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Cancer (Oncology)

Esophageal Cancer

Cancer of the esophagus (esophageal cancer) has two main forms. Squamous cell carcinoma starts in the squamous cells that line the esophagus, occurring anywhere along its length. Adenocarcinomas are cancers that start in the gland cells. Adenocarcinomas have recently surpassed squamous cell carcinomas in incidence rates and are now the most common form of esophageal cancer.

Gland cells do not normally line the esophagus, but this can happen in people with a condition known as Barrett's esophagus. Barrett's esophagus occurs in people with gastroesophageal reflux disease (GERD or reflux). GERD causes acid to escape from the stomach, up into the esophagus. If reflux continues for a long time, it can damage the lining of the esophagus – causing the squamous cells to be replaced with gland cells. People with Barrett's esophagus are at higher risk for cancer of the esophagus, although most people with Barrett's esophagus do not develop cancer.

Risk Factors

Certain factors increase the risk of developing the disease. One factor is age: 85 percent of cases are found in people over 55. Esophageal cancer is up to four times more common among men than among women. Having Barrett's esophagus is a risk factor, as is being overweight or obese. Smoking or chewing tobacco is a major risk factor for both types of esophageal cancer. Drinking alcohol also increases the risk of esophageal cancer; the risk increases when tobacco and alcohol are combined.

Diet may play some role – eating fruits and vegetables is linked to a lower risk of esophageal cancer. Although, there is no clear link to foods that raise the risk. Frequently drinking very hot liquids may damage the cells lining the esophagus, increasing the risk for the squamous cell variety of esophageal cancer. Rare conditions such as achalasia, tylosis, or Plummer-Vinson (also called Paterson-Kelly) syndrome can increase risk; as can exposure to lye or the solvents used for dry cleaning. People with a history of lung cancer, mouth cancer, and throat cancer also have a higher risk of getting squamous cell carcinoma of the esophagus.

Screening and Prevention

Not all cases of esophageal cancer can be prevented. Avoiding tobacco and alcohol, and having a healthy diet – high in fruits and vegetables – can limit the risk. People with Barrett's esophagus should receive constant examinations by their doctors, so that any abnormal signs can be detected early.

Symptoms

Unfortunately, symptoms often do not appear until they have progressed to an advanced stage. Symptoms that may indicate esophageal cancer include: trouble swallowing, chest or bone pain, unexplained weight loss, hoarseness, an unrelenting cough, hiccups, pneumonia or esophageal bleeding (which can turn stools black). Those symptoms are more likely to be caused by some other condition. Nevertheless, abnormal signs should be reported to a doctor.

Treatment

Treatment for esophageal cancer utilizes multimodality therapy including surgery, chemotherapy and radiation therapy. Often chemotherapy and radiation therapy are utilized prior to surgery.

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