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. Some risk factors, such as smoking, can be controlled. Others, like a person’s age or race, can't be changed.

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 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.

Sex

Compared with women, men have a more than 3 times higher rate of this cancer.

Barrett’s esophagus

This is caused by long-term reflux of acid from the stomach into the lower esophagus. Most people with Barrett’s esophagus have had symptoms of “heartburn,” but many have no symptoms at all. Over time, reflux can change the cells in the esophagus. This raises the risk of adenocarcinoma of the esophagus. But not everyone with Barrett’s esophagus will get cancer of the esophagus.

Reflux

Reflux (or GERD: gastroesophageal reflux disease) of acid and gastric juices from the stomach into the esophagus can cause symptoms such as heartburn or pain that seem to come from the middle of the chest. In some cases though, reflux doesn't cause any symptoms at all. GERD can cause Barrett’s esophagus, but it also increases the risk of this cancer even without Barrett’s esophagus. The risk goes up based on how long the reflux has been going on and how severe the symptoms are.

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 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 the more a person drinks.

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

Overweight

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

Diet

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. It is also possible, although it has not yet been proven, that a diet high in processed meat may increase the risk of esophageal cancer. (Processed meats are things like deli meats, hot dogs, and bacon.)

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 release food into the stomach. So the lower end of the esophagus expands. 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 develop small growths (papillomas) in the esophagus and are at a very high risk for esophageal cancer. They should be seen by a doctor regularly to watch for this cancer. Often this means having upper endoscopies (described in "How is cancer of the esophagus found?").

Esophageal webs

A web is an abnormal bulge of tissue that causes the esophagus to become narrow. 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. People who have these webs may have a syndrome (called Plummer-Vinson syndrome or Paterson-Kelly syndrome) that causes other symptoms, too, like problems with the tongue, fingernails, spleen, and other organs. About 1 in 10 people with this syndrome will get cancer of the esophagus.

Workplace exposure

Chemical fumes in certain workplaces may lead to an increased risk of esophageal cancer. Some studies have found that dry cleaning workers have a higher rate of cancer of the esophagus.

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 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.

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 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 places, including the US.


Last Medical Review: 12/26/2012
Last Revised: 12/26/2012