Esophageal Cancer: Risk Factors, Prevention, and Early Detection 

What is a risk factor?

A risk factor is anything that may increase your chance of having a disease. Risk factors for a certain type of cancer might include smoking, diet, family history, or other things. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer.

Things you should know about risk factors for cancer:

• Risk factors can increase a person's risk, but they don't always cause the disease.

• Some people with many risk factors never get cancer. Other people with cancer have few or no known risk factors.

• Some risk factors are very well known. But there's ongoing research about risk factors for many types of cancer.

Some risk factors, such as family history, may not be in your control. But others may be things you can change. Knowing about risk factors can help you make choices that might help lower your risk. For instance, if an unhealthy diet is a risk factor, you may choose to eat healthy foods. If excess weight is a risk factor, you may decide to try to lose weight.

Who is at risk for esophageal cancer?

Anyone can get esophageal cancer. But there are some factors that can increase your risk for it. These include:

• Older age. Your risk of esophageal cancer goes up as you get older.

• Gender. Men are far more likely to get this cancer than women.

• Tobacco use. The use of any form of tobacco increases your risk. This includes chewing tobacco, pipes, and cigars.

• Alcohol use. Drinking alcohol increases your risk. The more you drink, the higher your risk. The combination of drinking and smoking increases your risk much more than either one alone.

• Reflux. Gastroesophageal reflux disease (GERD) or reflux happens when acid from your stomach comes up into your lower esophagus. This can irritate it. Some esophageal cancer cases are related to reflux. Still, most people who have reflux don’t get this cancer. 

• Barrett esophagus. If reflux goes on for a long time, it can damage the cells in the esophagus. This is called Barrett esophagus. People with this condition are more likely to get esophageal cancer than those without it.

• Obesity. People who are overweight have a higher risk.

• Diet and nutrition. Some studies suggest that diets high in processed meats and low in fruits and vegetables may increase the risk. Drinking a lot of very hot beverages might also increase the risk.

• Achalasia. This rare disease affects the muscles of the esophagus. It causes the opening between the esophagus and the stomach to be too tight. Food does not pass easily into the stomach. This can stretch and irritate the esophagus.

• Tylosis. This rare, inherited disease causes changes in the cells that line your palms, soles, and esophagus.

• Plummer-Vinson syndrome.  This syndrome is linked with anemia, brittle fingernails, and esophageal narrowing. This makes it difficult to swallow and causes irritation. Over time, this irritation can lead to cancer.

• Having a history of certain other cancers. People who have had cancers of the mouth, throat or lungs have a higher risk of esophageal cancer. This may be because these other cancers are also linked to tobacco use.

• Lye exposure. Drinking a lye-based cleaner causes chemical burns in the esophagus. The resulting scars can narrow parts of the esophagus. Many years later, it can lead to cancer.

What are your risk factors?

Talk with your healthcare provider about your risk factors and what you can do about them. Some risk factors, such as your age, are not under your control. But there are some things you can do that might help lower your risk. They include:

• Don't use any form of tobacco. If you do, try to quit. Ask your healthcare provider for help.

• Stay away from or limit alcohol.

• Eat a well-balanced diet rich in fruits and vegetables.

• Get to and stay at a healthy weight. Ask your healthcare provider for help.

• Be physically active.

• If you have heartburn often or have been diagnosed with GERD, work with your healthcare provider to manage your symptoms. Ask your healthcare provider about screening to look for precancer changes in the lining of your esophagus. 

• If you have Barrett esophagus, ask your healthcare provider about medicines that may help keep it from progressing. You should also ask about screening to look for changes in the lining of your esophagus.

• Watch for signs of esophageal cancer. These include trouble swallowing, chest pain, weight loss, or hoarseness. Call your healthcare provider if you have any of these symptoms.  

Should you be screened for esophageal cancer?

Screening is the process of looking for cancer in people before they have symptoms. Screening for esophageal cancer in the general population isn't recommended by any major medical organization in the U.S. at this time. But if you're at high risk based on your risk factors, talk with your healthcare provider about screening. For example, a person with Barrett esophagus may be advised to have a screening for esophageal cancer.

Screening can be done by looking at the inside of your esophagus. This test is called an upper endoscopy. To do it, your healthcare provider uses a thin, lighted tube called an endoscope. It's put in your mouth and passed into your esophagus. It has a tiny camera on the end of it. This lets your healthcare provider see pictures on a screen. If changes are seen on the lining of your esophagus, your healthcare provider may take out tiny pieces of the tissue. This is called a biopsy. The tissue is tested for cancer, precancer changes, or other problems.

Talk with your provider about your risk for esophageal cancer and ask if screening might be right for you.