Risks for esophageal cancer

Some things can affect your risk, or chance, of developing cancer. Certain behaviours, substances or conditions can increase or decrease the risk. Most cancers are the result of many risks. But sometimes cancer develops in people who don't have any risks

More men than women develop esophageal cancer. Most people diagnosed with esophageal cancer are men over the age of 60. The most common types of esophageal cancer are squamous cell carcinoma (SCC) and adenocarcinoma. Cases of SCC of the esophagus are decreasing worldwide. SCC of the esophagus is most common in parts of China, Iran, South America, France and Africa. In contrast, cases of adenocarcinoma of the esophagus are increasing, especially in high- and middle-income countries. Low socioeconomic status increases the risk of esophageal cancer, especially SCC.

Some of the things that increase the risk for esophageal cancer may also cause precancerous conditions. Barrett’s esophagus is a precancerous condition of the esophagus. It isn’t cancer, but it can sometimes become esophageal cancer if it isn’t treated. Some of the risks for esophageal cancer may also cause Barrett’s esophagus. Find out more about Barrett’s esophagus.

If you have a genetic condition that increases your risk for esophageal cancer, you may need to visit your doctor more often. Talk to your doctor about your risk and if you need to have certain tests to check for esophageal cancer.

The following can increase your risk for esophageal cancer. Some of these risks can’t be changed. But in some cases, there are things you can do to lower your risk.

Smoking tobacco

Alcohol

Gastroesophageal reflux disease (GERD)

Excess weight

Drinking very hot beverages

Tylosis

Achalasia

Plummer-Vinson syndrome

Chemical injury to the esophagus

History of cancer in the upper airway

Exposure to ionizing radiation

Smoking tobacco increases your risk for esophageal cancer. All forms of tobacco, including cigarettes, cigars, pipes and smokeless (spit or chewing) tobacco, increase your risk.

The more you smoke and the longer you smoke, the greater your risk. The risk of developing esophageal cancer decreases with time after you quit smoking. Tobacco use combined with drinking alcohol increases the risk of developing esophageal cancer more than either risk factor alone.

Learn more about how to live smoke-free.

Betel quid, or paan, is areca nut (the seed from the fruit of the areca palm) and lime wrapped in a betel leaf. Some people chew areca nut by itself. Chewing betel quid is common in China, India and some other countries in Asia and among some Asian immigrants in Canada.

Betel quid and tobacco are often chewed together. Betel quid contains cancer-causing substances that increase the risk of developing esophageal cancer. So even if it’s chewed without tobacco, betel quid still increases the risk for esophageal cancer.

Drinking alcohol increases your risk for esophageal cancer. The more you drink, the greater your risk. Drinking alcohol combined with using tobacco increases the risk of esophageal cancer more than either risk alone.

Learn more about how to limit alcohol.

Gastroesophageal reflux disease (GERD) is a condition in which stomach acid backs up into the esophagus. This can cause heartburn, acid indigestion and damage to the lining of the esophagus.

People with GERD have a slightly higher risk of developing adenocarcinoma of the esophagus. GERD also increases the risk of Barrett’s esophagus, which increases the risk of developing esophageal cancer.

Overweight and obesity increases the risk for esophageal cancer. These factors also increase the risk of GERD.

Learn more about how to have a healthy body weight.

People who drink very hot coffee, tea, mate and other beverages (hotter than 65°C) have a higher risk of developing esophageal cancer, particularly SCC. Mate is made by pouring boiling water over leaves of the yerba mate plant. Drinking very hot mate is common in South American countries. Drinking very hot tea or coffee is common in China, Japan, Iran and Turkey.

Tylosis is a rare inherited disease that increases the risk of developing esophageal cancer. People with this abnormal gene develop scaly patches (hyperkeratosis) on the palms of their hands or soles of their feet. They also have growths with finger-like projections, called papillomas, in the esophagus.

Achalasia is an uncommon condition in which the nerves that control the normal rhythmic contractions in the esophagus and the lower esophageal sphincter do not work properly. Part of the esophagus above the lower esophageal sphincter becomes enlarged, making it harder to swallow food and liquid.

Achalasia increases the risk for esophageal cancer. Researchers think this is because food trapped in the esophagus can cause chronic irritation. After symptoms start, it can take many years for cancer to develop.

Plummer-Vinson syndrome (also called Paterson-Kelly syndrome) is a rare condition that causes a thin membrane of tissue (called an esophageal web) to grow along the esophagus. This causes the esophagus to narrow. Small webs may not cause any problems, but larger ones can lead to problems swallowing if food gets trapped in the esophagus. Doctors think Plummer-Vinson syndrome is caused by a lack of vitamins and iron. People with this syndrome often have iron deficiency anemia.

People with Plummer-Vinson syndrome have a higher risk of developing SCC of the esophagus or cancer in the lower part of the throat (called the hypopharynx).

The esophagus can be damaged by exposure to lye. Lye is a chemical found in strong industrial and household cleaners, and accidentally drinking lye-based cleaners can burn and destroy cells of the esophagus. As the esophagus heals, scar tissue develops and can narrow areas of the esophagus. These narrowed areas are called strictures. SCC of the esophagus can develop in these strictures many years after the chemical injury.

People who have had cancer that started in the upper airway, such as oral, pharyngeal or laryngeal (voice box) cancer, are at risk for SCC of the esophagus. These cancers have some of the same risk factors as esophageal cancer, such as tobacco and alcohol use.

People who have been exposed to ionizing radiation have a higher risk of developing esophageal cancer, mainly SCC of the esophagus. The risk of developing adenocarcinoma of the esophagus after exposure to ionizing radiation is much lower.

People who’ve been given radiation therapy to treat breast cancer or Hodgkin lymphoma have a higher risk of developing SCC of the esophagus. However, the benefit of treating cancer often greatly outweighs the risk of developing esophageal cancer later in life.

Ankylosing spondylitis (AS) is a type of arthritis that affects the spine. People who’ve been given x-rays to help diagnose AS have a higher risk of developing SCC of the esophagus.

The following have been linked with an increased risk of esophageal cancer, but more research is needed to know for sure that they are risks:

• a family history of esophageal cancer
• human papillomavirus (HPV) infection
• eating processed meat
• a diet low in vegetables and fruit
• physical inactivity

Significant evidence shows that you do not have a higher risk for esophageal cancer if you drink carbonated beverages or have a Helicobacter pylori (H. pylori) infection.

To make the decisions that are right for you, ask your doctor questions about risks. Learn how cancer can be prevented and what you can do to reduce your risk.