Esophageal Cancer

Risk Factors

The American Cancer Society defines a risk factor as anything that increases a person's chance of getting a disease such as cancer. According to ACS, different cancers have different risk factors. For example, unprotected exposure to strong sunlight is a risk factor for skin cancer, and smoking is a risk factor for lung cancer. Scientists have found several risk factors that make a person more likely to develop esophageal cancer.

According to the American Cancer Society, the following are risk factors for esophageal cancer:

Age: The incidence of esophageal cancer, or rate or frequency of occurrence, increases with age and peaks around ages 70 to 80 years old. For people under the age of 40 the chance of developing this cancer is less than 1 in 100,000.

Gender: Compared with women, men have a three-fold higher rate of esophageal cancer.

Race: African-Americans are two and a half times more likely to have esophageal cancer than whites. The reason for this difference is not known.

Tobacco: The use of tobacco products including cigarettes, cigars, pipes, and chewing tobacco is a major risk factor for esophageal cancer. The longer a person uses tobacco, the higher the cancer risk. The risk for adenocarcinoma is doubled in smokers of a pack or more a day. Over half of all squamous cell cancers are linked to smoking.

Alcohol: Long-term heavy drinking is an important risk factor for esophageal cancer, mainly the squamous cell type. Although alcohol is probably not as strong a risk factor as smoking, the combination of smoking and drinking alcohol raises a person's risk much more than using either alone.

Barrett's esophagus: This condition is associated with long-term reflux of stomach fluids into the lower esophagus. Some individuals with this condition feel "heartburn," while others have no symptoms. Over time, this area of abnormal cells in the esophagus can develop precancerous changes called dysplasia. Esophagus cells with dysplasia appear abnormal when seen under a microscope. Barrett's esophagus is a risk factor for adenocarcinoma of the esophagus, especially when high-grade dysplasia (abnormal, possibly precancerous change) is also present. People with Barrett's esophagus are about 50 times more likely than people without this condition to develop esophageal cancer. Although the exact risk is not known, researchers estimate it to be less than 1% per year, meaning that of 100 people with Barrett's esophagus, 1 person will probably develop esophageal cancer within 1 year.

Gastric Reflux: Whether Barrett's esophagus has been diagnosed, long-standing gastric reflux (heartburn) increases the risk of esophageal cancer. A Gallup poll found that 44% of adults in the US have heartburn at least once a month.

Diet: Diets short on fruits and vegetables, as well as certain minerals and vitamins, particularly vitamins A, C, and riboflavin, may increase the risk for esophageal cancer. Overeating, which leads to obesity, increases the risk of adenocarcinoma.

Very hot liquids: Frequent drinking of very hot liquids is thought to increase the risk of esophageal cancer.

Occupational exposures: Exposure to perchloroethylene, the solvent used for dry cleaning, may lead to a greater risk of esophageal cancer. Dry cleaning workers have a higher rate of esophageal cancer. Also, exposure to many other chemical fumes may lead to an increased risk of esophageal cancer.

Lye ingestion: Lye is a chemical found in strong industrial and household cleaners like drain cleaners. Lye is a corrosive agent, meaning it can burn and destroy cells. Children who find and accidentally swallow household chemicals have a high rate of esophageal cancer as adults. The cancers occur on average about 40 years after the lye was swallowed.

Achalasia: In this disease, the lower esophageal sphincter does not relax properly to allow food/liquid to pass into the stomach. The cause of this disease is probably a defect of nerve cells in the lower esophagus that keeps the lower esophageal sphincter from relaxing and thus makes it difficult to swallow. The esophagus above this narrowing becomes dilated (larger) and retains food. The reason that achalasia is a risk factor for esophageal cancer is not clear, but roughly 6% of all achalasia patients will develop squamous cell esophageal cancer.

Tylosis: This is a rare inherited disease that causes excess growth of the top layer of skin on the palms of the hands and soles of the feet. A mutation of a gene on chromosome 17 is thought to be responsible for the tylosis and esophageal cancer. People with this condition also have a very high risk (about 40%) for esophageal cancer, and therefore, require early and regular screening with endoscopy.

Esophageal webs: These abnormal protrusions of tissue into the esophagus can interfere with swallowing. This abnormality is sometimes present in patients who also have anemia and abnormalities of the tongue, fingernails, spleen, and other organs. This combination of abnormalities is usually called the Plummer-Vinson syndrome but is sometimes also referred to as Paterson-Kelly syndrome. About 1 in 10 patients with this syndrome eventually develop squamous cell cancer of the esophagus.

Support & Information

Esophageal Cancer Awareness Association
Includes resources, links, contacts, press releases, events and current information about esophageal cancer.

The Society of Thoracic Surgeons: Esophageal Cancer
Provides answers to commonly asked questions dealing with esophageal cancer, including basic symptoms, stages, and treatments of esophageal cancer.

Memorial Sloan- Kettering Cancer Center: Esophageal Cancer
Information about esophageal cancer including signs, symptoms and screening, treatments, risk factors, diagnosis, and survivorship and support groups.

Medline Plus Information: Esophageal Cancer
Information about different stages, prevention, treatment, screening, research, statistics, and organizations to provide more information on esophageal cancer.

Esophageal Cancer Education Foundation
The Esophageal Cancer Education Foundation's mission is to educate patients and their families, health care professionals and the public reguarding the risk factors, risk reduction, and treatment options and outcome for gastro-esophageal cancers at their earliest state as well as to advance mediacal research related to diagnosis, treatment and prevention.

Cancer Hope Network
We are a FREE and CONFIDENTIAL service, over 200 volunteers strong, providing one-to-one support to cancer patients and their loved ones. Patients are matched with trained Support. People (cancer survivors) who have successfully completed surgery, radiation, or chemotherapy. Our support people understand the same fears and concerns patients are experiencing. They encourage patients to fight to live, and instill HOPE.

National Family Caregivers Association
The organization provides services in the area of information, support and validation, public awareness and advocacy.

Patient Advocate Association
The Patient Advocate Association is a non-profit organization that provides education and legal counseling on a national level to cancer survivors concerning managed care, insurance and financial issues.