Trends in Esophageal Cancer
- A large population-based study of esophageal adenocarcinoma patients from 1975 to 2015 suggests that this most common type of esophageal cancer has become increasingly more common amongst people under age 50 and presents at more advanced stages compared with older patients.
- A 42-year-old father and esophageal cancer warrior recently posted on Reddit to share his esophageal cancer story and be a helping hand to others navigating the disease.
- Esophageal cancer can be treated if caught early. The common symptoms like difficulty swallowing, weight loss and heartburn can often mimic other diseases, so it's important to mention any health changes to your doctor.
Alex is a 42-year-old father and an esophageal cancer warrior. His cancer journey began when started having trouble swallowing for several weeks. Food kept getting stuck in his throat, and he kept having “massive hiccups.”
Read MoreHe has begun eating soft foods again as of last week, and he’s started doing overnight feedings via a J-tube directly into his small intestine. Despite going through a lot lately, Alex’s experience has surprised him in a positive way. Now, he’s sharing his story with the Reddit community to help anyone else facing a similar struggle.
“Overall, I thought it would be an awful summer due to treatment and it did suck but also wasn't nearly as bad as I thought it would be,” he wrote. “I'll be happy to answer any questions for others going through the scary esophageal stuff.”
Unfortunately, there probably are people out there who could have questions for Alex including other younger people.
“There appears to be a rise of esophageal, gastric and colon cancer among young people (<50 years old), which is a population that is typically less likely to get diagnosed with gastrointestinal cancer,” Dr. Emily Nachtigal, a UCLA-Olive View hematology-oncology fellow, tells SurvivorNet.
According to a recent population-based study, esophageal adenocarcinoma, the most common type of esophageal cancer, has become more common amongst younger people under the age of 50 in the United States with an annual incidence increase of 2.9 percent from 1975 to 2015. The study, which was published in Cancer Epidemiology, Biomarkers & Prevention a journal of the American Association for Cancer Research, also found that “young-onset” esophageal adenocarcinoma presented at more advanced stages compared with older patients.
"Patients who present with late-stage esophageal cancer typically have poorer outcomes than those with early-stage disease,” study author Dr. Prasad G. Iyer, a gastroenterologist for the Mayo Clinic in Rochester, Minnesota, said in a press release. “As such, it is important to understand the epidemiology of esophageal cancer to target our screening strategies.”
But why are we seeing younger patients with more advanced disease in the first place? The answers are unclear, but Dr. Nachtigal shared her theories.
“It might be that their type of cancer is inherently worse, or it could be due to delay in diagnosis,” Dr. Nachtigal said. “It can be hard for patients to be taken seriously when they are otherwise young and healthy.”
Both obesity and GERD, gastroesophageal reflux disease, are established risk factors for esophageal adenocarcinoma. And although reasons for the concerning trend are unclear, researchers noted rising obesity rates in younger individuals leading, in turn, to chronic GERD at an early age as possible causes.
“GERD that starts during childhood is also known to persist as a chronic condition in adulthood,” Dr. Hashem B. El-Serag, director of the Texas Medical Center Digestive Diseases Center, said. “And it’s possible that the reported increase in childhood GERD also underlies the observed trends in esophageal adenocarcinoma.”
Regardless of underlying causes, these diagnoses tend to come as a shock for young patients.
“Some patients are found to have a familial etiology (a genetic predisposition to the disease), but most often the cancer is unexpected and unexplainable,” Dr. Nachtigal explained.
The study’s lead author, Mayo Clinic gastroenterology fellow Dr. Don C. Codipilly, notes that this study serves as a reminder for physicians that esophageal adenocarcinoma is not just a disease of the elderly and outcomes for young people with the disease are “dismal.” In fact, the under 50 age group had a 22.9 percent five-year survival rate in the most recent time period of 2000 to 2011 compared to 29.6 percent for both the 50-69 and the 70-and-over age groups.
“Our findings suggest that physicians should have a low threshold of suspicion for patients who present with dysphagia (difficulty swallowing),” Dr. Codipilly said in a press release. “While younger patients would typically not be at high risk for EAC, they may benefit from an upper endoscopy.”
An upper endoscopy, examination of the upper lining of the digestive tract, could rule out esophageal adenocarcinoma or help diagnose the disease at an earlier, more easily treatable stage, according to the study authors.
So, how should we feel about these findings? Dr. Natchtigal explained that awareness is key, but young people shouldn’t be too worried overall.
“Young people shouldn’t lie awake at night worried they might have cancer,” she told SurvivorNet. “But it is important for people (including doctors) to note this rise in GI cancers among young people.”
Understanding Esophageal Cancer
The esophagus is a tube that goes from the throat to the stomach and plays an important role in your digestive system. When cancerous cells form inside the tissues of this organ, you have esophageal cancer. Overall, this cancer is rare, often difficult to diagnose and more common in American men. Of more than 19,000 cases of esophageal cancer expected to be diagnosed in the United States in 2021, almost 4,000 will be diagnosed in women. Risk factors for esophageal cancer include smoking, alcohol consumption, acid reflux disease and obesity.
Some people confuse esophageal cancer with throat cancer, but they are, in fact, different. The cause of most esophageal cancers is unknown though some risk factors like tobacco use can increase the likelihood of developing this cancer but human papillomavirus, a sexually transmitted virus also known as HPV, is a known cause of throat cancer. Treatment options for esophageal cancer include surgery, radiation, chemotherapy and immunotherapy.
In a previous conversation about treating esophageal cancer, Dr. Raja Flores, chair of thoracic surgery at Mount Sinai School of Medicine, told SurvivorNet the disease is often diagnosed in the later stages meaning it has already spread to distant parts of the body.
"Of [all the cases diagnosed in the U.S. per year], only about 1,000 get surgery, because the majority of them are identified at such a late stage," he said.
Dr. Brendon Stiles, chief of thoracic surgery at Montefiore Medical Center, previously shared his expertise on this disease with SurvivorNet.
"We know that esophageal cancer is a tough one, it's one of the cancers with one of the lowest cure rates out there," he said. "But like many cancers, if we find it early, we can often treat it effectively. Either with surgery, or surgery and chemotherapy surgery, chemotherapy and radiation sometimes. My message to patients is the same as it is for most cancers, try to get diagnosed early."
Esophageal Cancer: Signs to Look Out For
But why is it often diagnosed so late? One reason could be that its symptoms — weight loss, difficulty swallowing and heartburn — often mimic that of other diseases, according to Dr. Stiles. Things like heartburn are generally not cause for any serious concern, but it's important to communicate any issues with your doctor. The more proactive you are about your health, the more likely you are to have an early diagnosis if something serious were to arise.
Treatment Options for Esophageal Cancer
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