Screening and Diagnosis

Esophageal Cancer Risk Factors

The causes and risk factors of esophageal cancer depend on the type of cancer.

  • Age is one of the chief risk factors for esophageal cancer. In most cases, it develops in people over the age of 50.
  • Sex assigned at birth: In the U.S., people assigned male at birth tend to develop esophageal cancers more often than people assigned female at birth.
  • Race: Squamous cell esophageal cancer is more prevalent in Black people than white people in the U.S. Adenocarcinomas are much more prevalent among white people.

Risk factors for squamous cell carcinoma include:

  • Smoking
  • Heavy alcohol use
  • Human papillomavirus (HPV)
  • Achalasia

Although risk factors for development of adenocarcinoma are less understood, people with these conditions have a higher risk of developing it:

  • Barrett’s esophagus
  • Gastroesophageal reflux disease (GERD)
  • Obesity

Diagnosing Esophageal Cancer

If you are experiencing symptoms of esophageal cancer, contact your physician or advanced practice provider for diagnostic testing. If a tumor is found, they may refer you to a cancer specialist for more tests and imaging, that may include:

  • Barium swallow: This imaging test that uses X-rays to look at your upper gastrointestinal (GI) tract.
  • Endoscopy: This outpatient procedure uses a thin, flexible tube with a camera so your physician can examine the esophagus and, if necessary, collect a biopsy sample for analysis.
  • Endoscopic ultrasound: Like in an endoscopy, an ultrasound probe is used at the end of the scope to look at the tumor through the wall of the esophagus and for any signs that the tumor may have spread to nearby lymph nodes.
  • Computed tomography (CT) scan: This imaging test uses X-rays to make detailed images of the chest and abdomen and organs around the esophagus.
  • Positive emission tomography (PET) scan: This imaging study uses a radioactive tracer to show any abnormal areas with malignant (harmful) tumors and areas that may be affected if a tumor spreads.

Stages of Esophageal Cancer

“Staging” is the term oncologists (physicians specially trained in cancer care) use to define where esophageal cancer is located and how much it has spread. After the stage of esophageal cancer is determined, your physician can recommend a particular course of treatment.

Most cancer teams use the system developed by the American Joint Committee on Cancer, known as the TNM staging system.

T = Tumor
Where is the primary tumor and how large is it?

N = Nodes
Has the tumor spread to nearby lymph nodes (part of your immune system)?

M = Metastasis
Has cancer spread to other parts of the body?

For each letter, there are five numbered stages, from zero to four, depending on how much the cancer has spread. The lower the number, the more the cancer cells look like normal cells and the easier they are to treat and cure. A higher number means it has spread more.

The place where cancer forms is called the primary site. Cancer can spread from the primary site to other parts of the body. Even if esophageal cancer is found in other parts of your body, it’s still considered esophageal cancer. For example, if esophageal cancer has spread to the colon, it’s called metastatic esophageal cancer, not colon cancer.

For treatment, physicians often use a simpler system of categorizing esophageal cancer:

  • Resectable cancer: These cancers can be surgically removed (resected).
  • Borderline resectable cancer: These cancers can be surgically removed but are very close to major blood vessels or other important parts of your body.
  • Locally advanced cancer: These cancers are still only in the area around the liver, but they cannot be removed completely with surgery, often because they are growing into nearby blood vessels. This category is also called unresectable because the cancer cannot be removed with surgery.
  • Metastatic cancer: These cancers have spread to other parts of the body, so they cannot be removed completely with surgery (meaning they are also unresectable). Surgery may still be done, but it's used to relieve symptoms that the tumors in other areas of the body are causing.

Talk to your physician about your stage of cancer and how that will impact your treatment.

For more information about the stages of esophageal cancer, please visit our Health Library.