Inspire Hope

Heartburn can be more than just a penance for a spicy meal;
over time, it can cause cancer

BY SUSAN STEVENS
Daily Herald Health Writer
Posted Monday, September 25, 2006

Most people can name several causes of cancer: smoking, too much sun, unfortunate genes. An advertising blitz for the new cervical cancer vaccine is fast spreading the news that some cancers are even caused by a virus.

But one type of particularly deadly cancer is hitting a growing number of people with none of these problems. The culprit: acid reflux, or plain old chronic heartburn.

Tom Mikus is one of them. A father of three from Naperville, Mikus, 45, had just started a new job and was busy with his sons' baseball games and other activities on the weekends.

In May 2005, he noticed he had trouble swallowing his sandwich out on the golf course. He mentioned it to his wife, but didn't worry. He passed it off as indigestion.

But it wasn't indigestion. What caught in Mikus' throat was a tumor, one that had grown silently and spread into his lymph nodes.

By the time he was diagnosed in July 2005, Mikus had stage IV cancer of the esophagus. Only 20 percent of people with this advanced esophageal cancer will live a year.

A rising killer

"The worst thing about this cancer is that most people that are diagnosed are just like my husband," said Cyndi Mikus. "That's what's terrible about it. It's a really silent cancer. It's really going on, and you have no idea."

Esophageal cancer is the fastest-rising major cancer in the United States, and it's usually deadly. An estimated 14,550 people will be diagnosed this year, and 13,770 will die of the disease. Ann Richards, the former governor of Texas, died earlier this month of cancer of the esophagus.

The fastest-rising group are those with adenocarcinoma of the esophagus - the type of esophageal cancer that is thought to be due to acid reflux disease, a growing problem in the U.S.

That's why if you have chronic heartburn, popping antacids isn't enough; you should be under a doctor's care to be sure it doesn't progress to something more serious.

Heartburn, also called acid reflux disease, gastroesophageal reflux disease or GERD, bathes the lower part of the esophagus in concentrated gastric acid, damaging the cells lining the throat.

In some people - roughly 10 percent of those with GERD - the cells will change into a different type of tissue. This condition, called Barrett's esophagus, can develop into cancer.

Like Tom Mikus, most people are not diagnosed until their tumor has grown so large it partially blocks the esophagus.

A tumor must grow roughly a centimeter into the middle of the esophagus for a person to notice difficulty swallowing, said Dr. Wayne Hofstetter, a thoracic surgeon at the University of Texas M. D. Anderson Cancer Center in Houston, where Mikus was treated. But it only has to grow a few millimeters into the lining of the esophagus to reach the lymph nodes.

"By the time someone has symptoms, it has grown so far into the esophagus that it is difficult to cure," Hofstetter said. Only 25 percent to 30 percent of patients are candidates for surgery, the best treatment available.

Mikus didn't have the severe heartburn symptoms that would have driven him to the doctor. His doctors theorized that a faulty sphincter between his stomach and throat allowed acid to wash up while he was sleeping.

By the time he was diagnosed, the cancer had spread, and surgery was not possible. Mikus enrolled in two clinical trials at M. D. Anderson to access the latest chemotherapy treatments, which his wife credits for extending his life more than a year post-diagnosis. The family took a few vacations together before Mikus died at home Aug. 10.

Treating Barrett's

The standard treatment for people with Barrett's esophagus is careful monitoring. A doctor will often recommend an endoscopy, a 20-minute test in which a scope is inserted down the throat to check for pre-cancerous lesions. The test will be repeated every three years, or more frequently if the doctor notes changes that could be precursors to cancer.

Proton-pump inhibitor drugs like Prilosec and Nexium, as well as surgical procedures that tighten the valve between the stomach and the esophagus, decrease the acid that is damaging the throat and might lower the risk of cancer.

But neither pills nor surgery are definitive in preventing esophageal cancer, Hofstetter said. By the time someone develops Barrett's esophagus, he said, the cells in the throat might have already suffered DNA mutations that could develop into cancer - even if the acid stops.

In patients with the most advanced Barrett's, surgeons might cut out a portion of the esophagus.

Newer therapies include two less invasive methods of removing Barrett's cells from the esophagus, in hopes of preventing cancer from developing. In photodynamic therapy, doctors give the patient a light-sensitive drug and then burn away abnormal tissue with a laser.

A newer device made by Barrx Medical Inc. uses thermal energy to remove the diseased lining of the esophagus, allowing the regrowth of normal cells.

"It does not cure the reflux, but it gets rid of those cells that have the potential for forming cancer," said Dr. Alan Auerbach, chief of gastroenterology at Northwest Community Hospital in Arlington Heights.

Northwest Community has acquired Barrx's radio frequency device and is awaiting its first patient. Like colonoscopies, in which doctors remove precancerous polyps from the colon, Auerbach envisions radio frequency ablation as a way to lower cancer risk in people with Barrett's esophagus.

Because the devices are relatively new, so far there is little evidence that ablative therapies prevent cancer long term, said Dr. Nicholas Shaheen, director of the University of North Carolina Hospital's Center for Esophageal Diseases and Swallowing.

Shaheen is conducting a sham-controlled, multicenter trial funded by Barrx to test its HALO360 device in patients with dysplasia, an advanced stage of Barrett's in which cells develop precancerous traits.

Shaheen's trial will examine whether radio frequency ablation eliminates dysplasia for good and halts the progression to cancer.

Most people with Barrett's will not be a candidate for ablative therapy, however. Ablative therapies carry risks themselves, including creating a hole in the esophagus, so many doctors will not perform them unless a patient is at higher risk of developing cancer.

Someone with Barrett's esophagus has less than a 1 percent chance per year of developing esophageal cancer.

"The vast majority of patients who get Barrett's esophagus will never go on to get this cancer," Shaheen said. "It should be viewed as a chronic condition, like high blood pressure or diabetes, something that needs to be watched."

Catch it early

Since her husband's death, Cyndi Mikus has formed the Thomas S. Mikus Live Your Best Life Esophageal Cancer Foundation to raise awareness and money for research. The best chance to cure esophageal cancer is to catch it early, and she is telling everyone she knows about the dangers of acid reflux disease.

"People don't realize that," Cyndi Mikus said. "They're blown away when they hear you can get a very deadly cancer from acid reflux."

One person might already have benefited. Tom O'Neill of Orland Park had a 20-year history of heartburn and was diagnosed with Barrett's esophagus in February 2005, almost by chance. At the time of his colonoscopy, his doctor turned him over and did an endoscopy, too.

The doctor diagnosed Barrett's and advised O'Neill to keep an eye on it and return next year. A few months later, an acquaintance died of esophageal cancer. Then O'Neill heard through a mutual friend about Mikus' diagnosis.

"I said, wow, this is a real disease," O'Neill said. He made an appointment for an endoscopy, three months early, and doctors found a stage II tumor.

O'Neill went through chemotherapy and radiation at M. D. Anderson. His doctor told O'Neill the cancer was gone, but he opted for surgery anyway. Doctors removed two-thirds of his esophagus, half his stomach and 19 lymph nodes. They found more cancer in his esophagus, but his lymph nodes were clean.

O'Neill has a good prognosis and feels healed physically, though he is still coping with lack of energy and depression. Because his stomach is smaller, he needs to eat smaller, more frequent meals, and has lost about 18 pounds. Yet he feels incredibly lucky to have caught his cancer so early, when it could be treated.

"The odds are so bad because they usually catch it at stage IV. If they catch it early, it's an amazing thing," O'Neill said. "Somebody was looking out for me."

Reprinted from dailyherald.com, Health and Fitness, September 26, 2006