Causes, Risk Factors, and Prevention of Esophageal Cancer

In most esophageal cancers, the gene changes that lead to cancer are acquired during a person’s life rather than inherited. Acquired gene changes are not passed on to a person’s children.

Some acquired gene changes might be caused by something like tobacco or alcohol use. But sometimes they just occur randomly.

Some gene changes can be passed on in families and are found in all of a person's cells. These are called inherited gene changes.

Special genetic tests can find the gene changes linked to some of these inherited syndromes. If you have a family history of esophageal cancer or other symptoms linked to these syndromes, you may want to ask your doctor about genetic counseling and genetic testing.

The American Cancer Society recommends discussing genetic testing with a qualified cancer genetics professional before any genetic testing is done. Learn more about genetic testing on Understanding Genetic Testing for Cancer Risk and What Happens During Genetic Testing for Cancer Risk?

A very small number of esophageal cancers are strongly linked to inherited gene changes. Some examples include:

Tylosis with esophageal cancer (Howel-Evans syndrome): This is caused by an inherited change in the RHBDF2 gene. People with this gene change tend to have thick skin on the palms of their hands and the soles of their feet. They also develop small growths (papillomas) in the esophagus and have a very high risk of getting squamous cell esophageal cancer.

Bloom syndrome: This is caused by an inherited change in the BLM gene, which is important in making a protein that stabilizes DNA as a cell divides. Without this protein, the DNA can become damaged, which can lead to cancer. People with Bloom syndrome are at a higher risk of developing squamous cell esophageal cancer, as well as some other cancers. In this syndrome, the abnormal gene is usually inherited from both parents, not just one.

Fanconi anemia: This is a rare syndrome in which a person inherits a change in one of the FANC genes, which normally help repair damaged DNA. People with this condition have a higher risk of many cancers, including squamous cell esophageal cancer.   

Familial Barrett’s esophagus: Some families have several members with Barrett’s esophagus and adenocarcinoma of the esophagus or gastroesophageal junction. While this is thought to be due to an inherited gene change, the exact genes associated with this are still being studied.

In the United States, the most important lifestyle risk factors for cancer of the esophagus are tobacco and alcohol use. Each of these factors alone increases the risk of esophageal cancer many times, and the risk is even greater if they are combined.

Avoiding tobacco and alcohol is one of the best ways to limit your risk of esophageal cancer.

If you or someone you know would like to quit tobacco, call us at 1-800-227-2345 or see Stay Away from Tobacco.

Having excess body weight is linked with an increased risk of esophageal cancer, so staying at a healthy weight can help limit your risk.

A diet rich in fruits and vegetables may help lower esophageal cancer risk. Being physically active may also reduce your risk of esophageal cancer.

For more, see the American Cancer Society Guidelines for Diet and Physical Activity for Cancer Prevention.

Treating people who have gastroesophageal reflux disease (GERD, or just reflux) may help prevent Barrett’s esophagus and esophageal cancer.

Often, reflux is first treated with changes in diet and lifestyle (for example, weight loss for people with excess body weight), as well as drugs called H2 blockers or proton pump inhibitors (PPIs). Surgery might also be an option for treating reflux if it isn’t well controlled with diet, lifestyle changes, and medicines.

People at higher risk for esophageal cancer, such as those with Barrett’s esophagus, are often treated with a daily PPI to help lower their risk of developing dysplasia (a precancerous condition). They are also watched closely by their doctors with endoscopies to look for signs that the cells lining the esophagus have become more abnormal. (See Early Detection, Diagnosis, and Staging of Esophageal Cancer.) If dysplasia is found, the doctor may recommend treatments to keep it from developing into esophageal cancer.

Some studies have found that the risk of esophageal cancer in people with Barrett’s esophagus is lower if they’re taking daily aspirin or another nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen. However, taking these drugs every day can lead to problems such as kidney damage and bleeding in the stomach. For this reason, most doctors don’t advise that people take NSAIDs to try to prevent esophageal cancer. If you are thinking of taking an NSAID regularly, talk to your doctor first about the potential benefits and risks.