Esophageal Cancer Prevention

There are two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma, both of which are relatively rare. While rates of esophageal cancer have decreased slightly in the past several years, it remains one of the more lethal forms of cancer with a five-year relative survival rate of 20%. This is why it’s so important to prevent esophageal cancer. The first step is understanding what causes esophageal cancer.

The term esophageal cancer refers to any malignant (cancer) cells found in the esophagus, the muscular tube that connects the throat and stomach. Squamous cell carcinoma begins in the thin cells that line the esophagus, known as the epithelium. It generally develops in the upper and middle portions of the esophagus, although it also can occur down near the stomach.

Adenocarcinoma, on the other hand, affects glandular cells and almost always begins in the lower esophagus. Over the past several decades, researchers have noticed a decrease in squamous cell carcinoma but an increase in adenocarcinoma esophageal cancers. Each of these disease types has individual and shared risk factors. 

Squamous Cell Carcinoma Risk Factors

• Tobacco use. People who use tobacco in any form — cigarettes, cigars, E-cigarettes, pipe or chewing tobacco — are at the greatest risk for squamous cell esophageal cancer. The risk is cumulative, meaning the more tobacco you use, the higher your risk. And it does not diminish with quitting. Nevertheless, quitting tobacco can protect you from adenocarcinoma esophageal cancer, lung and other cancers, as well as heart disease and stroke — so it’s still a good idea to quit as soon as possible.
• Alcohol use. Risk of both types of esophageal cancer rises with alcohol use although it has a much larger influence on the appearance of squamous cell carcinoma. The more alcohol you drink, the higher your risk. And if you use both tobacco and alcohol, your risk is much higher than the use of either alone.
• Genetic conditions. Two rare genetic conditions — Tylosis and Plummer-Vinson syndrome — increase a person’s risk for esophageal cancer.
• Personal history of certain cancers. Your risk of developing squamous cell esophageal cancer goes up if you’ve ever been diagnosed with mouth, throat or lung cancer, likely due to tobacco use.

Adenocarcinoma Risk Factors

• Tobacco use. As with squamous cell carcinoma, the risk associated with tobacco use is cumulative, meaning the more tobacco you use, the higher your risk. But unlike squamous cell carcinoma, your risk of adenocarcinoma does decrease with quitting.
• Acid reflux. People who have gastroesophageal reflux disease (GERD), which typically is signaled by chronic heartburn, are at a slightly increased risk for adenocarcinoma. However, the majority of people who have GERD never develop esophageal cancer.
• Barrett esophagus. Left untreated, reflux disease can cause damage to the epithelial lining of the lower esophagus, a condition called Barrett esophagus. Having this condition greatly increases your risk for esophageal cancer, but treatment can reduce this risk. Emory gastroenterologists treat Barrett esophagus using minimally invasive endoscopic procedures to prevent abnormal cells from developing into esophageal cancer.
• Being overweight or obese. Having a body mass index of 25 or greater increases your risk for adenocarcinoma as does being physically inactive.

• Age. Your risk of esophageal cancer increases with age. More than 85% of esophageal cancers are diagnosed in people 55 and older.
• Sex. Males are three times more likely to develop esophageal cancer in their lifetime compared with females.
• Race. Due largely to environmental factors, race may indicate an elevated risk for developing esophageal cancer. Black men and women experience higher rates of esophageal cancer than other ethnic groups.

Because many esophageal cancers are preventable, it is possible to reduce your risk through lifestyle changes. Based on Winship-led research, along with findings from other NCI-designated cancer centers, NCI recommends the following esophageal cancer prevention guidelines:

• Not using any tobacco products
• Not consuming alcohol
• Maintaining a body mass index below 25
• Being physically active every day
• Eating a diet rich in fruits and vegetables and low in processed meats
• Seeking treatment for reflux disease and Barrett esophagus

While many esophageal cancers can be avoided by abstaining from tobacco or alcohol, some cannot. That is why Winship is committed to research that will let us better understand the root causes of esophageal cancer and discover new ways to prevent it.