Risk Factors

Both types of esophageal Cancer more commonly affect men older than 60 years, but risk factors for adenocarcinoma are different from those of squamous cell carcinoma.

Adenocarcinoma of the esophagus is most commonly seen within a segment of Barrett esophagus, chronic peptic sores in the lower esophagus. This is an acquired condition characterized by precancerous cells that replace the normal cellular lining of the lowest portion of the esophagus. The condition occurs as a complication of chronic reflux of gastric contents (GERD) into the lower esophagus.

Squamous cell carcinoma occurs more commonly in people who heavily use tobacco and alcohol or who have previously swallowed some caustic substance, for example lye. The disease is also more common in people who have been diagnosed with squamous cell cancer of the head and neck.

Men are up to 5 times more likely than women to be diagnosed with esophageal cancer.
Among men, African Americans have the highest rate, more than 2.7 times greater than the rate for non-Hispanic white men.
Incidence rates generally increase with age in all racial and ethnic groups.

Cancer of the esophagus is a common cancer in developing countries of the world, where most tumors are squamous cell Cancer.

Important risk factors in developing countries include the following:

• Nutritional deficiencies related to lack of fresh fruit and vegetables
• Drinking hot beverages
• A range of chewing and smoking habits

In the developed world, adenocarcinoma is becoming almost as common as squamous cell cancer.

Prevention

Reducing use of tobacco and alcohol can reduce the frequency of squamous cell carcinoma of the esophagus. At least 90% of cases of this Cancer in North America may be attributable to alcohol and tobacco.

Adenocarcinoma of the esophagus is a frequent complication in Barrett esophagus, which may be found in up to 20% of people with symptoms of gastroesophageal reflux disease (GERD).
People with frequent symptoms of reflux (heartburn or regurgitation) should undergo screening with endoscopy.

People with Barrett esophagus should have regular endoscopic tests to detect precancerous changes of the esophageal lining.
They also require tight control of the symptoms of gastroesophageal reflux, which may include dietary and lifestyle changes as well as medication and possible surgery, to prevent progression of Barrett esophagus.