Tobacco Use

Smoking and chewing tobacco contain cancer-causing agents (carcinogens) that are absorbed through the surface of the esophagus, causing irritation and cellular changes. The risk of cancer increases with the amount of tobacco used and the number of years as a tobacco user. All forms of tobacco are strongly and directly associated with esophageal cancer, especially squamous cell carcinoma. The risk drops once tobacco use is stopped.

Alcohol

Alcohol itself is not considered a carcinogen, but a by-product of alcohol may create a highly toxic agent that irritates the esophagus. As with tobacco, prolonged alcohol use is directly associated with an increased risk of esophageal cancer, especially squamous cell carcinoma.

Alcohol and Tobacco Combined

The combined effect of alcohol and tobacco use has been shown to substantially multiply the risk of esophageal cancer. The risk of esophageal cancer may increase 3-fold in people who use both alcohol and tobacco compared to using one either alone.

Diet

Diets high in red meat consumption are associated with an increased risk of esophageal cancer. Processed meats may also increase risk, but a clear link has not been established. Squamous cell carinoma risk is higher in those who drink very hot liquids without allowing time for them to cool down. Repeated exposure to high temperatures may affect the cellular structure of the esophagus.

Environmental Exposures

Exposure to certain chemicals through work, accidents, or lifestyle habits can harm the esophagus and increase the risk of cancer. These may include:

• Harsh chemicals like drain cleaners or lye can burn or damage cells that line the esophagus. Damage can result in scar tissue that narrows the esophagus, making it difficult for food to pass from the throat to the stomach.
• Certain occupations increase exposure to harmful chemicals. Inhaled chemicals may injure the esophagus. Risk may be higher in people who are exposed to solvents in dry cleaning.
• Radiation therapy aimed at the abdomen or chest may cause damage to the esophagus.

Medical Conditions

Current or history of certain medical conditions that may increase the risk of esophageal cancer include:

• Barrett’s esophagus —Barrett’s esophagus is the change in the cells of the lower esophagus when they are exposed to acid from the stomach. The acid reflux causes the cells to change from the normal squamous cells to columnar cells normally found in the intestine.
• Gastroesophageal reflux disease (GERD)—Gastric contents, including acid, chronically refluxes from the stomach into the esophagus causing irritation and discomfort..
• Obesity —Obesity is associated with Barrett's esophagus and GERD. Excess weight causes more pressure on the lower esophageal sphincter (LES), which contributes to acid reflux.
• Achalasia —The LES does not open properly, so food and liquids have a hard time moving into the stomach. The delay can cause irritation to the cells of the esophagus.
• Human papilloma virus (HPV) infection —HPV can cause normal cells to become abnormal. Persistent HPV infection has been linked to increased risk of several cancers.
• Nutrient deficiencies —Being deficient in folic acid, vitamins A and C, and riboflavin, molybdenum, and selenium increases the risk of esophageal cancer.