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Forty years ago the risk factors for esophageal cancer were cigarette smoking and excessive alcohol intake. At that time squamous cell carcinoma, cancer that arises in the squamous cells lining the inside of the esophagus, was the commonest form of esophageal cancer in the United States. Now most of the esophageal cancers are adenocarcinoma, which develops in the glands at the bottom of the esophagus. This type is associated with gastroesophageal reflux disease (GERD).
Squamous cell cancers can develop anywhere in the esophagus, but the adenocarcinomas always appear at the bottom, where the esophagus joins the stomach. The exact cause of malignancy in the esophagus is not yet determined, but studies have shown that there is a progressive increase in risk for adenocarcinoma as the gastroesophageal reflux worsens.
Starting with a chronic backwash of stomach acid up into the esophagus when you’re lying down or slumped in a chair, the mucous membranes of the esophagus become inflamed.
This leads to changes in the tissues, called metaplasia. The condition of having metaplastic changes in the esophagus is called Barrett’s esophagus, a severe form of GERD. If the changes continue, metaplasia becomes dysplasia, which is basically pre-cancer leading to high-grade dysplasia, where cancerous cells are now present. The last step is adenocarcinoma.
Only about 3 to 6 people in 100,000 develop adenocarcinoma of the esophagus, but the percentages are increased in people with GERD and greatly increased in those with Barrett’s esophagus. The risk of adenocarcinoma with Barrett’s esophagus is about 10 in 100. Men are much more likely to develop this malignancy than women and the risk increases with age. Most esophageal cancers develop after age 60.