London - For 20 years, Mike McCord suffered from heartburn almost every day. To him it became normal and making sure he had a packet of Rennies with him before he left home was as routine as checking he had his keys and wallet.
From time to time his wife Mimi asked him to go to the doctor about it, but he’d say: “Don’t worry, you can’t die of heartburn.”
In fact, he was wrong. By the time he did seek medical advice, Mike had advanced oesophageal cancer brought on by the heartburn he’d dismissed so breezily.
He died aged 47, leaving behind Mimi, widowed at just 44, and their two children, both at university.
Persistent heartburn can trigger oesophageal cancer and, unfortunately, thanks to our modern lifestyles, it has become an increasingly common cause.
Yet while many suffer from heartburn, they often know nothing about the heightened long-term risks, instead blithely crunching away on antacids for months or even years.
“Many people, and I’m afraid that includes some GPs, are unaware of the link between heartburn and cancer,” says Dr Rebecca Fitzgerald, a consultant gastroenterologist at Addenbrooke’s Hospital, Cambridge, in the UK.
Heartburn, often described as a burning sensation in the chest or acid taste in the mouth, occurs when acid leaks out from the stomach up the oesophagus (the tube that carries food from the mouth).
This can be caused by a weakened valve in the oesophagus; some people are born this way, but it can develop with age, too.
Other triggers include obesity, pregnancy or over-indulgence, where pressure on the stomach pushes some of its contents out.
Caffeine and rich, spicy or citrus foods can also be a problem, as these relax the valve in the oesophagus. A hiatus hernia – when part of the stomach is trapped behind the oesophagus – is another common cause.
“If heartburn happens once or twice it will heal as normal,” says Fitzgerald. “But if the problem persists, and acid repeatedly leaks up from the stomach, the body tries to protect the oesophagus and creates a new lining.
“This is a condition called Barrett’s oesophagus. Unfortunately, the new tissue is abnormal and far more likely to become cancerous than normal tissue.”
People at risk of developing Barrett’s are typically the obese, those who have regular heartburn and white males over 50.
“Around 10 percent of those with Barrett’s will develop oesophageal cancer,” says Fitzgerald. “However, most of these have no idea they have Barrett’s, because there are no symptoms.
“But once you have it then it could become cancerous at any time. Early diagnosis is key, so if you are having heartburn more than once a month, you should visit your GP.”
The survival rate for oesophageal cancer is shockingly low. Only 13 percent of patients survive beyond five years.
Worryingly, the number affected by heartburn-related cancer is rising. The two most common forms of oesophageal cancer are squamous cell carcinoma, which is linked to smoking and drinking, and adenocarcinoma – linked to heartburn.
Thirty years ago, squamous cell was by far the more common form, accounting for more than 70 percent of cases. Now almost half of those with oesophageal cancer have the adenocarcinoma form.
“This is probably because we are eating richer food and obesity rates are rising,” says Fitzgerald.
Mike was not overweight and ate a healthy diet. Heartburn can be hereditary, but there was no history of it in his family. His heartburn was simply bad luck.
“Mike was a picture of good health,” says Mimi. “His only problem was this wretched heartburn. He had no other symptoms, apart from the burning pain.”
He first suffered heartburn when he was 23, says Mimi, now 52. “Nothing in particular seemed to trigger it, rather everything did. And like many men, he did not want to go the doctor – he did not feel the need.
“In his early 40s he started complaining that the pain in the centre of his chest was getting more intense – but he would take a Rennie and it would go away.”
However, Mike’s condition began to go rapidly downhill when he was 47. “One morning he got hiccups while eating a piece of toast. And he started complaining his lunchtime sandwiches were getting stuck in his throat,” says Mimi. “He agreed to go to the doctor, who said it was just indigestion.
“But I was worried and made an appointment with a gastroenterologist. Three days before the appointment, he was sent home from work with breathing difficulties. He looked grey and was starting to look thin because he wasn’t eating as much as normal.”
The specialist gave Mike an endoscopy – where a tube with a tiny camera on the end is put down the throat – and diagnosed Barrett’s oesophagus and oesophageal cancer.
His cancer was at stage four – the most advanced. His food had been sticking because of a large tumour in the oesophagus.
The cancer had also spread to his liver, lungs, spine and brain. The news was horrifying.
“I felt as if I had been hit by a sledgehammer,” says Mimi. “We’d been married all our adult life, we were joined at the hip and utterly devoted to one another.
“That night we went home and talked it through. Mike was so terribly scared.”
The usual treatment for Barrett’s is medication to stop the heartburn and regular monitoring with an endoscopy every two years to check for pre-cancerous changes, says Fitzgerald.
“For pre-cancerous changes or small tumours of 2cm, we can use ablation, which involves burning off the tumour under local anaesthetic, and this has a success rate of around 80 percent.
“However, we often don’t get to see people at this stage, because they haven’t been to their doctor or those who have haven’t been referred on for further checks.”
When the disease is picked up at a later stage, chemotherapy can be given and the diseased part of the oesophagus removed.
“However, this is major surgery, as the chest cavity has to be opened and the stomach has to be relocated to connect to the remaining oesophagus,” says Fitzgerald. “In far too many cases the cancer is too advanced into the wall of the oesophagus to do anything much at all.”
Mike’s cancer was inoperable, and so doctors started him on chemotherapy to shrink the tumours in his liver to try to buy some time.
“The doctor told me he might make Christmas, which was just three months away,” says Mimi.
“I said to Mike: ‘You are not going to pull through this.’ He was totally distraught – mainly at the thought that we would be parted.”
Nine weeks after his diagnosis, in November 2002. Mike passed away at home.
“I went down like a stone,” says Mimi. “Part of my depression was finding out that Mike’s death had been preventable.”
Detecting Barrett’s earlier is clearly important. To this end Fitzgerald and her team at Addenbrooke’s have developed a medical “sponge” that they hope will be used as a screening test within five years.
It looks like a small capsule on a string that is swallowed. After three minutes, the sponge is pulled out, carrying some cells from the oesophagus, which can then be examined.
“The advantage is that it can be done at the doctor’s surgery and is so cheap that realistically you could screen all those at risk of Barrett’s – while the process and cost of an endoscopy make that unrealistic,” says Fitzgerald.
Such a development can’t come too soon, says Mimi, who has since remarried.
“My new husband is wonderful, but I still feel the grief,” she says.
“Our son married two years ago and we have a grandchild. Mike has missed all that – things that would have meant so much to him.
“Barrett’s is more common in men than women – no one really knows why – and I speak to so many women who have been left widowed like me.
“They all say: “If only we had known.” Well, I want to try to make sure that people do know.
“If you get regular heartburn, you need to get it checked.” – Daily Mail
* Cancer of the oesophagus affects 13 percent of the South African population, according to the National Cancer Registry. Its incidence is higher in males than in females, and it’s the third most common cancer among South African men.