Is Frequent Heartburn a Sign of Cancer?

That burning feeling behind the breastbone is heartburn. It happens when acid from your stomach backs up into your food pipe, called the esophagus. Heartburn is very common, and it is usually not cancer. But frequent, long-standing reflux is worth managing. Over many years, it can change the lining of the esophagus in ways that matter.

Heartburn comes from acid reflux, also called gastroesophageal reflux. When it happens often, it is called GERD (gastroesophageal reflux disease). Common triggers include:

• Large or fatty meals.
• Spicy foods, chocolate, or caffeine.
• Smoking or secondhand smoke.
• Being overweight, or being pregnant.
• Lying down soon after eating.

MedlinePlus says having reflux once in a while is common. If you have symptoms two or more times a week, or they damage the lining of your esophagus, you may have GERD.

The concern grows when reflux happens often over years, not once in a while. NCI says esophageal adenocarcinoma is strongly linked to GERD, especially when it lasts a long time and severe symptoms occur daily. Acid irritates the lining of the esophagus and can, over time, affect its cells.

In some people, this damage leads to a change called Barrett's esophagus. In Barrett's esophagus, the normal cells lining the lower esophagus get replaced by a different, abnormal cell type. Barrett's esophagus is not cancer, but NIDDK says people who have it are more likely to develop cancer of the esophagus. Most people with Barrett's esophagus do not develop cancer. Doctors most often find it with an upper endoscopy and a biopsy. If you have Barrett's esophagus, your doctor may repeat the endoscopy and biopsy on a set schedule. This is called surveillance. NCI says being overweight in combination with GERD may further raise the risk.

Certain medicines that relax the muscle at the bottom of the esophagus can make GERD more likely, which is another reason a doctor should know your full symptom picture and medicine list.

Reflux symptoms alone rarely mean cancer. But the National Cancer Institute lists several symptoms that are worth checking with a doctor, especially together or if they persist:

• Difficulty or pain when swallowing.
• Unexplained weight loss.
• Chest discomfort behind the breastbone.
• Hoarseness or a persistent cough.
• Indigestion or heartburn that will not settle.
• A lump you can feel beneath the skin.

These symptoms can come from esophageal cancer, but far more often they come from other, treatable conditions. The point of checking is not to assume the worst. It is to rule out a serious cause early, when it is easiest to treat.

See a doctor if any of the following apply to you:

• Heartburn happens two or more times a week.
• Reflux does not settle with usual over-the-counter measures.
• You have any difficulty or pain swallowing food or liquids.
• Food feels like it is sticking on the way down.
• You have lost weight without trying.

A doctor can treat straightforward reflux with medicine and lifestyle changes. If your symptoms are frequent or severe, they may also recommend an endoscopy to look directly at the esophagus lining and check for Barrett's esophagus or other changes.

Simple habits ease reflux for many people. MedlinePlus suggests eating smaller meals, not lying down for at least 2 to 3 hours after eating, and raising the head of your bed. Losing extra weight, if you carry it, often makes a real difference, because pressure on the stomach pushes acid upward. NIDDK says to see a doctor if your symptoms do not get better with over-the-counter medicines or lifestyle changes.

Tell your doctor how often your heartburn happens and how long you have had it. NIDDK says a doctor may recommend testing for Barrett's esophagus if you have weekly GERD symptoms for 5 or more years and at least three other risk factors. Ask whether this applies to you. If you already have Barrett's esophagus, ask how often you need follow-up endoscopies, since that schedule depends on what your last exam showed.

Treating reflux well, and getting persistent or unusual symptoms checked, is the sensible path. It protects your comfort now and your esophagus over the years ahead.

• Call 911 or go to an emergency department if chest pain comes with shortness of breath, or with pain in your jaw or arm. MedlinePlus says to get medical help right away, because this pattern can be a heart problem rather than reflux. Do not drive yourself.
• Call 911 or go to the nearest emergency department if you vomit blood or something that looks like coffee grounds, or your stools are black and tarry.
• Call your care team right away if food sticks on the way down, swallowing hurts, or you cannot get liquids down. If you cannot reach them, go to an emergency department.
• Call your doctor within a day or two if heartburn happens two or more times a week, over-the-counter remedies stop working, or you have lost weight without trying.

• MedlinePlus — GERD.
• NIDDK — Symptoms and Causes of GER and GERD.
• NIDDK — Barrett's Esophagus: Definition and Facts.
• NIDDK — Barrett's Esophagus: Diagnosis.
• National Cancer Institute — Symptoms of Esophageal Cancer.
• National Cancer Institute — Esophageal Cancer Causes, Risk Factors, and Prevention.
• National Cancer Institute — Esophageal Cancer.