There are 2 major types of esophageal cancer: squamous cell (upper esophagus) and adenocarcinoma (lower esophagus).

Squamous Cell Cancer

-       Facts

  •  Highest rates in Northern Iran, Central Asia, North-Central China (the so-called "esophageal cancer belt")
    • The major risk factors for SCC in the "esophageal cancer belt" are thought to include poor nutritional status, low intake of fruits + vegetables, drinking beverages at high temperatures
    • In the U.S., a history of smoking, alcohol consumption, and diets low in fruits and vegetables account for ~90% cases

-       Modifiable risk factors

  •  Cigarette, cigar and pipe smoking
  •  Alcohol consumption
    • The cumulative amount of alcohol is most important
    • Hard liquor may have a higher risk than wine or beer
    • Tobacco & alcohol together may synergistically increase risk
  •   Diet
    •  Foods containing N-nitroso compounds (carcinogens)
    •  Chewing areca nuts or betel quid, widespread in Asia
    • High temperature beverages & foods that cause thermal injury  
    • Red meat
    • Low selenium levels
    • Zinc deficiency
    • Low intake of dietary folate
  • Existing esophageal conditions- talk to your GI! You may need an endoscopy to evaluate for conditions such as achalasia
  • Possible:
    •  Medications: bisphosphonates
    • Poor oral hygiene

-       Protective Factors

  • A meta-analysis suggested a significant association between higher intake of fruits & vegetables and a reduced risk of esophageal cancer

 

Esophageal Adenocarcinoma (Lower esophagus)

-       Facts

  • Most common in white men age 45-65
  • Cancer may be caught early due to surveillance endoscopies for patient's with Barrett's esophagus (pre-cancerous condition)

-       Modifiable risk factors

From: http://www.mayoclinic.org/diseases-conditions/barretts-esophagus/home/ovc-20322957

From: http://www.mayoclinic.org/diseases-conditions/barretts-esophagus/home/ovc-20322957

  • GERD (acid reflux), especially long-standing (>20 years) and with severe symptoms
    • Also acid hypersecretory states (Zollinger-Ellison syndrome, surgical myotomy, scleroderma)
  • Barrett’s Esophagus, which is a potentially pre-cancerous cellular change due to long-standing GERD increases the cancer risk at least 30-fold above that of the general population
  •  Smoking, particularly in Barrett's esophagus
  • Obesity & metabolic syndrome: obesity is a proinflammatory state with secretion of multiple proinflammatory cytokines
  • Foods containing N-nitroso compounds (see above)

-       Protective factors

  • Total dietary cereal fiber
    • "Highest" ≥14.7 g/day of cereal fiber from whole-grain bread, crisp bread, oats, muesli, and other cold/hot breakfast cereals, pasta, rice.
    • Wheat fiber may neutralize mutagen formation from conversion of salivary nitrites to nitrosamines.
  • Diets high in fiber, beta-carotene, folate, vitamins C & B6  
  • Dietary antioxidants, fruits & vegetables protective against Barrett's esophagus