Esophageal Cancer Risk Factors and Screening

Esophageal cancer is a disease in which malignant (cancer) cells form in the tissues of the esophagus.

Esophageal cancer is found more often in men: Men are about three times more likely than women to have esophageal cancer. There are more new cases of esophageal adenocarcinoma each year and fewer new cases of squamous cell carcinoma. Squamous cell carcinoma of the esophagus is found more often in blacks than in whites. The chance of developing esophageal cancer increases with age.

Smoking, heavy alcohol use, and Barrett esophagus can affect the risk of developing esophageal cancer.

Anything that increases the chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor.

Risk factors for squamous cell esophageal cancer include the following:

  • Using tobacco.
  • Drinking a lot of alcohol.
  • Being malnourished (lacking nutrients and/or calories).
  • Being infected with human papillomavirus (HPV).
  • Having tylosis.
  • Having achalasia.
  • Having swallowed lye (a chemical found in some cleaning fluids).
  • Drinking very hot liquids on a regular basis.

Risk factors for esophageal adenocarcinoma include the following:

  • Having gastroesophageal reflux disease (GERD).
  • Having Barrett esophagus.
  • Having a history of using drugs that relax the lower esophageal sphincter (the ring of muscle that opens and closes the opening between the esophagus and the stomach).
  • Being overweight.

Esophageal Cancer Screening

There is no standard or routine screening test for esophageal cancer.

Screening for esophageal cancer is under study with screening clinical trials taking place in many parts of the country. 

Tests that may detect (find) esophageal cancer are being studied:

  • Esophagoscopy: A procedure to look inside the esophagus to check for abnormal areas. An esophagoscope is inserted through the mouth or nose and down the throat into the esophagus. An esophagoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
    A thin, lighted tube is inserted through the mouth and into the esophagus to look for abnormal areas.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. Taking biopsy samples from several different areas in the lining of the lower part of the esophagus may detect early Barrett esophagus. This procedure may be used for patients who have risk factors for Barrett esophagus.
  • Brush cytology: A procedure in which cells are brushed from the lining of the esophagus and viewed under a microscope to see if they are abnormal. This may be done during an esophagoscopy.
  • Balloon cytology: A procedure in which cells are collected from the lining of the esophagus using a deflated balloon that is swallowed by the patient. The balloon is then inflated and pulled out of the esophagus. Esophageal cells on the balloon are viewed under a microscope to see if they are abnormal.
  • Chromoendoscopy: A procedure in which a dye is sprayed onto the lining of the esophagus during esophagoscopy. Increased staining of certain areas of the lining may be a sign of early Barrett esophagus.
  • Fluorescence spectroscopy: A procedure that uses a special light to view tissue in the lining of the esophagus. The light probe is passed through an endoscope and shines on the lining of the esophagus. The light given off by the cells lining the esophagus is then measured. Malignant tissue gives off less light than normal tissue.