What are the risk factors for cancer of the esophagus?
A risk factor is anything that changes your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, smoking is a risk factor for lung cancer, as well as many other types of cancer.
Scientists have found several risk factors that affect your risk of cancer of the esophagus. Some are more likely to increase the risk for adenocarcinoma of the esophagus and others for squamous cell carcinoma of the esophagus.
But risk factors don't tell us everything. Having a risk factor, or even several, does not mean that you will get the disease. Many people with risk factors never develop esophagus cancer, while others with this disease may have few or no known risk factors.
The chance of getting esophageal cancer is low at younger ages and increases with age. Less than 15% of cases are found in people younger than age 55.
Compared with women, men have more than a 3-fold higher rate of esophageal cancer.
Gastroesophageal reflux disease
In some people, acid can escape from the stomach into the esophagus. The medical term for this is gastroesophageal reflux disease (GERD), or just reflux. In many people, reflux causes symptoms such as heartburn or pain that seem to come from the middle of the chest. In some though, reflux doesn't cause any symptoms at all.
People with GERD have a higher risk of getting adenocarcinoma of the esophagus. The risk goes up based on how long the reflux has been going on and how severe the symptoms are. GERD can also cause Barrett's esophagus, which is linked to an even higher risk (discussed below).
If reflux of stomach acid into the lower esophagus continues for a long time, it can damage the lining of the esophagus. This causes the squamous cells that usually line the esophagus to be replaced with gland cells. These gland cells usually look like the cells that line the stomach and the small intestine, and are more resistant to stomach acid. This condition is known as Barrett's (or Barrett) esophagus.
The longer someone has reflux, the more likely it is that they will develop Barrett's esophagus. Most people with Barrett's esophagus have had symptoms of "heartburn," but many have no symptoms at all.
Barrett's esophagus increases the risk of adenocarcinoma of the esophagus. This is because the gland cells in Barrett's esophagus can become more abnormal over time. This can result in dysplasia, a pre-cancerous condition. Dysplasia is graded by how abnormal the cells look under the microscope. High-grade dysplasia is the most abnormal and is linked to the highest risk of cancer.
People with Barrett's esophagus are much more likely than people without this condition to develop esophageal cancer. Still, most people with Barrett's esophagus do not get esophageal cancer. The risk of cancer is highest if dysplasia is present or if other people in your family also have Barrett’s.
Tobacco and alcohol
The use of tobacco products, including cigarettes, cigars, pipes, and chewing tobacco, is a major risk factor for esophageal cancer. The risk goes up with increased use: the more a person uses tobacco and the longer it is used, the higher the cancer risk. Someone who smokes a pack of cigarettes a day or more has at least twice the chance of getting adenocarcinoma of the esophagus than a nonsmoker. The link to squamous cell esophageal cancer is even stronger. The risk of esophageal cancer goes down if tobacco use stops.
Drinking alcohol also increases the risk of esophageal cancer. The chance of getting esophageal cancer goes up with higher intake of alcohol. Alcohol affects the risk of the squamous cell type more than the risk of adenocarcinoma.
Combining smoking and drinking alcohol raises the risk of esophageal cancer much more than using either alone.
People who are overweight or obese (very overweight) have a higher chance of getting adenocarcinoma of the esophagus. This is in part explained by the fact that people who are obese are more likely to have esophageal reflux.
A diet high in fruits and vegetables is linked to a lower risk of esophageal cancer. The exact reasons for this are not clear, but fruits and vegetables provide a number of vitamins and minerals that may help prevent cancer.
On the other hand, certain substances in the diet may increase the cancer risk. For example, there have been suggestions, as yet unproven, that a diet high in processed meat may increase the chance of developing esophageal cancer. This may help explain the high rate of this cancer in certain parts of the world.
Drinking very hot liquids frequently may increase the risk for the squamous cell type of esophageal cancer. This may be the result of long-term damage the liquids do to the cells lining the esophagus.
Overeating, which leads to obesity, increases the risk of the adenocarcinoma of the esophagus.
In this condition, the muscle at the lower end of the esophagus (the lower esophageal sphincter) does not relax properly. Food and liquid that are swallowed have trouble passing into the stomach and tend to collect in the esophagus, which becomes stretched out (dilated) over time. The cells lining the esophagus can become irritated from being exposed to foods for longer than normal amounts of time.
People with achalasia have a risk of esophageal cancer that is many times normal. On average, the cancers are found about 15-20 years after the achalasia is diagnosed.
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. People with this condition also develop small growths (papillomas) in the esophagus and have a very high risk of getting squamous cell cancer of the esophagus.
People with tylosis need to be watched closely to try to find esophageal cancer early. Often this requires regular monitoring with an upper endoscopy (described in "How is cancer of the esophagus diagnosed?").
A web is a thin membrane extending out from the inner lining of the esophagus that causes an area of narrowing. Most esophageal webs do not cause any problems, but larger webs may cause food to get stuck in the esophagus, which can lead to problems swallowing.
When an esophageal web is found along with anemia, tongue irritation (glossitis), brittle fingernails, and a large spleen it is called Plummer-Vinson syndrome. Another name for this is Paterson-Kelly syndrome. About 1 in 10 patients with this syndrome eventually develop squamous cell cancer of the esophagus.
Exposure to chemical fumes in certain workplaces may lead to an increased risk of esophageal cancer. For example, exposure to the solvents used for dry cleaning may lead to a greater risk of esophageal cancer. Some studies have found that dry cleaning workers may have a higher rate of esophageal cancer.
Injury to the esophagus
Lye is a chemical found in strong industrial and household cleaners such as drain cleaners. Lye is a corrosive agent, meaning it can burn and destroy cells. Sometimes small children mistakenly drink from a lye-based cleaner bottle. The lye causes a severe chemical burn in the esophagus. As the injury heals, the scar tissue can cause an area of the esophagus to become very narrow (called a stricture). People with these strictures have an increased rate of the squamous cell type of esophageal cancer as adults. The cancers occur on average about 40 years after the lye was swallowed.
History of certain other cancers
People who have had certain other cancers, such as lung cancer, mouth cancer, and throat cancer have a high risk of getting squamous cell carcinoma of the esophagus as well. This may be because all of these cancers can be caused by smoking.
Human papilloma virus
Genes from human papilloma virus (HPV) have been found in up to one-third of esophagus cancer tumors from patients living in Asia and South Africa. Signs of HPV infection have not been found in esophagus cancers from patients living in the other areas, including the US.
HPV is a group of more than 100 related viruses. They are called papilloma viruses because some of them cause a type of growth called a papilloma (or wart). Infection with certain types of HPV is linked to a number of cancers, including throat cancer, anal cancer, and cervical cancer.
Last Medical Review: 12/10/2012
Last Revised: 01/18/2013