Can GERD Cause Cancer?
Almost everyone gets a touch of heartburn now and then. However, if you experience the symptom frequently, talk to your doctor. Frequent heartburn may be a sign of gastroesophageal reflux disease (GERD), also known as acid reflux.
Some people with GERD have a slightly higher risk of developing cancer of the esophagus, a rare but serious condition.
“GERD is incredibly common, but esophageal cancer related to GERD is not very common. So it’s important to know that most people with GERD are not going to develop esophageal cancer,” says Douglas Smink, MD, MPH, a Brigham and Women’s Hospital gastrointestinal surgeon and chief of surgery at Brigham and Women’s Faulkner Hospital. “For people at higher risk, screening can catch things early, which leads to better outcomes.”
Understanding heartburn, acid reflux, and GERD
The esophagus is a tube about a foot long that connects your mouth to your stomach. Food travels down the esophagus into the stomach, where acids break it down and digest it. Between the esophagus and the stomach is a valve (sphincter) that keeps those stomach acids where they belong.
Sometimes acid leaks from the stomach into the esophagus, called acid reflux. Acid reflux usually causes a general burning sensation in the chest or throat, a symptom called heartburn. Heartburn can sometimes feel so severe that it’s mistaken for a heart attack.
Most people experience heartburn and esophageal reflux occasionally, but if it’s happening over and over again, you may be diagnosed with GERD.
GERD is caused by a structural problem in the valve between the stomach and esophagus. That valve can weaken or stretch over time, allowing acid to get through.
Some cases of GERD are related to a hiatal hernia. This condition happens when the opening in the diaphragm (muscle between your chest and belly that helps you breathe) is bigger than it should be or stretches out. The stomach then pushes up through the diaphragm.
Signs of GERD
Frequent heartburn is the most common sign of GERD. Eating a GERD diet and taking medications can alleviate the symptom. But they don’t stop reflux or cure GERD, Dr. Smink explains.
“People who need to take a medicine — especially those who are self-prescribing a medicine every day for themselves — should see a doctor. The occasional antacid is fine, but if you need it every day or every other day, you should at least talk to your primary care doctor, who may recommend referral to a gastroenterologist,” Dr. Smink advises.
Although frequent heartburn is the most common symptom of GERD, some people don’t experience it. They may notice other signs or symptoms that are related to GERD or could be potential signs of cancer, such as:
Anemia
Difficulty or pain during swallowing
Tooth decay
Unexpected weight loss
Voice changes such as hoarseness
“Sometimes people won’t feel the traditional symptom of heartburn but may still have acid reflux. If you are experiencing any of those symptoms and they are severe or long-lasting, they definitely need to be checked out. They’re not guarantees that you have esophageal cancer or any cancer, but they’re concerning enough that you should get them investigated,” Dr. Smink says.
Barrett’s esophagus
Over time, in some people, chronic acid in the esophagus can cause changes in cells, a condition called Barrett’s esophagus.
“The cells that line the esophagus are not built to withstand constant exposure to acid,” Dr. Smink says. “If a person has long-term reflux, the body tries to adapt, changing the lining of the esophagus so that the cells become more similar to the cells in the lining of the stomach. If that process goes haywire, more and more cells divide and move up into the esophagus. And this may become a precancerous state.”
People with Barrett’s esophagus can develop a type of esophageal cancer called adenocarcinoma.
Factors that are associated with higher risk for Barrett’s disease are:
Male biological sex
Age older than 50 years
GERD for more than 5 years
Family history of Barrett’s esophagus
If you have chronic GERD, your doctor may recommend an endoscopy to look at the lining of your esophagus. They thread a thin tube through your mouth and into your esophagus. The tube is equipped with a light and a camera so the doctor can see the lining and the cells. During the endoscopy, the doctor can take a small sample of cells for testing, called a biopsy.
“The large majority of people with Barrett’s do not get cancer,” Dr. Smink says. “It just means you are at increased risk for cancer, and it’s a high enough risk that you should get a screening endoscopy every couple of years. With screening, we can find these cellular changes and treat the condition before it becomes a cancer.”
Treatment to prevent chronic acid reflux and cancer
In addition to regular screening tests, your doctor may recommend a procedure or surgery to correct structural problems causing GERD. For example, using endoscopy, a doctor can pull together tissues to create a new valve or reinforce the valve. They also can remove precancerous cells with ablation, which destroys cells with laser or heat.
Surgery can fix a hiatal hernia in the diaphragm, tightening the hole around the esophagus. A surgeon also can recreate or reinforce the valve with a procedure called fundoplication, wrapping part of the stomach around the esophagus. Some institutions also offer surgical insertion of a magnetic device that helps strengthen the sphincter.
Early GERD treatment can reduce the risk of Barrett’s esophagus and esophageal cancer, Dr. Smink emphasizes. It also can catch cancer earlier, which is important because late stages of esophageal cancer are harder to treat.
