Cancer of the esophagus is the most rapidly increasing tumor type in Western countries. Between 1974 and 1994, the rate of esophageal adenocarcinoma rose by a remarkable 350 percent in the United States. Squamous cell carcinoma is on the rise elsewhere in the world, and remains a significant killer here. The American Cancer Society estimates 16,640 new cases of esophageal cancer and 14,500 deaths in the United States in 2010.
Adenocarcinoma and squamous cell carcinoma together make up 98 percent of esophageal cancer diagnoses. They have very different histories. The squamous cell type is almost always associated with smoking and alcohol. Both are risk factors by themselves, but together tobacco and heavy alcohol consumption increase the risk by 20-fold. Squamous cell esophageal cancer follows the epidemic of tobacco use, and is most prevalent today in northern China, India, southern Africa, and Iran. This type is more deadly, in part because it usually occurs higher in the esophagus, near the trachea.
The adenocarcinoma type is usually associated with gastroesophageal reflux disease (GERD). In this condition, acid from the stomach irritates the lining of the esophagus and causes growth of tissue that may be tougher in an acidic environment. Barrett's esophagus is an intermediate step toward cancer in many cases. Obesity increases the risk of GERD. Rising rates of obesity in the United States may explain at least part of the growing incidence of this cancer type, which now accounts for 60 percent of new esophageal cancer diagnoses in the United States.
Surgery offers the best hope for a cure, but this option is underutilized, according to a report from the University of Rochester, New York. In their study, only 29 percent of the total number of esophagus cancer patients in New York received surgical treatment. Males and whites were more likely to get the surgical referrals. However, the rates of surgery were much higher at a specialized center, where 64 percent of patients received exploratory surgery.
For patients who are not conventional surgery candidates, cryotherapy may be an important option.