Amy D'Orazio, PhD

Esophageal cancer has  two main subtypes, squamous cell carcinoma and adenocarcinoma. Until  the late 1960s, adenocarcinomas were so rare that some doctors questioned  whether they really existed. That has changed recently because of a rapid  increase in the number of adenocarcinomas, so much so that the incidence of  adenocarcinoma is currently greater than the incidence of squamous cell  carcinoma.

The increase might be  because of a rise in high-risk conditions and behaviors that lead to  adenocarcinoma. Differences in risk factors between the two esophageal cancer  subtypes include race, with adenocarcinoma being more prevalent in white males  and squamous cell carcinoma being more prevalent in black individuals. And while  obesity is considered a critical risk factor for adenocarcinoma, alcohol use is  not.

Gastroesophageal  Reflux Disease (adenocarcinoma)

: Continuous exposure of the esophagus  to stomach acid can lead to abnormal growth of the cells of the esophagus, a  condition known as Barrett’s esophagus. As a precursor to esophageal cancer,  risk of cancer increases with how long the patient has experienced reflux  symptoms and the severity the problem. Patients who have had surgical procedures  that affect the esophageal sphincter (the valve between the esophagus and  stomach) may also be at increased risk.

Smoking (both  types) and Alcohol Use (squamous cell)

: People who smoke a pack or more  a day have double the risk of developing adenocarcinomas of the esophagus as  well as an increase in the risk of squamous cell. And though not as strong a  risk factor as smoking, research shows that long-term heavy drinking increases a  person’s risk of developing squamous cell carcinoma.

: Diets rich in nitrates, found in pickled vegetables  and smoked meats, can lead to an increased risk. Betel nuts, which are chewed in  some parts of Asia, can also lead to an increased risk of esophageal cancer.

: Obesity (body mass index greater than 30) is associated with a  significant increase in the risk of esophageal adenocarcinoma. According to the  American Cancer Society, the risk of dying from this cancer is increased by  around 50 percent in obese men.

: Diseases of the esophagus can increase the risk of  esophageal cancer, including achalasia, a rare disorder that results when the  esophageal sphincter does not relax enough to allow the person to pass food into  the stomach. Patients with caustic esophageal injury (scarring caused by  exposure of the esophagus to burns or toxic substances, such as poisons or lye  [substances that contain sodium or potassium hydroxide]) or patients who have  had part of their stomach removed (partial gastrectomy) may have the same  increased risk because of slow movement of food into the stomach.

: Tylosis is a rare genetic disease that causes excess growth of  the top layer of skin on the palms of the hands and soles of the feet.  Individuals with this condition have about a 40 percent risk for esophageal  cancer and should therefore be closely monitored.

Amy D'Orazio, PhD

Risk Factors

Latest News