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We all know someone who lives with constant heartburn and indigestion. More than just the irritation that acid reflux or gastroesophageal reflux disease (GERD) can cause, these conditions may lead to a much more serious health issue – esophageal cancer. An estimated 150 million people have acid reflux, which puts a large portion of the population at risk for eventually developing the disease. That’s why controlling the effects of acid reflux or GERD is about more than alleviating pain and discomfort – it’s about cancer prevention, too.
Food getting stuck in your esophagus doesn’t necessarily mean cancer – you may be experiencing a stricture or narrowing due to another cause. As the condition worsens, people often change their eating habits without realizing it. Any change in your ability to swallow is a preliminary sign warning sign for esophageal cancer that should be evaluated right away.
Why is this kind of cancer on the rise?
When you go back 50 years, most esophageal cancers were a different type and in a different location than we are seeing today. Squamous cell carcinoma, which usually occurs in the middle of the esophagus, was due in part to nitrates in meats and preservatives in other foods. Excessive alcohol use and smoking were almost always associated.
Today, nearly all the esophageal cancers are adenocarcinomas – located at the bottom of the esophagus and directly related to acid reflux and the rise of obesity. There’s a been change in the last 30 years in the number of people who are obese and in the way people eat. Along with an increase in caffeine, chocolate, alcohol, and fatty food consumption, people are eating food in larger quantities. These factors could be leading to an evolutionary change that’s having an impact on the number of people diagnosed.
Digging a little deeper, there’s a valve at the bottom of the esophagus that connects to the stomach and keeps the acid inside contained. It’s called the lower esophageal sphincter. When this valve doesn’t function properly, it stays open and allows acid reflux to occur. People feel this when they eat a huge meal, burp or have indigestion. It usually feels even worse when you lie down because gravity is working in the wrong direction, letting acid move upward.
Some people are born with a dysfunctional esophageal sphincter, which also allows the stomach acid to creep up – and we don’t know what causes it to happen. But no matter the reason – a deformity or as a result of poor eating habits – we do know when acid comes from the stomach into the esophagus and throat repeatedly, you’re more like to develop a condition called Barrett’s Esophagus. This precancerous condition causes the normal lining of the esophagus to change – resembling more closely the lining of the intestines. When you have Barrett’s Esophagus, you’re at increased risk of developing esophageal adenocarcinoma.
When should I see a specialist?
If you have a sore throat, you know something isn’t right. When you twist an ankle, you know it needs attention. But if you wait for those typical warning signs of pain in the lungs or esophagus, it’s going to be too late for effective treatment. No one can feel those types of sensations in their chest, and that’s what makes early detection so difficult.
It’s important to see a gastrointestinal specialist immediately for further evaluation if you:
- have a history of cancer, especially cancers of the chest, and are living with constant heart burn or GERD.
- have heart burn and food isn’t going down like it should. Trouble swallowing is never normal and should evaluated.
- experience discomfort or pressure in your chest or worsening heartburn and indigestion that isn’t helped by a change in diet or medication.
- are constantly hoarse or have a chronic cough in combination with acid reflux.
Most of the time, esophageal cancers don’t cause symptoms until they are in an advanced stage – when they are more difficult to treat. Paying more attention to subtle changes is the first step in finding – and beating – this disease.
J. Rob Headrick, MD
Lung Cancer Stages: A Simple Explanation
If you’ve been recently diagnosed with lung cancer or know someone who has, the topic of staging has likely come up in the conversation. Correct staging is important and different for each type of cancer. What methods we use to treat lung cancer depends on where the cancer began and where it’s moved inside the body. Doctors determine staging through a history, physical and imaging studies.
Because lung cancer is complicated – and emotional – my goal is to talk with my patients and have a two-way conversation about treatment rather than give a speech about staging and treatment modalities. The easiest way to think about cancer staging is to imagine a city like Chattanooga.
If we find the cancer when it’s in the city limits of Chattanooga – or confined to one specific location – this is stage 1. The cancer is within the boundaries of one area, and it’s fairly straightforward to remove the cancer completely with surgery.
Stage 2 is similar to Stage 1 in terms of where the cancer has moved. The cancer is still within one main area like the city center but has begun to move to one or more of the surrounding communities like East Ridge or Signal Mountain. Within Stage 2, the cancer has moved to these areas through well-defined pathways (no back roads were taken). Again, surgery is the first approach to treatment.
Things get a little more complicated at Stage 3. The cancer cells that were originally in Chattanooga have moved farther down the road – to Dalton or Nashville or Knoxville. But in this stage, the cancer hasn’t necessarily stayed on the interstates. In fact, it’s likely used many backroads, with twists and turns we can’t predict and are harder to contain. It’s in Stage 3 that the benefits of surgery begin to fall off, and we think about chemotherapy or radiation therapy as our first line of treatment. Sometimes surgery is used later after these methods have done their work.
In Stage 4 lung cancer, what started in Chattanooga has now traveled a long distance – to Chicago, or Los Angeles or New York. Because of the multitude of ways to travel and the miles in between each location, cancer that has spread this far is much harder to treat. In this stage, chemotherapy is our main line of defense.
Proper Staging Leads to Effective Treatment
Staging is a valuable tool that sets the benchmark or standard for determining your ability to fight cancer and the best treatment options. I work with each of my patients to help them understand their cancer in simple terms and find a way to fight it most effectively. What we do is personalize care.
If you’ve received a diagnosis you don’t understand, we’d like to talk with you. Call our Second Opinion Clinic at (423) 495-5864 (LUNG) to schedule an appointment.
J. Rob Headrick, MD
What is a collapsed lung and who is at risk?
For many people, the thought of lung surgery brings up fears and thoughts of worry about a collapsed lung. People often have misconceptions about a collapsed lung because they oversimplify this complex organ. Lungs are less like a balloon and more like a sponge. They feel spongy because of the millions of alveoli inside them. Alveoli are tiny air sacs that diffuse oxygen. When we breathe in, our lungs expand and filter the oxygen from the air and pass it into our blood. When we exhale, our lungs release carbon dioxide, a gas that your body makes but doesn’t need.
A collapsed lung is when air escapes from the lung and fills the space between the lung and the chest wall. This build up air puts pressure on the lung, keeping it from expanding like it should when you take a breath. A collapsed lung can result from trauma to the chest, broken ribs, a stab wound or bullet, a hard hit in a contact sport like football or a medical procedure like a lung biopsy or central line placement.
In some cases, a collapsed lung is caused by air blisters (blebs) that break open, sending air into the space around the lung. When a collapsed lung occurs, there’s not a popping effect. It’s more like a nail in your tire that slowly releases pressure over time. When the lung is inadvertently punctured, a person may experience chest pain, shortness of breath, fatigue, rapid breathing and heartbeat, and a cough.
The slow buildup of air in the chest makes it harder to breathe – and it’s important to seal the leak quickly and get the air back inside the lung. Sometimes the lung will re-inflate on its own and make the repair with little intervention. The human body is amazing in its ability to solve its own problems. In these cases, we put in a tube to take the leaked air out of the body, which reduces the pressure on the lung, allowing it to close itself.
Other non-surgical methods to correct a collapsed lung include supplemental oxygen or needle aspiration to remove air in the chest with suction. When it’s not able to heal through one of these methods, we can go in surgically to remove the damaged area and seal it back up.
People who are at greater risk of a collapsed lung include those with underlying lung conditions like COPD, cystic fibrosis, lung cancer, asthma, emphysema and certain types of pneumonia. Although there is no way to prevent a collapse lung, you can decrease your risk by quitting smoking or choosing not to smoke.
J. Rob Headrick, MD
LOW DOSE LUNG CT SCREENING
Dr. Rob Headrick, M.D. discusses lung CT screening guidelines, awareness and treatment.