube that runs from your throat to your stomach.

This cancer, while relatively rare, can be one of two types, based on its location and the cells lining that area of the esophagus. In the upper part of the gullet, it is referred to as squamous cell carcinoma; in the lower two-thirds, adenocarcinoma. Treatment differs for each type.

This year, more than 16,000 patients will die of esophageal cancer, and another 18,000 will be diagnosed with it. Unfortunately, if this cancer is not caught in its early stages, the five-year survival rate for patients is only about 20%.

Hot Tea and the Esophagus

A recent transformational study found links between hot tea and squamous-cell carcinoma in the upper part of the esophagus. Based on 50,000 patients tracked over 10 years, the study took a close, long-term look at patients’ behavioral characteristics, such as their smoking and drinking habits and the socioeconomics of their lifestyles.

Researchers looked carefully at the type, quantity and temperature of the tea that these patients consumed. They found that all types of tea, particularly black tea, showed a connection to esophageal cancer; however, the main differentiators were not type of tea, but temperature and amount consumed. The study indicated that people who like their tea really hot—above 140 degrees F—and who drink at least 50 ounces of it daily have a 90 percent greater risk of squamous-cell esophageal cancer than those who drink cooler tea or none at all. Hot water alone does not seem to constitute a risk, it is the combination of very hot water with tea that creates the issue.

Fortunately, most people in the U.S. don’t drink as much scalding hot tea as do other regions of the world. But for Americans, it may be advisable to stick to one or two cups of tea a day, allowing your cup to cool a bit before drinking to avoid damage to the esophagus.

Other Risk Factors

Esophageal cancer is on the rise in America, mostly in middle-aged white men. We believe that long-standing gastroesophageal reflux disease, commonly known as GERD or reflux, is a critical risk factor. Typical candidates may be overweight and in their 50s and have pursued a generally unhealthy diet for years. For these patients, acid has regularly traveled up from the stomach and burned the lining of the esophagus. The scar tissue that forms in that region can become pre-cancerous, and then, over time, cancerous.

Years of reflux can cause long-term damage to the esophagus. Dr. Lazar addresses this risk and others. @jflazar @MedStarWHC https://bit.ly/3jkkTT6
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If you’ve experienced reflux for several years, inform your primary care doctor if you’ve been on antacid medication for a long time or have regularly used over-the-counter options (like Tums® or Rolaids®) and ask if you may need to move to stronger medication. Your health care professional may recommend an endoscopy—a procedure allowing the specialist to take a look at your stomach via a scope inserted through the mouth and throat.

Beyond factors like acid reflux and hot tea, other risk factors for esophageal cancer can include long-term smoking or alcohol consumption, as well as a family history of this type of cancer.

Treatments

At MedStar Washington Hospital Center, we use a multi-modality plan to treat adenocarcinoma in the lower portion of the esophagus. This includes chemotherapy and radiation to shrink the tumor and help with microscopic disease, then surgery to remove any cancerous cells potentially left behind.

In the case of squamous cell carcinoma, because the upper portion of the esophagus is difficult to reconstruct and because this carcinoma responds well to current chemotherapy agents, we typically opt for chemotherapy and radiation treatment.

When surgery is called for, we must essentially remove the portion of the esophagus with the cancer and replace it with another organ that can continue its function of moving food from mouth to intestines. We reconstruct the stomach from a sac into a tube, bring it up to your chest, and connect it to the part of the esophagus that has no cancer.

Previously, this four- to five-hour procedure was performed through two openings, one in the abdomen to create the tube, the other in the chest to remove the cancer and connect the tube. Today, we use minimally invasive laparoscopy, using a long scope with a camera at the end. In addition, many surgeons are moving toward robotics, which allow a very precise 3D approach to the procedure.

After Surgery

Because surgery of this type affects two areas of the body, patients are generally in the hospital for five to ten days, followed by recovery at home for two to four weeks.

Surgical removal of the cancer requires the surgeon to sever the nerves along the esophagus, so it loses the ability to contract and push food to the intestines. What remains are a muscle and a tube that depend on gravity to push food along. For this reason, post-surgery, the patient must adhere to a softer diet and cut solid food into very small pieces.

At MedStar Washington Hospital Center, our care team is very involved in supporting the patient’s recovery. Our interaction with patients is an ongoing, collaborative process, working through all the options and any challenges together.

It is important to understand potential risk factors and, if you are deemed high-risk, to visit your primary care doctor or a gastroenterologist regularly for diagnoses and advice on medication. High-risk individuals should adjust their diet and adopt a fitness plan to maintain a healthy weight and control GERD.

This is a tough disease but, if identified early, the odds of curing it can be much better.

LISTEN: Dr. Lazar discusses esophageal cancer in the Medical Intel podcast.

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Category: Healthy Living, Medical Intel     Tags: esophageal cancer causesesophageal cancer riskesophageal cancer treatmentths-2q