Esophageal Cancer

Esophageal cancer makes up around 6-7% of all GI cancer cases. Once considered a rare cancer, its rates are increasing around the world, however these increases are not being seen specifically in the U.S. It is one of the top causes of cancer death in the U.S., despite it being 1% of all cancer cases .Esophageal cancer is often caught in later stages because it poses few symptoms early on. For this reason, it can be aggressive and hard to treat.

What is esophageal cancer?

The esophagus is a 10-inch long tube that connects the throat to the stomach. It’s the first stop of the GI tract, and its muscles move food and drink from the back of the throat downward.

Esophageal cancer can form anywhere along this four-layered tube. Cancer will form inside the inner layers of the esophagus and grow outward as it spreads.

The gastroesophageal junction (GEJ junction - also called the esophagogastric junction (EGJ) or GE junction) is the place where the esophagus and stomach connect, and it’s the hotspot for a condition called Barrett’s esophagus. Uncontrolled heartburn can lead to this condition, which causes the lining of the esophagus to act more like stomach lining and causes cells to mutate, possibly becoming pre-cancerous. 

Esophageal cancer is not the same thing as throat cancer; these are two different parts of the body and the cancers that form in each of these areas need unique treatment plans.

Types of esophageal cancer

There are two main types of esophageal cancer, and they require different approaches to treatment. 

Squamous Cell Carcinoma (ESCC)

These are flat cells that make up the esophageal lining. Squamous cell cancer is more likely to start at the top or middle of the esophagus. This is the most common form of esophageal cancer worldwide. It’s caused mostly by smoking, alcohol, or chronic damage to the esophagus.

Adenocarcinomas

These are cancers that begin in glands that line internal organs and make mucus and other fluids. Adenocarcinomas in the esophagus grow toward the bottom part near the stomach. This is the most common form in the U.S. It’s caused mostly by reflux (also called heartburn or GERD). Smoking and obesity can also play a role.

Rare types of esophageal cancer

A few other rare types of esophageal cancer include neuroendocrine tumors and lymphoma.

Staging esophageal cancer

If you have esophageal cancer, you need to know your stage. This helps you understand the size of your tumor, where the cancer is now, and the best treatment plan for your unique situation. 

Esophageal cancer is staged on a scale from 0-4 (many researchers use roman numerals 0-IV) using the TNM staging system. 

The histologic grade (also called “grade”) of esophagus cancer also plays a role in staging. Grades describe how normal or abnormal the cells look under a microscope.

Staging esophageal cancer can be complex, and adenocarcinomas are staged differently from squamous cell carcinomas. In general:

• Stage 0 (high-grade dysplasia): Abnormal cells are in the inner layer of the esophagus.
• Stage 1: Cancer is in the mucosa, submucosa or muscle layer of the esophagus.
• Stage 2: Cancer has spread into the outer layers of the esophagus and/or may be in lymph nodes.
• Stage 3: Cancer may have grown to the wall of the esophagus, past the esophagus, and/or be in lymph nodes.
• Stage 4 (also called “metastatic”): The cancer may have spread to tissue, 7+ lymph nodes, and/or distant organs like the liver and/or lungs. 

Cancers at the GE junction use the Siewert types 1-3.

What causes esophageal cancer?

Risk factors put you at a higher risk of getting cancer. Some risk factors can be controlled with lifestyle changes, and others cannot. Older age, smoking, and obesity increase your risk of many cancers. Smoking (even smokeless tobacco), being overweight, and heavy alcohol use are major causes of esophageal cancer. 

Just because you have a risk factor, that doesn’t mean you will get cancer. 

These are other scenarios researchers have found that can increase your risk:

• Barrett’s esophagus
• Long-term heartburn (Gastroesophageal reflux disease (GERD))
• Difficulty swallowing because a muscle won’t relax (achalasia) 
• Personal history of head and neck cancer
• Prior radiation to chest or abdomen
• HPV
• Long-term exposure to certain substances like dry cleaning chemicals and certain paints
• Drinking lye
• Howel-Evans Syndrome and other inherited syndromes
• Esophageal webs
• Drinking very hot liquids on a regular basis

Preventing esophageal cancer

Barrett’s esophagus is a known risk factor of esophageal cancer (adenocarcinomas), and by identifying and treating it early, esophageal cancer can be prevented. 

As with every cancer, there are steps you can take to adopt a healthy lifestyle and reduce your overall cancer risk, such as maintaining a healthy weight, not smoking, and limiting or eliminating alcohol. 

Learn more about cancer prevention from the American Institute for Cancer Research.

How common is esophageal cancer? 

The 2025 American Cancer Society estimated rates for esophageal cancer in the United States:

About 22,070 new esophageal cancer cases diagnosed (17,430 in men and 4,640 in women)

About 16,250 deaths from esophageal cancer (12,940 in men and 3,310 in women)

The average age of diagnosis is 69 years old, and it is four times more likely to be found in men versus women.

Ninety percent of cases are in people age 55 or older.

See more statistics from the National Cancer Institute’s SEER program. 

What are my odds of surviving it?

Doctors use what’s called “survival statistics” to understand the likelihood of a patient beating the disease.

According to the National Cancer Institute, around 22% of patients are alive five years after an esophageal cancer diagnosis.

Detailed survival statistics are based on where the cancer is located and if it has spread:

Localized

The cancer hasn’t spread

• 19% of cases
• 49% of patients are alive five years after diagnosis

Regional

The cancer spread to nearby lymph nodes

• 32% of cases
• 28% of patients are alive five years after diagnosis

Distant

The cancer has spread to lymph nodes and/or organs

• 39% of cases
• 5% of patients are alive five years after diagnosis

What types of tests should I expect to undergo?

Doctors typically use these tests to diagnose esophageal cancer:

• Barium swallow 
• Upper endoscopy
• Biopsy

Once you’ve been diagnosed, you can expect these tests:

• Blood tests
• CT scan
• Chest x-ray
• Endoscopic ultrasound
• PET scan

Ask your doctor about these additional tests—ideally before you begin treatment.

• Biomarker testing
• Genetic testing

I’m facing a diagnosis: What are my next steps?

If you’re facing a diagnosis, the GI Cancers Alliance is here for you. 

If you’re newly diagnosed, work with your doctor to create a treatment plan. 

The first question to ask when making a treatment plan is if surgery is an option. Although many minimally invasive surgical options are available, many patients are not candidates because the disease is advanced and has spread. However, in these cases, doctors may still recommend a combination of radiation, chemotherapy, targeted therapy, and immunotherapy.

Esophageal cancer treatment plans may include:

• Endoscopic therapy
• Surgery 
• Chemotherapy
• Radiation
• Targeted therapy
• Immunotherapy

You may also meet with a nutrition expert, as treatment for esophageal cancer can make eating and drinking difficult. 

We strongly encourage you to get a second opinion from another trusted doctor so you feel confident moving forward.