In recent years the incidence of diseases like oesophageal or gastric cancer are on the increase. Thanks to the stresses and strains of modern life – in some cases unhealthy diets, an overabundance of processed foods and excessive levels of alcohol can contribute to the development of cancer, however, in many cases no obvious causes are ever determined.

As with most cancers, if they’re diagnosed at an early stage, they’re more likely to be treatable and – in many cases – curable.

The problem is, however, that these two types of cancer tend to be more gradual than others since their symptoms often resemble those of less serious and often simply annoying medical conditions such as heartburn, indigestion, difficulty swallowing and even plain hiccupping. For some people symptoms don’t begin to appear until the cancer is more advanced.

Heartburn/indigestion

We’re all familiar with the Gaviscon adverts, aren’t we? The firemen putting out the fire with their hoses and everything returning to normal? Anyone watching those adverts thinks, ‘Yes, I get heartburn. That will do nicely thanks….’ A couple of spoons of an anti-heartburn medication and you’re good to go….

Think that way?

Think again….

Certainly heartburn and indigestion are now common occurrences – and increasingly so – thanks to acidic foods, fatty meals, fizzy drinks and excess alcohol, but, unfortunately, heartburn and other ‘annoying’ medical issues can be a sign that there’s much more wrong than first meets the eye.

First, let’s look at the science…

Although it’s called ‘heartburn’, heartburn doesn’t actually have anything to do with the heart. In fact, it’s not even located over the heart, but behind the breastbone. In most cases it’s caused by acid reflux, which involves the acid in the stomach travelling back up the oesophagus (your gullet), causing a burning sensation in the oesophagus.

Put simply, at the point where your oesophagus meets your stomach, there is a muscle valve called the oesophageal sphincter, which ensures that your food passes in one direction from your gullet to your stomach. As soon as you eat something, this sphincter opens up to let food pass into your stomach. For the rest of the time, however, it should remain closed so that the contents of your stomach don’t come back up again. 

If this sphincter – or valve if you like – isn’t working properly, then the contents of your stomach are regurgitated or brought back up into your oesophagus, causing acid reflux and heartburn. Over a period of time the acid can cause inflammation in your gullet, leading to pain.

Unfortunately, this pain can range from the benign to the much more serious. When heartburn becomes almost permanent and is accompanied by other related symptoms, it is then referred to as gastro-oesophageal reflux disease (GORD).

At this stage it may also be accompanied by symptoms such as:

  • Hoarseness
  • Regurgitation of food
  • Pain with swallowing
  • Frequent heartburn
  • Difficulty swallowing
  • Unexpected weight loss
  • Coughing during a meal
  • Drooling 

While in some people the acid reflux may not even cause burning, but may simply cause a dull pain in the centre of the chest, in others the pain in the chest can become so acute that it can be mistaken for a heart attack. 

Difficulty in swallowing (dysphagia)

And then there’s the difficulty in swallowing….

In many people this feels as if they’re swallowing over a lump in their throat. The condition is actually called globus or dysphagia and, while it can be accompanied by pain, in most people it is painless. Again, this symptom is often attributed to the extreme form of acid reflux – gastro-oesophageal reflux disease (GORD) – but it can also be caused by oesophageal motor disorders, inflammatory issues such as tonsillitis and chronic sinusitis.

Some people with dysphagia will experience problems swallowing certain foods or liquids, while others will be unable to swallow at all. 

Other signs of dysphagia, which may accompany the swallowing difficulties include:

  • Coughing or choking when eating or drinking
  • Persistent drooling of saliva
  • Being unable to chew food properly
  • Bringing food back up
  • Experiencing the sensation that food is ‘stuck’ in the throat or chest

While dysphagia can be caused by another health condition, such as a condition that affects the nervous system, such as a stroke or head injury, and can also be linked to – and caused by GORD – there is also the chance that it is being caused by a mouth cancer or oesophageal cancer.

Hiccups

You may be surprised by this one, but hiccups may occur when an oesophageal tumour invades the phrenic nerve or diaphragm. When these structures are irritated, they cause repeated contractions of the diaphragm, hence the hiccups!

While hiccupping is a normal occurrence, is familiar to most people and usually terminates on its own, it should be investigated if it lasts longer than a month or so, when it is much less common. In the central nervous system, the upper spinal cord, brain stem and hypothalamus can all be involved in the production of hiccups and all signs can be transmitted to the diaphragm. Gastrointestinal causes of hiccups therefore include GORD, oesophageal cancer and hiatus hernia. 

If hiccupping lasts longer than two days and is linked to other issues, such as heartburn or trouble swallowing (see below) then, you should consult your GP for further examination.

When the symptoms are more serious

So, how do you tell the difference between everyday, benign conditions such as heartburn, indigestion, hiccups and dysphagia, and more serious illnesses, such as oesophageal or gastric cancer?

Well, the first thing that you can do is take a good look at your symptoms before seeking medical advice.

When it comes to indigestion and heartburn, you’ll probably experience the following:

  • Heartburn, particularly after eating
  • Feeling full and bloated
  • Feeling sick
  • Belching and passing wind
  • Bringing up food or experiencing bitter-tasting fluids in your mouth

If, however, you experience sensations such as stomach ache, or back pain, then you need to have these investigated, since these are not symptoms of indigestion or heartburn. You may simply be constipated, but the symptoms definitely need to be looked into.

If you are suffering the symptoms of dysphagia, or if your hiccupping lasts longer than 48 hours and is accompanied by either of the previous conditions, you should always seek medical opinion. Early investigation can help to rule out more serious conditions, but your GP can assess you and refer you on for further tests, if required.

The OG Cancer NI Catch It Early campaign, funded by the National Lottery and OG Cancer, strives not only to increase the awareness of the signs of oesophageal-gastric cancers in the public but also throughout the medical and caring professions.

For further information follow #OGCancerNI, call 07568 157450 or make an appointment to see your local GP today.

Early Diagnosis is Key #CatchItEarly

Oesophageal cancer like many other cancers does not discriminate between age or sex and knowing and recognising the signs and symptoms are crucial to early diagnosis.  If you suffer from any of the following symptoms for longer than 3 weeks you should consult your doctor.

  • Persistent Indigestion
  • Difficulty swallowing or food sticking
  • Heartburn acid reflux
  • Hiccupping that wont go away
  • Unexplained weight loss.

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