Symptoms of esophageal cancer and why you shouldn’t ignore it
John Hutchison kept brushing off his nagging cough as insignificant.
Thankfully, he decided he was long overdue for a routine physical.
“I explained to the physician that I had a cough that wouldn’t go away, and I frequently had to clear my throat,” he recalls. “I also had been battling acid reflux and taking an over-the-counter antacid medicine for relief.”
The doctor scheduled a computerized tomography (CT) scan, and it showed a questionable hazy area on his esophagus.
The next step was an upper endoscopy (esophagoscopy, or EGD). The exam revealed a tumor about two inches in size in Hutchison’s lower esophagus. “When we learned the diagnosis was esophageal cancer in September 2018, my family and I were shocked,” he explains. “It was scary, but I am fortunate we caught this cancer when we did.”
Esophageal cancer occurs in the esophagus, the long hollow tube that runs from your throat to your stomach. When you swallow food, your esophagus helps move it from the back of your throat to your stomach where it is digested.
“Our multi-disciplinary team approach is our best strategy to individualize each patient’s case,” explains Philip Rascoe, MD, a cardiothoracic surgeon with UT Physicians and associate professor at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth). “This was our approach for John and it included chemotherapy, radiation, immunotherapy, and surgery.”
“Radiation therapy is an important component in the management of esophageal cancer,” says Angel Blanco, MD, associate professor in the Department of Neurosurgery at McGovern Medical School and medical director, radiation oncology and Gamma Knife centers, Memorial Hermann – Texas Medical Center. “In John’s case, we opted for triple-modality treatment, (surgery preceded by radiation and chemotherapy) to provide maximal probability of cure. We also incorporated recent advances, such as lower-dose radiation and advanced “hybrid” treatment planning to reduce unintended radiation doses to neighboring normal tissues.”
“Thankfully, the triple-modality treatment shrunk John’s cancer mass before surgery,” explains Putao Cen, MD, associate professor in the Division of Oncology at McGovern Medical School. Dr. Cen is on John’s team and started his chemotherapy immediately after the diagnosis.
Dr. Rascoe performed an esophagectomy on John on January 18, 2019, removing the abnormal part of his esophagus. “Dr. Rascoe was kind and explained everything very well,” says Hutchison. “He gave me confidence about the plan and this was important because not only was this my first surgery, I had never even been a hospital patient.”
“We were very impressed with the team,” says Hutchison’s wife, Haike, “and how well they worked together. Everyone at Memorial Hermann did an excellent job.”
“John did extremely well throughout treatment, and enjoyed an excellent recovery, with a good prognosis on the basis of final pathology,” notes Dr. Blanco.”
“We can’t over emphasize the importance of early detection,” says Dr. Rascoe, “but esophageal cancer in its early stages typically has no sign or symptoms. Most patients come to us when they experience weight loss and difficulty swallowing.”
Signs and symptoms of esophageal cancer include:
- Difficulty swallowing
- Weight loss, without trying
- Chest pain, pressure or burning
- Worsening indigestion or heartburn
- Coughing or hoarseness
Having one or more risk factors does not mean you will get esophageal cancer. But a risk factor changes your chance of getting a disease. Esophageal cancer risk factors include tobacco and alcohol; gastroesophageal reflux disease (GERD); obesity; Barrett’s esophagus (precancerous changes in the cells of the esophagus); and not eating enough fruits and vegetables.
“The incidence of adenocarcinoma of the esophagus, esophagogastric junction and gastric cardia has increased dramatically over the past three decades,” adds Dr. Cen. “This increase is in part due to the increase of obesity and GERD. White people were affected five times more often than black people, and men eight times more often than women.”
Barely two months after surgery, Hutchison is doing great and encourages everyone not to ignore symptoms. “Immediately go to the doctor and don’t wait until swallowing becomes difficult. This type of cancer can grow quickly.”
Dr. Rascoe has more advice. “Patients with severe long-standing GERD disease should see a gastroenterologist. These patients may need a screening endoscopy for Barrett’s esophagus, a condition that greatly increases your risk for esophageal cancer.” Those patients with known Barrett’s disease undergo routine endoscopic surveillance to detect any evidence that the disease may be progressing to cancer.
If you, a family member or friend, develop any of these symptoms, contact 888-4UT-DOCS (888-488-3627) immediately.
— Wendy Cederberg, UT Physicians