Esophageal cancer is most commonly caused by repeated injury to the esophageal lining. These injuries are usually caused by indigestion, heartburn, a long-standing history of smoking, excessive alcohol use or drinking very hot liquids.

According to the National Cancer Institute, more than 18,000 Americans are diagnosed with esophageal cancer each year. Because esophageal cancer often has no symptoms in the early stages, it is usually detected at a more advanced stage and becomes more challenging to treat.

Esophageal cancer types

Adenocarcinoma: Adenocarcinoma begins in gland cells in the esophageal tissue, most often in the lower part of the esophagus near the stomach. Heartburn, which is also called reflux or gastroesophageal reflux disease (GERD), is a major risk factor. Other risk factors include obesity, smoking and Barrett’s esophagus. Adenocarcinoma is the most common type of esophageal cancer in the Western Hemisphere, especially in white males.

Squamous cell carcinoma: Squamous cell carcinoma or cancer, also called epidermoid carcinoma, begins in the tissue that lines the esophagus, particularly in the middle and upper parts. Risk factors include smoking and drinking alcohol. Squamous cell carcinoma is the most common type of esophageal cancer worldwide, although it is on the decline in the United States and Western Europe.

The following cancer types can also occur in the esophagus:

Neuroendocrine tumors: Cancer that affects the hormone-producing cells of the esophagus

Lymphoma: Cancer that affects the body’s immune system; this arises from lymph nodes out of the esophagus, not the lining of the esophagus itself

Esophageal cancer risk factors

Anything that increases your chance of getting esophageal cancer is a risk factor. Esophageal cancer causes and risks include:

Age: Most cases of esophageal cancer are in people over 55.

Gender: Men are three times more likely than women to develop esophageal cancer.

Long-term heartburn: Long-term heartburn is a factor in half of esophageal cancers. Heartburn is a symptom caused by stomach juices with acid and bile coming into the esophagus. Reflux and gastroesophageal reflux disease (GERD) are the medical names for heartburn.

Heartburn can be controlled by medication and sometimes surgery. Speak to your doctor to determine the best way to keep your heartburn under control.

Long-term history of smoking: Half of squamous cell esophageal cancers involve smoking. Smoking also increases the risk of adenocarcinoma.

Excessive alcohol consumption: The more alcohol you drink, the higher the risk for esophageal cancer. Combining smoking and drinking alcohol also increases the risk for esophageal cancer.

Barrett's esophagus: If you have uncontrolled heartburn for a long time, the cells at the end of the esophagus might change to become more like the cells lining other parts of the digestive tract. This is called Barrett’s esophagus. In some people, Barrett’s esophagus is a pre-cancerous condition that can transform into esophageal cancer and needs to be watched closely.

Diet and weight: The risk of esophageal cancer is higher if you are overweight, tend to overeat or do not eat a healthy diet.

Exposure to chemicals: Lye ingestion or being around dry-cleaning chemicals are esophageal cancer risk factors.

Medical history: A history of any of the following may be associated with an increased risk for esophageal cancer:

• Squamous cell cancers related to tobacco use
• Head and neck cancer
• Oral human papilloma virus (HPV)

Medical conditions: Having any of the following may increase your risk for esophageal cancer:

• Achalasia: A disease in which the sphincter, or muscle, at the bottom of the esophagus fails to open and move food into the stomach
• Tylosis or Howel Evans Syndrome: A rare, inherited disorder that causes excess skin to grow on the soles of the feet and palms. Patients with this disorder have nearly a 100% chance of developing squamous cell esophageal cancer.
• Esophageal webs: Flaps of tissue which protrude into the esophagus, making swallowing difficult

Not everyone with risk factors gets esophageal cancer. However, if you have risk factors, you should discuss them with your doctor.

The best thing you can do to prevent esophageal cancer is to keep your heartburn under control, maintain a healthy weight, avoid smoking and only drink alcohol in moderation. Visit our prevention and screening section to learn how to manage your risk.

Why come to MD Anderson for your esophageal cancer care?

From the moment you arrive at our Gastrointestinal Center for your esophageal cancer treatment, our highly specialized physicians and support specialists make your care their priority. From individualized treatment to minimally invasive procedures to groundbreaking research, we are constantly striving to provide our esophageal cancer patients with better outcomes and hope for the future.

A team approach to individualized treatment

Our Tumor Board of experts from different esophageal cancer disciplines meets weekly to make recommendations about patient care plans. This means your treatment is not just a one-sized-fits-all recommendation: It is a thorough, personalized assessment developed by some of the nation’s leading cancer physicians. Additionally, our faculty members hold a variety of leadership roles in organizations such as the American Joint Committee on Cancer (AJCC), which establishes a system for esophageal cancer staging, and the National Comprehensive Cancer Network (NCCN), which establishes guidelines for esophageal cancer treatment.

Minimally invasive procedures

At MD Anderson, our experts specialize in minimally invasive procedures. For example, our endoscopic mucosal resection program for patients with very early stage esophageal cancer can preserve the function of the esophagus and stomach.

If your treatment plan includes surgery, our highly experienced surgeons work to ensure your quality of life after surgery will be excellent, allowing you to eat all types of food and return to normal activities.

Novel research

As one of the world's largest cancer research centers, MD Anderson is leading the investigation into new methods of esophageal cancer prevention, diagnosis and treatment. Our researchers are constantly striving to learn more about the biology behind esophageal cancer, cancer resistance and cancer recurrence. Researchers work closely with physicians to develop innovative approaches that advance esophageal cancer care.