As is the case with most cancers, it is possible for anyone to develop cancer at some point in his or her life; however, certain people are at a greater risk of developing esophageal cancer than others. Patients who suffer from severe or prolonged Gastroesophageal Reflux Disease (GERD) are prime candidates to develop Barrett’s Disease. Barrett’s Esophagus occurs in the area where the esophagus joins the stomach. Continuous exposure to stomach acid can cause the cells in the lower esophagus to become damaged, changing the architecture of the cells and increasing an individual’s risk of developing esophageal cancer.
Dysplasia is a precancerous condition that can only be diagnosed by examining tissue samples under a microscope. When dysplasia is seen in the tissue sample, it is usually described as being high-grade, low-grade or indefinite (or indeterminate). If dysplasia is confirmed, Dr. Singh, Dr. Rashbaum, Dr. Nitin Parikh, Dr. Long B. Nguyen, Tammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRN; might recommend more frequent endoscopies, or a procedure to destroy or remove the tissue. Barrett’s tissue has a different appearance from the normal lining of the esophagus and is visible during an endoscopy procedure.
Types of Esophageal Cancer
Dr. Ranvir Singh, Dr. Stephen Rashbaum, and Dr. Nitin J. Parikh believe that most cases of Esophageal Cancer begin with Barrett’s Esophagus. Because the early stages of esophageal cancer can be silent or asymptomatic, it is often diagnosed in the later stages where the survival rate is low. Thus, it is important to be evaluated early in order to avoid this preventable cancer.
- Adenocarcinoma: Adenocarcinoma is the most common type of Esophageal Cancer. This type of cancer forms in glandular cells in the lining of the esophagus that releases mucus. It typically develops in the lower part of the esophagus, closer to the stomach.
- Squamous Cell Carcinoma: Squamous Cell Carcinoma develops in the flat cells that line the esophagus. This type of esophageal cancer is typically found in the upper and middle parts of the esophagus.
Testing for Esophageal Cancer
Both of these techniques allow Dr. Singh, Dr. Rashbaum, Dr. Nitin Parikh, Dr. Long B. Nguyen, Tammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRN; to view the end of the esophagus and determine whether or not the normal lining has changed to look for potential dysplasia.
- Upper Endoscopy: Your doctor will first perform an imaging procedure of the Esophagus using Endoscopy to see if there are sufficient changes for Barrett’s Esophagus. In an Upper Endoscopy, the physician passes a thin, flexible tube called an endoscope through the mouth and into the esophagus, stomach, and duodenum. The endoscope has a camera lens and a light source and projects images onto a video monitor. This allows the physician to see if there is a change in the lining of the Esophagus. If your doctor suspects Barrett’s esophagus, a sample of tissue (biopsy) will be taken to make a definitive diagnosis.
- Capsule Endoscopy: Capsule Endoscopy is another test that has been used to examine the esophagus. In capsule endoscopy, the patient swallows a pill-sized video capsule that passes naturally through the digestive tract while transmitting video images to a data recorder worn on the belt. With capsule endoscopy, the physician is not able to take a sample of the tissue (biopsy).
Barrett’s Esophagus Facts
- Twice as common in men as women.
- Occurs in middle-aged Caucasian men who have had heartburn for many years.
- No agreement among experts on who should be screened. Even in patients with heartburn, Barrett’s Esophagus is uncommon and esophageal cancer is rare.
- One recommendation is to screen patients older than 50 who have had significant heartburn or who have required regular use of medications to control heartburn for several years. If that first screening is negative for Barrett’s tissue, there is no need to repeat it.
Medicines and/or surgery can effectively control GERD which sometimes leads to Barrett’s Esophagus; however, neither medication nor surgery for GERD can reverse the presence of Barrett’s Esophagus or eliminate the risk of cancer. There are some treatments available that can destroy Barrett’s tissue. Fortunately, there is a revolutionary therapy available called Endoscopic Radiofrequency Ablation (HALO System), offering new hope to those suffering from Barrett’s disease.
Screening, Diagnostics, and Surveillance
The risk of esophageal cancer developing in patients with Barrett’s Esophagus is quite low, approximately 0.5% per year (or 1 out of 200 per year). Therefore, the diagnosis of Barrett’s Esophagus should not be a reason for alarm. It is, however, a reason to have periodic upper endoscopy examinations with biopsy of Barrett’s tissue.
If you have Barrett’s Esophagus and your first two upper endoscopy examinations with biopsies (performed about one year apart) do not show dysplasia, then upper endoscopy with biopsy should be repeated about every three years. If the biopsy shows Dysplasia, then your doctor will make further recommendations regarding the next steps.
Board certified physicians Dr. Singh, Dr. Rashbaum, Dr. Nitin Parikh, Dr. Long B. Nguyen, and providers Tammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRN; care for patients in the north Atlanta, GA; area including Johns Creek, GA; Cumming, GA; Alpharetta, GA; and Lawrenceville, GA. The In-House Endoscopy Suite at Digestive Care Physicians is a certified facility which has achieved the highest level of accreditation by the Association for Ambulatory Health Care (AAAHC). If you suffer from gastrointestinal problems contact us at (770) 227-2222 to schedule an appointment.