Esophageal cancer is a serious and often silent disease, but with awareness and early action, outcomes can improve.
Nicholas LeBlanc, MD, a thoracic surgeon with Our Lady of the Lake Cancer Institute, recently shared his expertise on this complex and often silent disease during a recent episode of Medical Monday with Brian Haldane.
What Is Esophageal Cancer?
“Esophageal cancer is a malignancy, or a cancer, of the esophagus, which is a muscular tube that starts at the back of our throat and runs down through the chest, through the diaphragm into the abdomen, and meets the stomach,” Dr. LeBlanc explains.
This cancer can develop anywhere along that path. In the U.S., the most common type is adenocarcinoma, also known as glandular carcinoma. This type of cancer develops in glandular tissues, which are responsible for secreting substances like mucus, hormones, and enzymes. These tissues line parts of the esophagus, and chronic irritation — often caused by acid reflux — can trigger cellular changes that may eventually lead to cancer.
“In South Louisiana, unfortunately, we fit the bill,” he says. “We have obesity, chronic reflux, which is linked to obesity, and all of that leads to increased abdominal pressure, pushing gastric and bile contents into the esophagus.” Over time, the esophagus tries to protect itself, and those changes can eventually turn into cancer.
Risk Factors You Shouldn’t Ignore
Dr. LeBlanc highlights several common risk factors for esophageal cancer: obesity, chronic acid reflux (GERD), smoking, heavy alcohol use, family history and a precancerous condition known as Barrett’s esophagus.
“There’s a huge overlap in smoking and drinking alcohol that can cause cancers from the throat and the esophagus,” he explains. “They’re intimately related because the esophagus starts where the throat ends.”
Symptoms: Don’t Wait Until It’s Too Late
Esophageal cancer often goes unnoticed until it’s advanced, making early symptoms especially important to catch.
“The body’s a wonderful machine that can compensate, so most symptoms don’t begin until later on,” says Dr. LeBlanc.
The most common symptom is dysphagia, or difficulty swallowing.
“It is not normal when you’re trying to eat pudding or a slice of pizza and everything just gets stuck. Food getting stuck is not normal and that absolutely warrants a conversation.”
Other symptoms include chest pain, unintentional weight loss and fatigue. Family history and Barrett’s esophagus are also considered early warning signs.
“If someone is losing weight and they’re not trying, that’s concerning,” Dr. LeBlanc adds. “It’s a highly consumptive process. The cancer is taking all your energy and using it to feed itself.”
Early Detection Is Everything
“Early detection is the key,” Dr. LeBlanc emphasizes.
If someone is having trouble swallowing, it’s common to begin with a swallow study, where contrast is used to observe how food moves down the esophagus. But the most definitive tool is the EGD scope.
“That’s short for esophagogastroduodenoscopy,” he explains. “Getting a scope with a gastroenterologist is typically the first step.”
These tools can detect cancer—or even precancerous changes—before it becomes life-threatening. “If you find it early, like in the precancerous Barrett’s changes, you can eradicate it. With an ablation or an endoscopic removal, it’s gone. It will never turn into cancer.”
The Harsh Reality — and the Hope
“All comers of esophageal cancer, stage one through four lumped together, have a five-year survival of only about 22 to 23 percent,” Dr. LeBlanc shares.
But there is hope.
“We’re trending up because we’re getting wiser,” he says. “We’re following up with patients, doing surveillance and routine screening.”
Awareness Is the First Step
If you notice trouble swallowing, persistent acid reflux or unexplained weight loss, don’t wait.
“Food getting stuck is not normal,” Dr. LeBlanc urges. “Have that conversation. Get the scope. It could save your life.”
