Esophageal cancer usually does not cause symptoms in its early stages. Most people with esophageal cancer don't know they have it until symptoms develop, and these symptoms generally occur only after the cancer is in its advanced stages. This is one of the reasons why five-year survival rates for the disease are so low.
The most common symptom of esophageal cancer is difficulty swallowing (dysphagia). When the cancer has grown large enough to narrow the esophagus by about half its diameter, it can interfere with swallowing. By this time, the cancer is often too large to be curable. Difficulty swallowing first occurs with solid food, but eventually even swallowing liquids becomes painful.
As the cancer grows, symptoms may include difficult or painful swallowing, severe weight loss, pain in the throat or back, hoarseness or chronic cough, vomiting, or coughing up blood.
Weight loss is common with esophageal cancer. About half of the people with esophageal cancer also have unwanted weight loss. Weight loss occurs as the patient stops eating or reduces the amount of solid food that he or she eats. The cancer itself can also cause a loss of appetite or changes in metabolism that result in weight loss.
Pain in the throat or back, between the breastbones, or between the shoulder blades occurs rarely in esophageal cancer. Although these symptoms occur with esophageal cancer, they also occur with many other common problems such as heartburn, and are often ignored
Several risk factors have been identified for esophageal cancer, but there are people who get the disease who have none of the known risk factors.
As with many other cancers, the risk of developing esophageal cancer increases with age. People under the age of 45 rarely develop esophageal cancer. Most cases occur in men over the age of 60.
Use of tobacco and chronic or excessive use of alcohol are the major risk factors for esophageal cancer. Tobacco use, either by smoking or chewing, increases the risk of developing esophageal cancer. The longer a person uses tobacco, the higher the risk. Chronic and/or heavy alcohol use is also a risk factor for developing squamous cell esophageal cancer, although probably less so than is the case with tobacco. People who use both alcohol and tobacco have an especially high risk for esophageal cancer, perhaps because the substances may increase each other’s harmful effects.
Men are three times more likely to develop esophageal cancer than women. This may be in part because men in general drink and smoke more than women do, and both drinking and smoking are risk factors for squamous cell esophageal cancer.
If stomach acid rises into the esophagus, it irritates the tissues lining the esophagus, and increases a person's risk of developing adenocarcinoma of the esophagus. Chronic gastric reflux is a condition in which the contents of the stomach flow backward into the lower esophagus. Some people with this condition feel heartburn; others have no symptoms. Over time, the irritation caused by the stomach acid causes the cells lining the esophagus to become abnormal, developing into a precancerous state called Barrett's esophagus. People with Barrett's esophagus are about 50 times more likely to develop esophageal cancer as the general population.
In addition to these major risk factors, several other minor factors increase a person's risk for developing esophageal cancer. These risk factors include swallowing lye or other irritants, genetic conditions such as tylosis (a rare disease that results in excessive growth of the skin on the palms of the hands or soles of the feet), achalasia (a condition in which the lower esophageal sphincter does not open properly), and esophageal webs (abnormal protrusions of tissue into the esophagus).
Diet may also be a factor. Diets that are high in fat, low in calories, or low in protein may contribute to esophageal cancer. In addition, exposure to substances called nitrosamines—sometimes found in cured meats, dried milk, and beer—may also be a risk factor.
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