Esophageal cancer describes the disease where cells that line the esophagus change or mutate and become malignant. These cells grow out of control and form a mass or tumor.
According to the National Cancer Institute, there will be almost 17,000 new cases of esophageal cancer in the United States in 2017. Approximately 15,600 people will die of the disease.
In the 1970s, more than 90% of esophageal cancers were of the squamous cell type. Now, almost 70% are adenocarcinoma.
It occurs more frequently as people age and is more commonly diagnosed in male patients, aged 60 to 70. Esophageal cancer affects males more than females, almost four to one. It is 20 times more common to be found in patients older than age 65 than in those who are younger.
There are two main types of esophageal cancer:
- Esophageal squamous cell carcinoma affects the squamous cells and usually develops within the middle third of the esophagus. Squamous cells describe thin, flat cells that line the inner surface of the mid-portion of the esophagus.
- Adenocarcinoma of the esophagus affects the lower third of the esophagus. This type of cancer arises from the glandular cells found in that area of the esophagus.
- Adenocarcinoma of the gastroesophageal junction (GEJ or GE junction, a specific part of the esophagus where the esophagus and stomach meet) is a specific subset of esophagus cancers.
What are risk factors and causes of esophageal cancer?
Esophageal cancer occurs because changes occur in the DNA of cells that line the esophagus. The exact reason for these changes or mutations is uncertain, but there are known risk factors for developing these cancers.
- Squamous cell cancer of the esophagus is related to the use of alcohol and tobacco products, both smoke and smokeless. When the two are used together, the risk of this type of cancer increases.
- Adenocarcinoma involves the lower third of the esophagus and is thought to be related to gastro-esophageal reflux disease (GERD). When acid backwashes from the stomach into the lower esophagus, inflammation and cell damage may occur. Over a period of time, abnormal cells begin to form (metaplasia) and if the GERD is not treated and inflammation continues, the lining of the esophagus begins to change the way it looks and functions (dysplasia).
- Adenocarcinoma of the GE junction describes cancers that arise either in the lower esophagus or upper stomach, very close to the GE junction.
- Barrett's esophagus describes abnormal dysplasia and is thought to perhaps be a precursor to the development of further cell mutations and adenocarcinoma.
- Smoking increases the risk of adenocarcinoma.
- Other potential risk factors for esophageal cancer include esophageal burns due to accidental or intentional swallowing of caustic materials such as bleach; unusual infections with yeast, fungi, or human papillomavirus (HPV); and certain unusual foods (for example betel nuts that are prominent in some Asian diets).
- Esophageal cancer tends to be a disease of older people, usually occurring after the age of 65, and tends to affect males much more frequently than females.
- Achalasia, a motility disease of the esophagus where it does not contract appropriately, increases the risk of esophageal cancer.
- There are some chromosome and gene abnormalities that are associated with an increased risk of esophageal cancer.
- There has been a shift in the type of esophageal cancer that is now prevalent in the United States and Western Europe. In the past, squamous cell cancer was the most common worldwide, but that has changed. Adenocarcinoma is more common than squamous cell cancer in western countries, including the U.S. The reason for this change has yet to be determined.
- Esophageal adenocarcinoma of the GEJ junction is becoming more frequent as well.
Signs and symptoms of esophageal cancer are weight loss and painful or difficult swallowing.
These and other signs and symptoms may be caused by esophageal cancer or by other conditions. Check with your doctor if you have any of the following:
- Painful or difficult swallowing.
- Weight loss.
- Pain behind the breastbone.
- Hoarseness and cough.
- Indigestion and heartburn.