Esophagus Cancer Overview

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Causes, Risk Factors, and Prevention TOPICS

What are the risk factors for cancer of the esophagus?

We don’t know the exact cause of esophageal cancer, but we do know some of the risk factors that make this cancer more likely. A risk factor is anything that affects a person’s chance of getting a disease like cancer. Different cancers have different risk factors. Some risk factors, such as smoking, can be controlled. Others, like a person’s age or race, can’t be changed.

But having a risk factor, or even several, does not mean that you will get the disease. Many people with risk factors never get esophagus cancer, while others with this disease may have few or no known risk factors.

Age

The risk of this cancer goes up with age. Less than 15% of cases are found in people younger than age 55.

Gender

Men are more than 3 times as likely as women to get this cancer.

Reflux

The stomach normally makes strong acid and enzymes to help digest food. In some people, acid can escape from the stomach into the lower part of the esophagus. This is called gastroesophageal reflux disease (GERD), or just reflux. In many people, reflux causes symptoms such as heartburn or chest pain. In some, though, reflux doesn’t cause any symptoms.

People with reflux have a slightly higher risk of cancer of the esophagus. But reflux is very common, and most people who have it do not get esophageal cancer. Reflux can also cause Barrett’s esophagus, which is linked to an even higher risk (discussed below).

Barrett’s esophagus

If reflux goes on for a long time, it can damage the inner lining of the esophagus. This causes the squamous cells that normally line the esophagus to be replaced with gland cells, which 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. Many people with Barrett’s esophagus have symptoms of heartburn, but others have no symptoms at all.

People with Barrett’s esophagus are much more likely than people without this condition to develop cancer of the esophagus (the adenocarcinoma type). Still, only a small portion of people with Barrett’s esophagus will get esophagus cancer.

Tobacco and alcohol

Using any form of tobacco (cigarettes, cigars, pipes, chewing tobacco) raises the risk of this cancer. The longer a person uses tobacco, the greater the risk. The risk of esophagus cancer goes down if tobacco use stops.

Drinking alcohol also increases the risk of esophagus cancer. The chance of getting esophagus cancer goes up the more a person drinks.

Those who both smoke and drink alcohol raise their risk of esophageal cancer much more than using either alone.

Being overweight

People who are overweight or obese have a higher risk of esophageal cancer. This may be because people who are obese are more likely to have esophageal reflux.

Diet

A diet high in processed meat (like deli meats, hot dogs, and bacon) may increase the risk of esophagus cancer because of certain substances in these foods. On the other hand, eating a lot of fruits and vegetables is linked to a lower risk of esophagus cancer. The exact reasons for this are not clear, but fruits and vegetables have a number of vitamins and minerals that may help prevent cancer.

Overeating, which leads to being overweight, also raises the risk.

Drinking a lot of very hot liquids might increase the risk of this cancer, too.

Achalasia

In this disease, the muscle at the bottom of the esophagus does not relax to let food into the stomach. The lower end of the esophagus gets stretched out, and food collects there instead of moving into the stomach. Over time, this raises the risk for esophageal cancer.

Tylosis

This is a rare, inherited disease that causes extra skin to grow on the palms of the hands and soles of the feet. People with tylosis also get small growths (papillomas) inside the esophagus and are at a very high risk for esophageal cancer. They should be seen regularly by a doctor to watch for this cancer. Often this means having upper endoscopies (described in “How is cancer of the esophagus found?”).

Plummer-Vinson syndrome

People with this rare syndrome have webs in the upper part of the esophagus, often along with low red blood cell counts, tongue irritation, brittle fingernails, and sometimes a large thyroid gland or spleen. Another name for this is Paterson-Kelly syndrome.

A web is a thin membrane sticking out from the inner lining of the esophagus that causes narrowing. Most webs do not cause any problems, but larger ones can cause food to get stuck in the esophagus, which can lead to problems swallowing.

About 1 in 10 people with this syndrome will get cancer of the esophagus.

Workplace exposure

Being exposed to fumes from chemicals used in some workplaces might increase the risk of esophageal cancer. For example, working near or with some of the solvents used for dry cleaning might lead to a greater risk of esophageal cancer.

Injury to the esophagus

Lye is a chemical found in strong cleaners such as drain cleaners. Lye can burn and destroy cells. Sometimes small children Mistakenly drinking a lye-based cleaner can cause a severe chemical burn in the esophagus. As the injury heals, the scar tissue can narrow an area of the esophagus (called a stricture). People with strictures have an increased risk of the squamous cell type of esophageal cancer, (which often occurs many decades later).

Other cancers

People who have had certain other cancers such as lung cancer, mouth cancer, and throat cancer have a high risk of getting esophageal cancer, too. This could be because all of these cancers can be caused by smoking.

Human papilloma virus (HPV) infection

HPV is a group of more than 100 related viruses. Infection with certain types of HPV is linked to a number of cancers, including throat cancer, anal cancer, and cervical cancer.

Signs of HPV infection have been found in up to one-third of esophagus cancers from patients in parts of Asia and South Africa. But signs of HPV infection have not been found in esophagus cancers from patients in other areas, including the US.


Last Medical Review: 05/21/2014
Last Revised: 05/27/2014