Cancer of the Esophagus and the Acid Reflux Connection
Over the past three decades, the incidence of esophageal cancer has increased more than any other form of cancer during the past ten years. Now, scientists have come closer to discovering the complete pathway from gastroesophageal reflux disease (GERD) complicated by a pre-cancerous condition called Barrett's esophagus, to the development of esophageal cancer.
Weibiao Cao, a researcher at Rhode Island Hospital and lead author of a recent article in the Journal of Biological Chemistry, is unraveling the pathway in order to help physicians prevent cancer of the esophagus. "The role of acid is controversial. But we show that by exposing cells to acid for short periods of time, that affects a particular enzyme, triggering a chain of events that possibly leads to cancer of the esophagus. Now that we have a better understanding of the signaling pathway, we can possibly identify who is at risk of developing cancer by determining the levels of this enzyme.”
For the first time, Cao, along with other researchers, have been able to show how acid exposure increases production of a particular enzyme and hydrogen peroxide, which may contribute to the progression from Barrett’s esophagus to esophageal cancer.
"Now that we know the sequence, we may be able to slow down or even block the progression of cancer by blocking these different steps. This may have therapeutic value if we can block this particular enzyme, NOX5, in Barrett's esophageal cancer cells," Cao says.
Cao's research is critical for those who may develop esophageal cancer in the future. Currently, the median survival rate is less than 18 months and the projected five-year survival rate after surgery on operable tumors is less than 20 percent. The major risk factor continues to be GERD complicated by Barrett's esophagus.
Even at this early stage of research, Cao suggests that increased treatment with proton pump inhibitors (drugs that reduce gastric acid production) for Barrett's esophagus patients may help prevent or slow down the progression of the development of pre-cancerous and cancerous cells.
Cao continues to study the mechanisms of how acid causes the progression to cancer and hopes to further map out the intermediate steps. His research is funded by grants from the COBRE Center for Cancer Research Development at Rhode Island Hospital and the National Institutes for Health.
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