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Lowering Your Risk of Esophageal Cancer

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Updated July 13, 2010

There are 2 main types of esophageal cancer: Squamous cell carcinoma and adenocarcinoma.

Squamous cell carcinoma
Cancer that forms in squamous cells, the thin, flat cells lining the esophagus. This cancer is most often found in the upper and middle part of the esophagus, but can occur anywhere along the esophagus.

Adenocarcinoma
Cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the esophagus produce and release fluids such as mucus. Adenocarcinomas usually form in the lower part of the esophagus, near the stomach.

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The following risk factors and preventive factors may affect whether a person develops esophageal cancer. Some of these risk factors are beyond our control, while others may be decreased by lifestyle changes.

Age
Most people who do develop esophageal cancer are over 50 years old.

Sex
Men are approximately three times more likely to develop esophageal cancer than women.

Race
African-Americans are three times more likely to develop the squamous cell esophageal cancer than whites. However, Caucasians have a higher incidence of adenocarcinomas of the lower esophagus than African-Americans.

Tobacco and Alcohol Use
Squamous cell cancer of the esophagus is strongly associated with tobacco and alcohol use. Studies have shown that avoiding tobacco and alcohol decreases the risk of developing esophageal cancer.

Diet
A diet low in fruits and vegetables and certain minerals and vitamins has been associated with a higher risk of esophageal cancer. Nitrates in foods and fungal toxins from pickled vegetables also have been associated with esophageal cancer.

Nonsteroidal Anti-Inflammatory Drugs
Some studies have shown that the use of nonsteroidal anti-Inflammatory drugs (such as aspirin and other drugs that reduce fever, swelling, pain, and redness) is associated with a reduced risk of developing both squamous cell cancer and adenocarcinoma of the esophagus.

Helicobacter Pylori Infection and Gastric Atrophy
Infection with the Helicobacter pylori bacteria causes inflammation and ulcers in the stomach lining, which may lead to a condition called gastric atrophy (cells that line the stomach are destroyed). This condition may increase the risk of developing squamous cell cancer of the esophagus.

Gastric Reflux and Barrett's Esophagus
Gastric reflux may irritate the esophagus and may, in time, cause Barrett's esophagus. Barrett's esophagus is a condition in which the cells lining the lower part of the esophagus have changed or been replaced with abnormal cells that could lead to adenocarcinoma of the esophagus.

Obesity
Obesity is a risk factor for adenocarcinoma of the esophagus, with the risk of dying from this cancer among obese men increases by approximately 50%.

Very hot liquids
Drinking very hot liquids may increase the risk for the squamous cell type of esophageal cancer.

Achalasia
Achalasia is a disease where the lower esophageal sphincter does not relax properly to allow food/liquid to pass into the stomach. The cause of this disease is probably a defect of nerve cells in the lower esophagus that keeps the lower esophageal sphincter from relaxing and thus makes it difficult to swallow. The esophagus above this narrowing becomes dilated (larger) and retains food. The reason that achalasia is a risk factor for esophageal cancer is not clear, but roughly 6% of all achalasia patients develop squamous cell-type esophageal cancer.

Esophageal webs
These are abnormal protrusions of tissue into the esophagus that can interfere with swallowing. This condition has been associated with the Plummer-Vinson syndrome (also referred to as Paterson-Kelly syndrome). Approximately 10% of patients with this syndrome eventually develop squamous cell cancer of the esophagus.

Hiatal Hernias
The most common complication of hiatal hernia is gastroesophageal reflux disease (GERD). GERD, in turn, increases the risk of esophageal cancer.

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Lightdale, M.D., Charles J.. "Esophageal Cancer." Vol. 94, No. 1, 1999. The American Journal of Gastroenterology. http://www.acg.gi.org/physicians/guidelines/EsophagealCancer.pdf

"What You Need to Know About Cancer of the Esophagus - Risk Factors" National Cancer Institute. http://www.cancer.gov/cancertopics/wyntk/esophagus/page4

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