Esophageal Cancer

Esophageal cancer starts in the cells of the esophagus, the foot-long hollow tube that carries food and connects the throat to the stomach. The wall of the esophagus has several layers and cancer often starts in the inner layer.

Esophageal malignancies are in a group known as gastrointestinal (GI) cancers, and the Wilmot Cancer Institute offers the largest team of GI specialists in the Finger Lakes region and performs more surgeries for this cancer than any other place in upstate New York. Wilmot also provides the most advanced treatments and technology, including clinical trials testing the latest therapies.

Esophageal cancer types

• Squamous cell carcinoma, which begins in the flat cells that line the esophagus. It used to be the most common type but now it makes up less than half of all cases. It's more common in African Americans.
• Adenocarcinoma, which begins in the gland cells that make and release fluids into the esophagus. They are found mainly in the lower esophagus. It's more common in white people.
• Esophageal dysplasia is a pre-cancerous condition in the cells lining the inside of the esophagus.
• Some lymphomas, melanomas, and sarcomas can start in the esophagus but they are rare.

Esophageal cancer facts

About 17,000 new cases are diagnosed annually, and esophageal cancer is three to four times more common in men than in women. Esophageal cancer makes up only about 1 percent of all cancers diagnosed in the U.S. Five-year survival rates have increased slightly over the past several decades from only 5 percent to up to 40 percent.

Causes and risk factors

Although the lifetime risk of developing esophageal cancer is low, being older (between 55 and 85) and being a heavy alcohol and tobacco user are strong risk factors.

Additional risk factors include:

• Gastroesophageal reflux disease (GERD) is when acid escapes from the stomach and moves up into the esophagus. GERD is very common. While most people with GERD do not get esophageal cancer, the condition does slightly increase the risk.
• Barrett's esophagus, which can be the result of longtime GERD. The stomach acid can damage the lining of the esophagus and cause esophageal dysplasia, a pre-cancerous condition.
• Heavy alcohol and tobacco use, especially in combination, strongly increases the risk. Tobacco includes cigars, pipes, and chewing tobacco. Smoking one pack of cigarettes a day doubles the risk of getting adenocarcinoma compared to nonsmokers; alcohol has a bigger impact on the risk of squamous cell carcinoma.
• Obesity boosts the risk in part because of the higher chance of having GERD.
• Diet. Processed meats and frequently drinking very hot liquids can damage the esophagus.
• Achalasia, a condition in which the sphincter muscle at the low end of the esophagus doesn't relax properly, forcing food to collect in the esophagus instead of spilling into the stomach. This increases the risk of cancer 15-20 years after achalasia is diagnosed.
• Plummer-Vinson syndrome. About 1 in 10 people with this rare condition get esophageal cancer because they have webs in their esophagus that cause food to get stuck, damaging the cells of the esophagus.
• A history of throat, mouth, or lung cancer, or a history of human papilloma virus (HPV) infection can boost the risk.

Prevention

The best way to prevent esophageal cancer is to avoid alcohol and tobacco. Maintaining a healthy weight and eating plenty of fruits and vegetables, particularly cruciferous vegetables (broccoli, cauliflower, and cabbage) can also prevent the disease. Some studies have shown that taking aspirin or non-steroidal anti-inflammatories such as ibuprofen, lowers the risk. But aspirin therapy carries other risks, so it's important to discuss this with a doctor. People who have Barrett's esophagus might prevent cancer by taking acid reflux medicines or statins, which is usually prescribed to lower cholesterol. 

Screening

There is no standard screening test for esophageal cancer. But for people with Barrett's esophagus, many experts recommend an upper endoscopy. This involves placing a thin tube with a tiny camera into the throat and esophagus to search for lesions.