About Esophageal Cancer

What should people know about cancer of the esophagus?

The esophagus is a muscular tube that connects the throat to the stomach. It lies behind the windpipe (trachea) and in front of the spine and in adults is about 10-13 inches long. It carries food and liquids to the stomach.

There are two main types of cancer of the esophagus. Adenocarcinoma of the esophagus is usually found in the lower part of the esophagus, near the stomach. In New York State, adenocarcinoma is the most common type of esophageal cancer and has been increasing since the 1980s. Squamous cell carcinoma of the esophagus is usually found in the upper part of the esophagus. It accounts for less than half of all cancers of the esophagus.

Each year in New York State, about 800 men and over 250 women are diagnosed with cancer of the esophagus. About 650 men and about 180 women in New York die from this disease each year.

Who gets cancer of the esophagus?

Cancer of the esophagus occurs most often in older people. Most people with esophageal cancer are 65 years of age or older at the time they are diagnosed. Men are 3 to 4 times more likely than women to get esophageal cancer. In New York State, esophageal cancer occurs more frequently among Whites and Blacks than in Asians.

What factors increase risk for developing cancer of the esophagus?

At this time, the causes of cancer of the esophagus are not well understood. However, scientists agree that certain factors increase a person's risk of developing this disease. These risk factors include:

  • Tobacco and alcohol. Using any form of tobacco raises the risk of developing cancer of the esophagus. The longer a person uses tobacco, the greater the risk. Drinking alcohol also increases the risk of esophageal cancer. The risk of getting esophageal cancer increases the more a person drinks alcoholic beverages. Smoking and drinking alcohol combined raises the risk of esophageal cancer much more than using either alone.
  • Acid reflux. Acid reflux is the abnormal backward flow of stomach acid into the esophagus. Reflux is very common. A symptom of reflux is heartburn, but some people do not have symptoms. Stomach acid can damage the tissue of the esophagus. After many years of reflux, this tissue damage may lead to adenocarcinoma of the esophagus in some people.
  • Barrett's esophagus. Over time, damage to the esophagus caused by acid reflux may cause a condition known as Barrett's esophagus. In Barrett's esophagus, the cells in the lower part of the esophagus are abnormal. Most people who have Barrett's esophagus do not know it. Having Barrett's esophagus increases the risk of adenocarcinoma of the esophagus.
  • Personal health history. People with a history of achalasia (a disease in which the muscle at the bottom of the esophagus does not relax to release food into the stomach) or esophageal webs (an abnormal bulge of tissue that causes the esophagus to become narrow) are more likely to develop cancer of the esophagus. Tylosis 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 higher risk for esophageal cancer.
  • Obesity. Being obese increases the risk of adenocarcinoma of the esophagus.
  • Workplace exposures. Chemical exposures in certain workplaces have been shown to increase risk of esophageal cancer. Studies show that workers in the rubber, automobile, cement, plastics, dye and dry cleaning industries have a higher risk of getting cancer of the esophagus.

What other risk factors for cancer of the esophagus are scientists studying?

Scientists are also studying many other possible risk factors for cancer of the esophagus. These include the use of smokeless tobacco, socioeconomic status, infection with certain viruses (HPV [human papilloma virus, the virus that causes cervical cancer] and Helicobacter pylori [the virus that causes stomach ulcers]), intake of salt and nitrosamines, and celiac disease.

Studies suggest that diets low in fruits and vegetables may increase the risk of esophageal cancer. It is also possible, although it has not yet been proven, that a diet high in processed meat (e.g. deli meats, hot dogs, and bacon) may increase the risk of esophageal cancer. Drinking a lot of very hot liquids may also increase the risk of esophageal cancer.

Other exposures tentatively linked to esophageal cancer include metal dust, asbestosis, silica dust, combustion products, organic solvents (particularly in the dry cleaning industry), and polycyclic aromatic hydrocarbons (PAHs).

Additional research is needed to determine the role, if any, these factors may have in the development of cancer of the esophagus.

What can I do to reduce my chances of getting cancer of the esophagus?

To help reduce the risk of getting esophageal cancer:

  • Do not smoke. If you currently smoke, quit. Avoid exposure to second hand smoke. For more information on quitting smoking, visit the NYS Smoker's Quitline at www.nysmokefree.com or call 1-866-NY-QUITS.
  • Limit alcohol use.
  • Be aware of your family history and discuss any concerns with your health care provider.
  • Choose a healthy diet to achieve and maintain a healthy weight. Eat more vegetables, fruits and whole grains and eat less red and processed (e.g., bacon, sausage, luncheon meat, hot dogs) meats. These actions may reduce the risk of developing many types of cancer as well as other diseases.
  • Be aware of workplace health and safety rules and follow them.

How else can I reduce my risk for cancer?

The following may help reduce the risk of developing cancer:

  • Exercise regularly.
  • Discuss the risks and benefits of medical imaging, such as CT scans, with your health care provider to avoid unnecessary exposure to ionizing radiation. This is particularly important for children.
  • Talk with your health care provider about recommended cancer screenings.

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