Not Simple Heartburn

Monday, May 31, 2004, was a fresh, brilliantly sunny day in To­ron­to. I remember waking up and feeling an immediate rush of relief. This was the day of a long-awaited hospital test for my husband, Bill Cameron; the day we would finally determine why, for several months, food had been sticking in his throat.

His health problems had been building for years. He was a broadcaster, but his voice was getting thinner, often hoarse. A globe-trotting journalist with a yen for spicy condiments, he kept a stash of antacids in his travel kit and considered heartburn an occupational hazard. He was wheezy and was prescribed an asthma puffer. He had bouts of hiccups. He was told he might have a hiatal hernia, possibly sleep apnea, possibly an esophageal pouch. An ear, nose and throat specialist suggested an expensive regimen of private speech pathology.

The swallowing trouble was inconvenient, at first—then frightening. By mid-winter, Bill occasionally would lurch from the table to throw up his dinner, pounding his breastbone to force up food that simply would not go down.

The May 31 appointment for an endoscopy—a procedure using mild anesthetic that would allow doctors to look inside his esophagus using a flexible scope—had been scheduled in late March, after he had undergone a barium swallow X-ray test.

It seemed like an eternity, but we waited it out. Today, we said, we’ll get some answers and get on with life.

But life as we knew it was about to change dramatically.

In a busy hospital hallway, the thoracic surgeon gave me the news. They’d extracted a piece of tissue for analysis, but he’d seen this too many times before.

“Esophageal cancer. Adenocarcin­oma,” he said. “Advanced. Aggressive.”

My mind was swimming. I struggled to formulate a question.

“What about survival rates?” I asked, expecting re­assur­ance.

“About 20 percent,” the doctor said, then, seeing my shocked face, quickly put his hand sympathetically on my arm.

There was talk of surgery, a clinical trial; it was all a blur. I’d never heard of esophageal cancer. The muscular tube that pilots food from the back of the throat to the stomach suddenly had become a pathway to life or death.

And then the killer question: “Why,” the surgeon wanted to know, “was this left so long?”


Esophageal cancer was once primarily squamous cell—the type linked closely to excessive drinking and smoking. But today, esophageal adeno­carcinoma accounts for 70 to 80 percent of esophageal tumours. Adeno­carcinomas are found in the lower part of the esophagus, close to the organ’s junction with the stomach, where acids can back up through a faulty lower esophageal sphincter and cause indigestion.

Esophageal cancer makes up less than one percent of new cancer cases in Canada. But it is one of the deadliest forms of cancer—second only to pancreatic. And its incidence is one of the fasting growing of all cancers in the Western World. “Most other types are flatlining,” says Dr. Gail Darling, director of the thor­acic surgery clin­ic­al research department at Toronto’s University Health Network. “This one is growing exponentially. Before 1980, it was almost unheard of.”

Darling, a world-renowned thoracic surgeon and leading esophageal-cancer researcher, says about 80 percent of her patients are diagnosed in the late stages, so their long-term survival chances are extremely low. By the time my husband was diagnosed, the cancer had metastasized to his brain and liver; he had less than a five-percent chance of surviving.