Friday 24 January 2020

How persistent indigestion, acid reflux or chronic heartburn could be warning signs of oesophageal cancer

With the Christmas season in full swing, there’s a tendency for people to overdo it on the festive fun when catching up with friends or going out over the holidays.

It’s not uncommon for the festivities to take their toll but persistent indigestion, heartburn or acid reflux could also be a sign of a bigger problem. It’s easy to dismiss these symptoms as a consequence of excessive eating and drinking but the Oesophageal Cancer Fund (OCF) has advised the public that they can sometimes mask a bigger problem.

These very common symptoms, if persistent or severe, can be a warning sign of oesophageal cancer in some people. This cancer affects almost 500 people a year in Ireland, and can be difficult to treat and cure.

They can also be the first indication of Barrett’s oesophagus, a condition that carries a risk of progressing over time to cancer.

The OCF has been at the forefront of the fight against this cancer for over two decades and the funds it raises are vital in developing awareness, treatment and research initiatives. To find out more the risks, identification and treatment of this disease, we spoke to Professor of Clinical Surgery at the St James's Hospital and Trinity College Dublin, John Reynolds.

What are the warning signs of Barrett’s oesophagus and oesophageal cancer?

Professor Reynolds says that the common symptom of oesophageal cancer is difficulty swallowing. However, persistent acid reflux or indigestion, excessive hiccups, feeling fuller than you normally would after meals, iron deficiency anaemia or unexplained weight loss are what a patient may initially present with on occasions.

“If the symptoms persist for a couple of weeks, you should present to your GP,” Professor Reynolds says.  

Over two thirds of patients diagnosed with oesophageal cancer have symptoms for two or more months before they are seen by a specialist.

Where reflux is the main problem, and it persists, an endoscopy may diagnose Barrett’s oesophagus.

“Acid reflux may present as heartburn, food repeating immediately, or sometimes waking up at night with acid or food coming into your mouth. If this is the case and it persists, have it properly investigated and treated. If it’s properly treated, then there’ll be less burning, less inflammation of the oesophagus and therefore we would anticipate a lower risk of cancer development.

“This applies to both patients who have just acid reflux, or those that have been diagnosed with Barrett’s oesophagus. In both scenarios, treatment to control reflux is essential to reduce the cancer risk.”

Identifying and addressing these issues early can be the best form of preventative action but early detection of Barrett’s oesophagus or oesophageal cancer can ultimately improve your chances of successful treatment, cancer prevention, and cure if it is diagnosed at an early stage.

Those most at risk are males aged 50 and over. It may be associated with unhealthy lifestyles, smoking and obesity in particular increases the risk. However, severe acid reflux, particularly of long duration, can itself increase the cancer risk.  

What’s the link between Barrett’s oesophagus and oesophageal cancer?

“Barrett’s oesophagus is just a change in the lining of the oesophagus that happens in some patients who have chronic reflux and heartburn over many years, particularly if it’s bad,” explains Professor Reynolds.

“The lining actually changes to protect the patient from a lot of the symptoms. It’s an adaptive thing but that type of lining is something that can become cancerous in about one in 20 with the diagnosis. So, the vast majority of people who have Barrett’s oesophagus never get cancer. This is important as many will be worried. Our job is really to reassure them, and manage those that are at higher risk of progressing to cancer.”

The OCF has contributed €1.8million in funding to oesophageal cancer research initiatives, such as the establishment of Ireland’s first National Barrett’s Oesophagus Registry and Bio Bank. This is a vital step in understanding and tackling this cancer, developing strategies to both prevent the cancer, diagnosing it early where it occurs, and curing it with relatively simple new treatments.

Studying patients with Barrett’s oesophagus offers invaluable insights into how this cancer develops and the associated risk factors. It also helps to continuously monitor those who register for any signs of cancer.

“Because that’s the only visible target for this cancer, a lot of the effort and the focus of the OCF in terms of research has been identifying patients with Barrett’s oesophagus with the National Barrett’s Oesophagus Registry.

“It’s looking at ways to tackle it both through prevention but, particularly with patients who already have it, to try and prevent them from going on to develop cancer. And through research, to try to work out those that are most at risk of developing cancer. If anyone is unlucky enough to develop cancer and it’s diagnosed early, it can be treated simply without any major complex operations, or chemotherapy or radiation therapy.”

Bringing the good fight to a bad cancer

Established in 2001 by a group of friends who lost a friend to this cancer, the OCF has made huge strides towards tackling this disease. The impressive work in this area is already bearing fruit and survival rates in Ireland have almost doubled in the last 20 years, according to a report in The Lancet Oncology.

“The actions started by the OCF are truly making a significant difference nationally through raising awareness, encouraging prevention strategies and early diagnosis, working to improve cure rates, enhancing recovery of quality of life, and optimising survivorship,” adds Professor Reynolds.

“As a cancer surgeon and researcher, I cannot thank enough Noelle Ryan (CEO, OCF) and all in OCF for what they have achieved for patients with oesophageal cancer, both in clinical care and in research awareness, over almost 20 years, and to thank all who have supported the OCF through their generous fundraising.”

Fundraising through annual initiatives like Lollipop Day have been vital and work with the National Barrett’s Oesophagus Registry is helping experts to understand this cancer, identify those at risk and get early treatment for those who are unlucky enough to get cancer.

“The biggest thing is that they have been able to do, through the funds raised for years now through Lollipop Day, is to channel most of that funding into projects that are aimed towards prevention or early diagnosis, or improved cure rates for cancer. This approach has an enormous impact.”

70pc of patients experience symptoms for over two months before visiting their GP.

It’s not a problem if it’s not ignored.

Visit the new OCF website to educate yourself and help them fight the good fight.


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