Esophageal cancer risk factors: what raises the risk

The two main types

The esophagus is the hollow, muscular tube that moves food and liquid from the throat to the stomach. Esophageal cancer starts on its inside lining (NCI what is). The two most common forms are named for the cells where they start (NCI what is):

• Squamous cell carcinoma forms in the thin, flat cells lining the esophagus. It is most often found in the upper and middle part, but can occur anywhere along it.
• Adenocarcinoma begins in glandular cells, which make fluids such as mucus. It usually forms in the lower part of the esophagus, near the stomach.

The risk factors and protective factors for the two types are not the same (NCI risk factors). Overall, your risk is higher if you smoke, drink heavily or have acid reflux, and it also goes up as you age (MedlinePlus).

Squamous cell carcinoma: smoking and alcohol

Studies have shown that the risk of squamous cell carcinoma of the esophagus is higher in people who smoke or drink a lot, and lower in people who do not use tobacco and alcohol (NCI risk factors).

If you smoke, the quit smoking help check covers the help available. To see where your drinking falls, try the AUDIT-C alcohol check, and the alcohol and cancer risk guide covers the other cancers linked to alcohol. Tobacco and alcohol also raise the risk of mouth cancer; see oral cancer risk factors.

Adenocarcinoma: acid reflux and Barrett esophagus

Adenocarcinoma of the esophagus is strongly linked to gastroesophageal reflux disease (GERD), especially when GERD lasts a long time and severe symptoms occur daily (NCI risk factors). In GERD, stomach contents, including acid, flow up into the lower esophagus. Over time this irritation may change the cells lining the lower esophagus, a condition called Barrett esophagus. The changed cells are replaced with abnormal cells, which may later become adenocarcinoma (NCI risk factors).

• Obesity together with GERD may raise the risk further (NCI risk factors). The BMI calculator shows where your weight falls.
• Medicines that relax the lower esophageal sphincter muscle may make GERD more likely, because a relaxed sphincter lets stomach acid flow up (NCI risk factors). General safety advice: do not stop a medicine without talking to the doctor who prescribed it.

It is not known whether surgery or other treatment to stop reflux lowers the risk of adenocarcinoma of the esophagus. Clinical trials are studying whether surgery or medical treatments can prevent Barrett esophagus (NCI risk factors). GERD also raises the risk of cancer in the upper stomach; see stomach cancer risk factors.

What may lower the risk

• Not using tobacco and alcohol lowers the risk of squamous cell carcinoma (NCI risk factors).
• NSAIDs such as aspirin. Some studies have shown that these drugs may lower the risk of both types. However, NSAIDs raise the risk of heart attack, heart failure, stroke, bleeding in the stomach and intestines, and kidney damage (NCI risk factors). General safety advice: ask your doctor before taking them for prevention.
• Radiofrequency ablation for Barrett esophagus with abnormal cells. In one study, people treated this way were less likely to be diagnosed with esophageal cancer. More studies are needed, and the procedure can cause narrowing of the esophagus and bleeding (NCI risk factors).

NCI advises talking to your doctor or other health care professional about how you might lower your risk (NCI risk factors).

Signs to check with a doctor

Early esophageal cancer usually does not cause symptoms (MedlinePlus). Signs can be caused by esophageal cancer or by other conditions. Check with your doctor if you have (NCI symptoms):

• painful or difficult swallowing
• weight loss
• pain behind the breastbone
• hoarseness and cough
• indigestion and heartburn
• a lump under the skin

Screening: what NCI says

There is no standard or routine screening test for esophageal cancer. Tests such as esophagoscopy with biopsy are being used or studied, and taking biopsies from several areas of the lower esophagus may find early Barrett esophagus in people who have risk factors for it (NCI screening). These tests have rare but serious risks, and NCI suggests discussing any screening test with your doctor first (NCI screening).

All cancer checks are on the cancer screening hub.

Common questions

Does acid reflux cause esophageal cancer?

Long-lasting GERD with severe daily symptoms is strongly linked to adenocarcinoma of the esophagus, mainly through Barrett esophagus (NCI risk factors). General safety advice (not part of the NCI text): heartburn that keeps coming back is worth raising with your doctor.

Does alcohol raise esophageal cancer risk?

Yes, for squamous cell carcinoma. Studies show a higher risk in people who drink a lot (NCI risk factors). NCI's alcohol and cancer fact sheet puts it at about 1.3 times the risk in light drinkers and about 5 times in heavy drinkers, and people who both drink and use tobacco have a much greater risk than people who use only one (NCI).

Does esophageal cancer risk go up with age?

Yes. MedlinePlus says the risk goes up as you age (MedlinePlus).