Richards' Death Highlights Rise in Esophageal Cancer

Sept. 14, 2006 — -- Breast, colon, lung and skin cancer often make headlines, but few people realize that the cancer that took the life of former Texas governor and political firecracker Ann Richards is one of the fastest-growing cancers in the United States.

Richards was diagnosed with esophageal cancer in March of this year, only six months before her death, a testament to the deadliness of the disease.

This year more than 14,000 people in the United States will be diagnosed with esophageal cancer. Of those, just 16 percent -- or about 2,200 patients -- will be alive in five years.

Over the past two decades, experts have seen a sixfold increase in the number of people diagnosed with esophageal cancer, mostly due to increasing rates of obesity.

There are two main types of esophageal cancer.

The first, cancer in the upper esophagus (the tube that connects the mouth to the stomach), is linked to alcohol and smoking. Richards admitted to heavy drinking and smoking in her younger years, saying she "smoked like a chimney and drank like a fish."

Recently, though, this type of cancer has declined, in large part because fewer people smoke.The second form takes hold in the lower esophagus and is believed to be caused by chronic irritation from stomach acid traveling up the esophagus, a condition commonly known as heartburn.

And this, in turn, is linked to obesity, doctors said.

The rise in esophageal cancer, said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, "is the direct result of GERD [gastric esophageal reflux disease], which has been increasing as our nation gets heavier." In both forms, irritation -- whether from smoking, alcohol or stomach acid -- causes damage to cells, which the body then repairs. Unfortunately, these new cells are much more susceptible to cancer.

Along with full-blown cancer, a milder form of the disease, called Barrett's esophagus, is diagnosed when a large amount of normal cells have been replaced by more cancer-prone cells. People with Barrett's esophagus are 30 times more likely to develop esophageal cancer than those without.

The major problem with esophageal cancer is that it's a silent killer. People do not tend to experience symptoms until very late, when the cancer has advanced to the point at which it blocks the esophagus, making eating very difficult. The symptoms include difficulty swallowing, pain in the throat and weight loss.

The current recommended treatment is chemotherapy or radiation therapy, followed by surgery. In many cases, chemotherapy and radiation therapy are used together. Unfortunately, the survival rate is still quite grim.

"So far, all people can do to decrease their risk of this cancer is stop smoking, stop drinking and lose weight," Lichtenfeld said.

Several experimental treatments are currently being tested to see how well they disrupt the change from normal cells to malignant (cancerous) cells. Treatments include radiofrequency ablation (using signals to burn the cells), cryotherapy (freezing the cells), photodynamic therapy (using light to kill the cells) and surgical removal of abnormal cells. However, it's not known how well these methods work in the long-term.

See Dr. Tim Johnson discuss this condition on "World News" Monday, Sept. 18, as part of a special series on heartburn and acid reflux.