Scientists have found several factors that affect your risk of cancer of the esophagus. Some are more likely to increase the risk for adenocarcinoma of the esophagus and others for squamous cell carcinoma of the esophagus. But having a risk factor, or even several, does not mean that you will get the disease. Many people with risk factors never develop esophagus cancer, while others with this disease may have few or no known risk factors.
• Achalasia
In this condition, the muscle at the lower end of the esophagus (the lower esophageal sphincter) does not relax properly. Food and liquid that are swallowed have trouble passing into the stomach and tend to collect in the esophagus, which becomes stretched out (dilated) over time. The cells lining the esophagus can become irritated from being exposed to foods for longer than normal amounts of time. People with achalasia have a risk of esophageal cancer that is many times normal. On average, the cancers are found about 15 to 20 years after the achalasia is diagnosed.
• Age
The chance of getting esophageal cancer is low at younger ages and increases with age. Less than 15% of cases are found in people younger than age 55.
• Barrett’s Esophagus
If reflux of stomach acid into the lower esophagus goes on for a long time, it can damage the inner lining of the esophagus. This causes the squamous cells that normally line the esophagus to be replaced with gland cells. These gland cells usually look like the cells that line the stomach and the small intestine, and are more resistant to stomach acid. This condition is known as Barrett’s (or Barrett) esophagus. The longer someone has reflux, the more likely it is that they will develop Barrett’s esophagus. Most people with Barrett’s esophagus have had symptoms of heartburn, but many have no symptoms at all.
The gland cells in Barrett’s esophagus can become more abnormal over time. This can result in dysplasia, a pre-cancerous condition. Dysplasia is graded by how abnormal the cells look under the microscope. Low-grade dysplasia looks more like normal cells, while high-grade dysplasia is more abnormal and is linked to the highest risk of cancer. People with Barrett’s esophagus are much more likely than people without this condition to develop adenocarcinoma of the esophagus. Still, most people with Barrett’s esophagus do not get esophageal cancer. The risk of cancer is highest if dysplasia is present or if other people in your family also have or have had Barrett’s.
• Diet
Certain substances in the diet may increase esophageal cancer risk. For example, there have been suggestions, as yet not well proven, that a diet high in processed meat may increase the chance of developing esophageal cancer. This may help explain the high rate of this cancer in certain parts of the world.
On the other hand, a diet high in fruits and vegetables is linked to a lower risk of esophageal cancer. The exact reasons for this are not clear, but fruits and vegetables have a number of vitamins and minerals that may help prevent cancer. Drinking very hot liquids frequently may increase the risk for the squamous cell type of esophageal cancer. This might be the result of long-term damage the liquids do to the cells lining the esophagus. Overeating, which leads to obesity, increases the risk of the adenocarcinoma of the esophagus.
• Gastroesophageal Reflux Disease
The stomach normally makes strong acid and enzymes to help digest food. In some people, acid can escape from the stomach into the lower part of the esophagus. The medical term for this is gastroesophageal reflux disease (GERD), or just reflux. In many people, reflux causes symptoms such as heartburn or pain that seem to come from the middle of the chest. In some, though, reflux doesn’t cause any symptoms at all.
People with GERD have a slightly higher risk of getting adenocarcinoma of the esophagus. This risk seems to be higher in people who have more frequent symptoms. But GERD is very common, and the vast majority of people who have it do not go on to develop esophageal cancer.
• Gender
Esophageal cancer is more common in men than in women, but the gender gap is narrowing.
• History of Certain Other Cancers
People who have had certain other cancers, such as lung cancer, mouth cancer, and throat cancer have a high risk of getting squamous cell carcinoma of the esophagus as well. This may be because all of these cancers can be caused by smoking. The Risk Factors for Esophagus Cancer.
• Human Papilloma Virus (HPV) Infection
HPV is a group of more than 100 related viruses. They are called papilloma viruses because some of them cause a type of growth called a papilloma (or wart). Infection with certain types of HPV is linked to a number of cancers, including throat cancer, anal cancer, and cervical cancer.
Signs of HPV infection have been found in up to one-third of esophagus cancers from patients in parts of Asia and South Africa. But signs of HPV infection have not been found in esophagus cancers from patients in the other areas, including the US.
• Injury to the Esophagus
Lye is a chemical found in strong industrial and household cleaners such as drain cleaners. Lye is a corrosive agent that can burn and destroy cells. Accidentally drinking from a lye-based cleaner bottle can cause a severe chemical burn in the esophagus. As the injury heals, the scar tissue can cause an area of the esophagus to become very narrow (called a stricture). People with these strictures have an increased risk of squamous cell esophageal cancer, which often occurs many years (even decades) later.
• Lye
Accidental ingestion of cleaning liquids containing lye may increase a person's chances of getting squamous cell esophageal cancer, especially if the accident occurred in childhood.
• Obesity
Being severely overweight and having too much body fat can increase a person's risk of developing esophageal adenocarcinoma.
• Plummer-Vinson Syndrome
People with this rare syndrome have webs in the upper part of the esophagus, typically along with anemia (low red blood cell counts) due to low iron levels, tongue irritation (glossitis), brittle fingernails, and sometimes a large thyroid gland or spleen. Another name for this is Paterson-Kelly syndrome.
A web is a thin membrane extending out from the inner lining of the esophagus that causes an area of narrowing. Most esophageal webs do not cause any problems, but larger ones can cause food to get stuck in the esophagus, which can lead to problems swallowing. About 1 in 10 patients with this syndrome eventually develop squamous cell cancer of the esophagus or cancer in the lower part of the throat (hypopharynx).
• Race
Squamous cell cancer of the esophagus is more common among blacks than whites. Adenocarcinoma is more common in white men than men of other races.
• Tobacco and Alcohol
Use of tobacco in any form can increase your risk of developing esophageal cancer — particularly squamous cell carcinoma. The more you smoke and the longer you smoke, the greater your risk of esophageal cancer.
The same is true of heavy use of alcohol over a long period of time. The combination of smoking with heavy alcohol use is the most significant risk factor for squamous cell carcinoma of the esophagus, greatly increasing your chances of developing the disease.
• Tylosis
This is a rare, inherited disease that causes excess growth of the top layer of skin on the palms of the hands and soles of the feet. People with this condition also develop small growths (papillomas) in the esophagus and have a very high risk of getting squamous cell cancer of the esophagus.bPeople with tylosis need to be watched closely to try to find esophageal cancer early.
• Vitamin Deficiencies
Some studies have linked esophageal cancer with deficiencies in beta carotene, vitamin E, selenium, or iron.
• Workplace Exposures
Exposure to chemical fumes in certain workplaces may lead to an increased risk of esophageal cancer. For example, exposure to some of the solvents used for dry cleaning might lead to a greater risk of esophageal cancer. Some studies have found that dry cleaning workers may have a higher rate of esophageal cancer, but not all studies have found this link. The Risk Factors for Esophagus Cancer.