Esophageal Cancer

John Han-Chih Chang, MD and Kenneth Blank, MD
Last Modified: November 1, 2001

Dear Oncolink,  
My husband died 9 years ago of extensively metastatic esophageal cancer, which was found in a Barrett's Esophagus. He had a hiatal hernia, with many years of acid reflux. I'm very alarmed about our 12-year-old son, who has always burped easily and readily. Over the past 2 months, NOT RELATED to a full or semi-full stomach, he will burp and both air AND some brownish gastric contents. It doesn't hurt him and he has no problems swallowing. I'm a nurse and very concerned about our son. I am calling his physician for an appointment. Do you think it's unreasonable to ask for a gastroscopy? I realize that you cannot give advice per se. This Web page has been an anchor for me in so far as treating cancer. How I wish my husband had lived long enough for us to get more help!

I'm just scared that esophageal cancer will get my son, too.  
Please advise, if you can. Thank you.

John Han-Chih Chang, MD and Kenneth Blank, MD, Editorial Assistants for Oncolink, respond:

Dear M.L.,  
Thank you for your interest and question.

Esophageal cancer arises in the mucosal lining of the esophagus and spreads quickly up and down the length of the organ submucosally. The wall of the esophagus is so thin that it often is invasive into the surrounding tissues at the time of diagnosis. Adenocarcinoma of the esophagus usually arises in "Barrett's Esophagus" secondary to the continued dysplasia that is caused by acid reflux. In infants and young children, the lower esophageal sphincter or LES (closes off esophagus from the stomach to prevent reflux) is much weaker and less developed than adults are. Thus, they have a tendency to burp or regurgitate more often than an adult does.

What is somewhat concerning about your son is that this has come on, from what I understand, just recently. Also, he is slightly to old to continue to have a less developed lower esophageal sphincter. Gastroscopy (actually esophagogastroduodenoscopy or EGD) would likely not be the first study. Most likely, a barium swallow would be enough to determine whether there was an abnormality in that region. If a lesion were detected, perhaps EGD would be the next step. At his age, your son most likely has reflux from a weaker LES. It is unlikely that he has an esophageal malignancy. Discuss with your pediatrician about consideration of surgical correction, if this is the case.