Esophageal cancer risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Common risk factors in the development of esophageal cancer are tobacco smoking, alcohol, gastroesophageal reflux disease, and Barrett's esophagus.
Risk Factors
Increased risk
There are a number of risk factors for esophageal cancer. Some subtypes of cancer are linked to particular risk factors:
- Age: Most patients are over 60, and the median in US patients is 67.
- Gender: It is more common in men.
- Tobacco smoking and heavy alcoholic beverage use increase the risk, and together appear to increase the risk more than these two individually.
- Swallowing lye or other caustic substances
- Particular dietary substances, such as nitrosamine
- A medical history of other head and neck cancers increases the chance of developing a second cancer in the head and neck area, including esophageal cancer.
- Plummer-Vinson syndrome (anemia and esophageal webbing)
- Tylosis and Howel-Evans syndrome (hereditary thickening of the skin of the palms and soles)
- Radiation therapy for other conditions in the mediastinum.
- Celiac disease predisposes towards squamous cell carcinoma.[1]
- Gastroesophageal reflux disease (GERD) and its resultant Barrett's esophagus increase esophageal cancer risk due to the chronic irritation of the mucosal lining (adenocarcinoma is more common in this condition, while all other risk factors predispose more for squamous cell carcinoma).[2] Giving that obesity predisposes to reflux, there appears to be an increased risk of adenocarinoma in obesity.[3]
- Recent epidemiologic studies have found that obesity (measured as BMI) is another strong risk factor for esophageal adenocarcinoma.[4]
Decreased risk
- Risk appears to be less in patients using aspirin or related drugs (NSAIDs).[5]
- The role of helicobacter pylori in progression to esophageal adenocarcinoma is still uncertain, but, on the basis of population data, it may carry a protective effect.[6][7] It is postulated that helicobacter pylori prevents chronic gastritis, which is a risk factor for reflux, which in turn is a risk factor for esophageal adenocarcinoma.[8]
- Diets high in cruciferous (cabbage, broccoli, cauliflower) and green and yellow vegetables and fruits are associated with a decreased risk of esophageal cancer.[9]
References
- ↑ Green PH, Fleischauer AT, Bhagat G, Goyal R, Jabri B, Neugut AI (2003). "Risk of malignancy in patients with celiac disease". Am. J. Med. 115 (3): 191–5. PMID 12935825.
- ↑ Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999;340:825-31. PMID 10080844.
- ↑ Layke JC, Lopez PP (2006). "Esophageal cancer: a review and update". American family physician. 73 (12): 2187–94. PMID 16836035.
- ↑ Lagergren J, Bergström R, Lindgren A, Nyrén O (1999). "Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma". N. Engl. J. Med. 340 (11): 825–31. PMID 10080844.
- ↑ Corley DA, Kerlikowske K, Verma R, Buffler P. Protective association of aspirin/NSAIDs and esophageal cancer: a systematic review and meta-analysis. Gastroenterology 2003;124:47-56. PMID 12512029. See also NCI - "Esophageal Cancer (PDQ®): Prevention".
- ↑ Wong A, Fitzgerald RC. Epidemiologic risk factors for Barrett's esophagus and associated adenocarcinoma. Clin Gastroenterol Hepatol. 2005 Jan;3(1):1-10. PMID 15645398
- ↑ Ye W, Held M, Lagergren J, Engstrand L, Blot WJ, McLaughlin JK, Nyren O. Helicobacter pylori infection and gastric atrophy: risk of adenocarcinoma and squamous-cell carcinoma of the esophagus and adenocarcinoma of the gastric cardia. J Natl Cancer Inst. 2004 Mar 3;96(5):388-96. PMID 14996860
- ↑ Nakajima S, Hattori T. Oesophageal adenocarcinoma or gastric cancer with or without eradication of Helicobacter pylori infection in chronic atrophic gastritis patients: a hypothetical opinion from a systematic review. Aliment Pharmacol Ther. 2004 Jul;20 Suppl 1:54-61. PMID 15298606
- ↑ NCI Prevention: Dietary Factors, based on Chainani-Wu N. Diet and oral, pharyngeal, and esophageal cancer. Nutr Cancer 2002;44:104-26. PMID 12734057.