Heartburn is the most important risk factor for the most common type of esophageal cancer.
Over time, gastroesophageal reflux disease can cause inflammation of the lining of the esophagus.
If there is enough inflammation, the normal lining is replaced with an abnormal lining, called Barrett’s esophagus.
In some cases, Barrett’s esophagus can then lead to esophageal cancer.
Esophageal cancer is often at an advanced stage upon diagnosis, so treatment needs to be rapid and aggressive, requiring the expertise of specialists who are experienced in treating the disease.
James L. Lin, MD is here to discuss esophageal cancer, it's diagnoses and treatments, and why City of Hope is leading the way.
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Barrett's Esophagus and the Risk for Esophageal Cancer
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Learn more about Dr. Lin
James L. Lin, MD
Dr. Lin is highly experienced in the field of endoscopic ultrasound (EUS), ERCP, and other advanced endoscopy services.Learn more about Dr. Lin
Transcription:
Barrett's Esophagus and the Risk for Esophageal Cancer
Melanie Cole (Host): Barrett esophagus can be a serious complication of GERD and can lead to esophageal cancer. My guest today is Dr. James Lin. He is highly experienced in the field of endoscopic ultrasound at City of Hope. Welcome to the show, Dr. Lin. Tell us a little bit about Barrett esophagus. What is it, and how does it relate to GERD?
Dr. James Lin (Guest): Well, Barrett esophagus is the condition where the normal cells in the lining of the distal esophagus are replaced by a different type of cell, almost look like intestinal cells. This process usually occurs as a result of repetitive damage to the distal esophagus from longstanding acid reflux or gastroesophageal reflux disease, GERD. This repetitive exposure to the acid damages lining of the esophagus and yet it changes in the lining from squamous mucosa of the normal esophagus to columnar epithelial, where the cells look more intestinal-like.
Melanie: Okay. So what is that relationship between Barrett esophagus and cancer? If we hear about this precancerous lesions or you’ve got reflux disease, what is that link?
Dr. Lin: What is that link? Like we discussed, Barrett esophagus, in the esophagus, it’s squamous epithelium. And when you get chronic acid damage from GERD, the lining changes. It becomes a metaplastic, and it turns into this columnar epithelium, and it’s this change to the columnar epithelium that predisposes to cancer. The lining can progress to a thing called dysplasia, and there’s a progression of dysplasia from low-grade dysplasia to high-grade dysplasia to cancer.
Melanie: Wow. What can people do about it, and how is it diagnosed? Do you do endoscopic ultrasound? What are you looking for?
Dr. Lin: Well, the first thing to diagnose the Barrett esophagus is you have to get an upper endoscopy. This is a procedure where we put a flexible camera down into the esophagus and we look for these changes in the lining and we do biopsies to confirm whether there is Barrett esophagus or not. That will be the first step.
Melanie: Then what do you do after that?
Dr. Lin: Well, if it’s just Barrett esophagus with no evidence of dysplasia, then we do a surveillance where we would do endoscopy every three to five years to check up and see if there’s any new changes. If we do the endoscopy and we actually discover dysplasia, low-grade or high-grade dysplasia, then we need to talk about how we’re going to manage this.
Melanie: Who is most at risk, if it’s people that just have the gastroesophageal reflux disease, or is there other things that contribute—coffee, drinking, spicy foods—any of these things contribute to Barrett esophagus?
Dr. Lin: Yes. Well, the main thing is the chronic acid reflux, the GERD. Other risk factors for Barrett esophagus include older age—greater than 50. It’s more common in males, 2:1 male to female ratio. Caucasians are at more risk of developing compared to other ethnicities. Obesity and also having a hiatal hernia, which predisposes to having more reflux symptoms. These are the risk factors for Barrett’s.
Melanie: How often should somebody who has these precancerous lesions or Barrett’s or you think that there are risks for Barrett’s, how often should they have an endoscopy?
Dr. Lin: Once the diagnosis of Barrett’s is established, what we want to know is if there’s any dysplasia. If there’s no dysplasia, then the recommendation is to have upper endoscopy every three to five years for checkup. If you have a low-grade dysplasia, it already has some precancerous changes, then recommendation is to have an endoscopy either 6 to 12 months. Or if you have high-grade dysplasia, once this is established that you have high-grade dysplasia, then we really talk about treatment. If treatment is not an option, then we do surveillance every three months for the endoscopy.
Melanie: Before we talk about treatment, Dr. Lin, do you see that like colonoscopy, which is now covered under insurance as a well thing to prevent colon cancer, that endoscopy will now be something that can help prevent esophageal cancer if caught early enough and it might be something that’s also considered under insurance?
Dr. Lin: That’s a great question. Once you have Barrett’s or established the diagnosis of Barrett’s esophagus, I think the screening and surveillance is indicated and covered. The question becomes should everyone who has acid reflux be screened for Barrett’s esophagus. That question is still up to debate. Right now, it’s managing the chronic acid reflux, we would try medications first. And then if symptoms don’t improve, then we talk about doing an upper endoscopy for further evaluation.
Melanie: What kind of treatments do you do? You try and manage the acid reflux. If someone doesn’t even know that they have acid reflux, that could be going on silently for quite a long time. What do you do besides managing the acid reflux? Is there something to calm the esophagus? Is there something to help heal those lesions?
Dr. Lin: The main form of treatment for Barrett’s esophagus is aggressive control of the reflux symptoms. A lot of the times with the Barrett’s esophagus is once you have the changing of the lining from squamous to a columnar epithelium, the columnar epithelium is more resistant to the acid in the stomach. That’s why you may not feel it as much as before. That’s one of the challenges why the people with Barrett’s, they may tell you that they don’t even have reflux symptoms.
Melanie: Then what other things can you do?
Dr. Lin: Other things that you can do is really a lot of behavior and lifestyle modification. Certain foods can actually cause worsening of the reflux. Coffee, tea, chocolate, alcohol, fatty foods can make the acid reflux worse. Diet and lifestyle modification is a huge part of the treatment for the reflux.
Melanie: Dr. Lin, in just the last few minutes, please give the listeners your very best advice about people suffering from GERD that risk for Barrett’s esophagus and what you really want them to know about Barrett’s esophagus and its link to cancer and why they should come to City of Hope for their ultrasound and endoscopies.
Dr. Lin: Barrett’s esophagus is a precancerous condition of the esophagus. Most patients with Barrett’s esophagus will not progress to esophageal cancer, but if you develop a condition called dysplasia, which is a precancerous change, then you’re progressing towards esophageal cancer. And that you need more of a workup. And there’s a lot of different treatment options for dysplasia. One of the treatment options, the new thing that we have at City of Hope is radiofrequency ablation. Radiofrequency ablation is the treatment where it’s essentially a thermal type ablation of the tissue. So we destroy the Barrett’s esophagus and allow it to heal and you’ve got a new squamous lining. It treats the Barrett’s esophagus with dysplasia. This radiofrequency ablation treatment currently is indicated for patients with high-grade dysplasia. There are treatment options for patients who do have Barrett’s esophagus with dysplasia.
Melanie: That’s fascinating. Thank you so much for such great information. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Barrett's Esophagus and the Risk for Esophageal Cancer
Melanie Cole (Host): Barrett esophagus can be a serious complication of GERD and can lead to esophageal cancer. My guest today is Dr. James Lin. He is highly experienced in the field of endoscopic ultrasound at City of Hope. Welcome to the show, Dr. Lin. Tell us a little bit about Barrett esophagus. What is it, and how does it relate to GERD?
Dr. James Lin (Guest): Well, Barrett esophagus is the condition where the normal cells in the lining of the distal esophagus are replaced by a different type of cell, almost look like intestinal cells. This process usually occurs as a result of repetitive damage to the distal esophagus from longstanding acid reflux or gastroesophageal reflux disease, GERD. This repetitive exposure to the acid damages lining of the esophagus and yet it changes in the lining from squamous mucosa of the normal esophagus to columnar epithelial, where the cells look more intestinal-like.
Melanie: Okay. So what is that relationship between Barrett esophagus and cancer? If we hear about this precancerous lesions or you’ve got reflux disease, what is that link?
Dr. Lin: What is that link? Like we discussed, Barrett esophagus, in the esophagus, it’s squamous epithelium. And when you get chronic acid damage from GERD, the lining changes. It becomes a metaplastic, and it turns into this columnar epithelium, and it’s this change to the columnar epithelium that predisposes to cancer. The lining can progress to a thing called dysplasia, and there’s a progression of dysplasia from low-grade dysplasia to high-grade dysplasia to cancer.
Melanie: Wow. What can people do about it, and how is it diagnosed? Do you do endoscopic ultrasound? What are you looking for?
Dr. Lin: Well, the first thing to diagnose the Barrett esophagus is you have to get an upper endoscopy. This is a procedure where we put a flexible camera down into the esophagus and we look for these changes in the lining and we do biopsies to confirm whether there is Barrett esophagus or not. That will be the first step.
Melanie: Then what do you do after that?
Dr. Lin: Well, if it’s just Barrett esophagus with no evidence of dysplasia, then we do a surveillance where we would do endoscopy every three to five years to check up and see if there’s any new changes. If we do the endoscopy and we actually discover dysplasia, low-grade or high-grade dysplasia, then we need to talk about how we’re going to manage this.
Melanie: Who is most at risk, if it’s people that just have the gastroesophageal reflux disease, or is there other things that contribute—coffee, drinking, spicy foods—any of these things contribute to Barrett esophagus?
Dr. Lin: Yes. Well, the main thing is the chronic acid reflux, the GERD. Other risk factors for Barrett esophagus include older age—greater than 50. It’s more common in males, 2:1 male to female ratio. Caucasians are at more risk of developing compared to other ethnicities. Obesity and also having a hiatal hernia, which predisposes to having more reflux symptoms. These are the risk factors for Barrett’s.
Melanie: How often should somebody who has these precancerous lesions or Barrett’s or you think that there are risks for Barrett’s, how often should they have an endoscopy?
Dr. Lin: Once the diagnosis of Barrett’s is established, what we want to know is if there’s any dysplasia. If there’s no dysplasia, then the recommendation is to have upper endoscopy every three to five years for checkup. If you have a low-grade dysplasia, it already has some precancerous changes, then recommendation is to have an endoscopy either 6 to 12 months. Or if you have high-grade dysplasia, once this is established that you have high-grade dysplasia, then we really talk about treatment. If treatment is not an option, then we do surveillance every three months for the endoscopy.
Melanie: Before we talk about treatment, Dr. Lin, do you see that like colonoscopy, which is now covered under insurance as a well thing to prevent colon cancer, that endoscopy will now be something that can help prevent esophageal cancer if caught early enough and it might be something that’s also considered under insurance?
Dr. Lin: That’s a great question. Once you have Barrett’s or established the diagnosis of Barrett’s esophagus, I think the screening and surveillance is indicated and covered. The question becomes should everyone who has acid reflux be screened for Barrett’s esophagus. That question is still up to debate. Right now, it’s managing the chronic acid reflux, we would try medications first. And then if symptoms don’t improve, then we talk about doing an upper endoscopy for further evaluation.
Melanie: What kind of treatments do you do? You try and manage the acid reflux. If someone doesn’t even know that they have acid reflux, that could be going on silently for quite a long time. What do you do besides managing the acid reflux? Is there something to calm the esophagus? Is there something to help heal those lesions?
Dr. Lin: The main form of treatment for Barrett’s esophagus is aggressive control of the reflux symptoms. A lot of the times with the Barrett’s esophagus is once you have the changing of the lining from squamous to a columnar epithelium, the columnar epithelium is more resistant to the acid in the stomach. That’s why you may not feel it as much as before. That’s one of the challenges why the people with Barrett’s, they may tell you that they don’t even have reflux symptoms.
Melanie: Then what other things can you do?
Dr. Lin: Other things that you can do is really a lot of behavior and lifestyle modification. Certain foods can actually cause worsening of the reflux. Coffee, tea, chocolate, alcohol, fatty foods can make the acid reflux worse. Diet and lifestyle modification is a huge part of the treatment for the reflux.
Melanie: Dr. Lin, in just the last few minutes, please give the listeners your very best advice about people suffering from GERD that risk for Barrett’s esophagus and what you really want them to know about Barrett’s esophagus and its link to cancer and why they should come to City of Hope for their ultrasound and endoscopies.
Dr. Lin: Barrett’s esophagus is a precancerous condition of the esophagus. Most patients with Barrett’s esophagus will not progress to esophageal cancer, but if you develop a condition called dysplasia, which is a precancerous change, then you’re progressing towards esophageal cancer. And that you need more of a workup. And there’s a lot of different treatment options for dysplasia. One of the treatment options, the new thing that we have at City of Hope is radiofrequency ablation. Radiofrequency ablation is the treatment where it’s essentially a thermal type ablation of the tissue. So we destroy the Barrett’s esophagus and allow it to heal and you’ve got a new squamous lining. It treats the Barrett’s esophagus with dysplasia. This radiofrequency ablation treatment currently is indicated for patients with high-grade dysplasia. There are treatment options for patients who do have Barrett’s esophagus with dysplasia.
Melanie: That’s fascinating. Thank you so much for such great information. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.