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How to prevent esophageal cancer? Hot liquids, genetic factors and alcohol risks
Top thoracic cancer surgeon on protecting esophagus from cancer (it is often discovered late and has high mortality)
Esophageal cancer is diagnosed in almost half a million people globally. And in the United States the esophageal cancer rate is not very high, but in certain areas of China, Middle East, the rate could be 30x higher for esophageal cancer. What could people do to prevent esophageal cancer? Because it’s a very aggressive, there is only 18% five-year survival rate and esophageal cancer is usually discovered quite late. – Yes. So esophageal cancer clearly is a cancer that has high mortality. And prevention of esophageal cancer, it really depends on where you are in the world. So in the Western world a lot of the esophageal cancers are from acid reflux. So the repetitive injury of you having untreated acid reflux can injure the lower esophagus. And then over time that injury pattern can transition into an invasive esophageal cancer. How you prevent that? You treat reflux symptoms, you get endoscopy if you have chronic reflux symptoms, you go on medicine. And then if medicines are not working then there are operations that we can do to improve reflux. And some of them are laparoscopic operations. We call them fundoplications, where we kind of wrap the stomach around the lower esophagus and create a new sphincter. If, for example, you’re in the Asian continent, the risk factors for esophageal cancer are very different there. So that we see more esophageal cancers in the middle or upper esophagus in that part of the world. It’s unclear what exactly is causing them, but we think it’s diet and environment. We think it could be perhaps their diets, hot tea and something in the diet that could increase esophageal cancer risk. And because risk is so high, as you mentioned, there’s a screening program much like we have screening colonoscopy in the US. They have screening upper endoscopy in the Asian continent. I think that for me to answer how do you prevent esophageal cancer [in Asian continent], I don’t know the answer to that. That’s a different [type of esophageal cancer], where the intervention is unclear. – How do you define “hot” in a hot drink and hot tea? Or any hot liquid that could be a risk factor for esophageal cancer. What is considered hot? – So there is this theory, when people drink tea in the temperature range that burns to the tongue and so that would be clinically hot. And so what is that in Fahrenheit? I don’t know, close to a hundred degrees Celsius. But hot enough to burn your tongue. We think that probably can be something that can injure the esophagus as it’s going down, and maybe that’s why we see more upper esophageal cancers in that population. It doesn’t translate easily, because if you look at folks in India who also drink a lot of hot tea, we’re not seeing the same amount of upper esophageal cancers in those patients. So it’s a weak argument. Ultimately, I’d say the answer is “we are not entirely clear why”. We think it’s their diet and perhaps genetics, the genetic background that predisposes them to the upper esophageal cancers. More so than in the US, where we see in the Western world more lower esophageal cancers. Do you think irritation by alcoholic drinks is a risk factor for esophageal cancer? For example, is there a difference between drinking or sipping wine, or sipping whiskey, or having a shot of vodka, for example, that supposedly goes [through esophagus] faster but nevertheless is irritating to esophagus? It’s an interesting question. I think that any of those that you mentioned in moderation should not increase your risk of getting esophageal cancer. On the other hand we clearly know that if you have alcohol dependency and alcohol abuse, whatever alcohol you drink, those patients tend to get more squamous cell cancers that are in the upper upper esophagus. That’s understood.