Esophageal Cancer

Esophageal cancer (also called oesophageal cancer) makes up around 2-3% of all global cancers.

Scientists estimate the global burden of esophageal cancer will increase by more than 50% from 2020 to 2040, leading to almost 1 million cases per year. Esophageal cancer is the eighth most commonly diagnosed cancer and the sixth leading cause of cancer death worldwide.

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. Chronic acid reflux (where stomach acid repeatedly crosses this junction and irritates the lower esophagus) can lead to Barrett's esophagus, a condition in which the lining of the lower esophagus changes and cells may become 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, or SCC)

These are flat cells that make up the esophageal lining. Squamous cell cancer (SCC) 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 tobacco use, alcohol consumption, or chronic damage to the esophagus.

This is most common in Eastern Asia and Southern and Eastern Africa.

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. and Europe.

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.

Stages of 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. Endoscopic ultrasound and PET/CT are often used to determine the stage and if there's any spread. For SCC, the tumor's location will influence both the staging and treatment decisions.

Staging esophageal cancer can be complex, and adenocarcinomas are staged differently from SCC. Clinical staging (happens before you receive treatment and is based on imaging/endoscopy) may differ from pathologic staging (happens after surgery); restaging is common.

In general:

• Stage 0 (high-grade dysplasia): Abnormal cells are in the inner layer of the esophagus.
• Stage 1: The cancer is small and contained within the inner layers of the esophagus wall, with no spread to lymph nodes.
• Stage 2: The cancer has grown deeper into or through the esophagus wall, and/or has spread to a small number of nearby lymph nodes.
• Stage 3: The cancer has grown through the esophagus wall into nearby tissues and/or has spread to more regional lymph nodes, but has not reached distant organs.
• Stage 4 (also called “metastatic”): The cancer has spread to distant organs (such as the liver or lungs) and/or to distant lymph nodes beyond the esophagus region.

GEJ tumors and tumors within 2 cm of the GEJ are staged using the esophageal staging system. The Siewert classification system uses types 1-3 and guides surgical approaches.

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. These are the major risk factors of esophageal cancer: 

• Older age
• Smoking tobacco
• Heavy alcohol consumption
• Obesity

These are other scenarios researchers have found that can increase your risk of esophageal cancer.

ESCC (Squamous Cell Carcinoma) Risk Factors

• Difficulty swallowing because a muscle won’t relax (achalasia) 
• 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
• Nitrosamines
• Micronutrient deficiencies

Adenocarcinoma Risk Factors

• Barrett’s esophagus
• Long-term heartburn (Gastroesophageal reflux disease (GERD))

Shared Risk Factors

• Prior radiation to chest or abdomen
• Personal history of head and neck cancer

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

Can you prevent esophageal cancer?

Barrett’s esophagus and heartburn are known risk factors of esophageal cancer (adenocarcinomas). By identifying and treating these conditions early, esophageal cancer risk can be reduced. 

There are not any current recommendations for routine esophageal cancer screening for the general population.

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.

What are some esophageal cancer statistics? 

Based on GLOBOCAN 2022 data:

• An estimated 511,054 people were diagnosed with esophageal cancer globally, and 445,391 died from the disease.
• For every 10 people diagnosed, roughly 9 will die from it. Esophageal cancer is one of the most deadly cancers.

According to the World Cancer Research Fund:

• 11th most common cancer worldwide, the 7th most common cancer in men, and the 16th most common cancer in women
• 6th leading cause of cancer death globally
• Approximately 44% of all global cases are in China

According to the American Cancer Society:

• The average age of diagnosis is 69 years old (Global averages skew slightly younger in regions like East Africa and Central Asia)
• 90% of cases are in people age 55 or older

According to Thorac Cancer: 

• Approximately 70% of cases occur in men
• Approximately 75% of both cases and deaths were estimated to occur in Asia
• The esophageal "cancer belt" runs from northern Iran through Central Asia to Mongolia and north-central China, where 90% of cases are SCC.

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 (In the U.S.).

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

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. 

Ask about surgery

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.

Explore therapies

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.

Request testing

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

• Biomarker testing
• Genetic testing

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