Esophageal cancer causes and risk factors

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was updated on May 19, 2022.

Esophageal cancer is rare, affecting less than 1.1 percent of men and women, according to the National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results Program.

The esophagus is the muscular tube that connects the throat to the stomach. Two types of cancers may form in the esophagussquamous cell carcinoma or adenocarcinoma. Squamous cell carcinoma forms on the inner lining of the esophagus, in the upper and middle sections. Adenocarcinoma starts in glandular cells, in the lower part of the esophagus.

What causes esophageal cancer?

While the exact cause of esophageal cancer isn't known, this condition develops when cells located in the esophagus mutate, or change, causing them to divide and grow uncontrollably. The cells then form tumors that can grow and potentially spread to other areas.

Esophageal cancer risk factors

Risk factors for esophageal cancer may vary. Knowing the risk factors for esophageal cancer may help reduce the chance of developing the disease.

Life habits (risk factors) that can be controlled

Most of the genetic mutations that may lead to cancer occur during a person’s lifetime, called acquired mutations. Because they don’t occur in all the cells, they aren’t passed down through families. Some causes of these mutations are known and may be avoidable; examples include tobacco and alcohol use. Smoking is the greatest avoidable risk for esophageal cancer. For smokers, the risk is five times higher than for nonsmokers.

Risk factors include:

  • Smoking and alcohol use—These are risk factors particularly for squamous cell esophageal cancer, especially when they occur together.
  • Gastroesophageal reflux disease (GERD)—Stomach acid that seeps up into the esophagus is a strong risk factor for adenocarcinoma of the esophagus.
  • Extra weight or obesity—This also appears to be a factor for adenocarcinoma of the esophagus, most likely because it increases the risk of esophageal reflux.
  • A diet high in processed meats—Some evidence suggests that this kind of diet, with foods such as hot dogs, bacon or preserved lunch meats, may increase the risk of esophageal cancers.

Risk factors that can't be controlled

Some unavoidable risk factors for developing esophageal cancer include:

  • Age—The risk increases with age (esophageal cancer is rare in patients younger than 55).
  • Gender—Men are three to four times more likely to be diagnosed with this cancer than women.
  • Race—White men are at higher risk for adenocarcinoma. Black men are at higher risk for squamous cell cancer.

Other conditions may increase the risk of esophageal cancer:

  • Barrett’s esophagus—This disease is caused by long-term esophageal reflux. As stomach acid seeps up into the esophagus, the irritation changes the types of cells lining that area. These cells become much more likely to turn into cancer cells.
  • Achalasia—This disease causes the opening of the esophagus into the stomach to malfunction. Food and secretions collect at the bottom of the esophagus and, over time, may cause irritation that leads to cancer.
  • Plummer-Vinson syndrome—This disease causes obstructive webs to grow in the upper esophagus, leading to trapping of food. People living with this condition have an increased risk, about 10 percent, of developing squamous cell esophageal cancer.
  • Other cancers, such as lung, mouth and throat cancers, may increase the risk of esophageal squamous cell cancer.

Is esophageal cancer hereditary?

With esophageal cancer, several gene mutations have been identified that occur in all cells and may be passed down through families. These mutations cause only a small number of esophageal cancers, but the risk isn’t avoidable. They include:

  • Tylosis (Howel-Evans syndrome)
  • Bloom syndrome
  • Fanconi anemia
  • Familial Barrett's esophagus

Esophageal cancer prevention

While it’s not possible to completely prevent esophageal cancer, there are ways to greatly reduce the risk. Doctors suggest starting with these lifestyle changes:

  • Avoid all forms of tobacco use (cigarettes, pipes, cigars, vapes, chewing tobacco).
  • Avoid alcohol or use alcohol in moderation. Don’t combine smoking and alcohol.
  • Inform doctors about heartburn, chest pain or difficulty swallowing.
  • Diagnose and treat Barrett’s esophagus.
  • Maintain a healthy weight.
  • Eat a diet high in nutrients from fresh vegetables and fruits (these nutrients may be protective for many cancers).
  • Avoid processed meats.
  • Exercise regularly. Some studies suggest that people who exercise regularly may have a reduced risk for adenocarcinoma.

Research shows that taking medications called nonsteroidal anti-inflammatory drugs (NSAIDs, including aspirin and ibuprofen) may reduce the risk of developing both squamous cell carcinoma and adenocarcinoma of the esophagus, according to the NCI. However, NSAIDs may increase the risk for heart disease, stroke and other conditions, so they’re ultimately not recommended to prevent esophageal cancer.

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