How diet, nutrition and physical activity affect oesophageal cancer risk. In total, we analysed 46 studies from around the world, comprising 15 million adults and nearly 31,000 cases of oesophageal cancer.
The oesophagus is the muscular tube through which food passes from the pharynx to the stomach. The oesophagus is lined over most of its length by squamous epithelial cells, where squamous cell carcinomas arise. The portion just above the gastric junction (where the oesophagus meets the stomach) is lined by columnar epithelial cells, from which adenocarcinomas arise.
In addition to the findings on diet, nutrition and physical activity outlined above, other established causes of bladder cancer include:
Smoking is a cause of both types of oesophageal cancer. Squamous cell carcinoma is more strongly associated with smoking than adenocarcinoma.
Between 12–39% of oesophageal squamous cell carcinomas worldwide are associated with human papilloma virus (HPV) infection.
Risk of adenocarcinoma of the oesophagus is increased by gastro-oesophageal reflux disease, a common condition in which stomach acid damages the lining of the lower part of the oesophagus. This type of oesophageal cancer is also increased by a rare condition, oesophageal achalasia (where the valve at the end of the oesophagus fails to open and food gets stuck).
Pathogenesis: how does oesophageal cancer develop?
There are two main forms of cancer of the oesophagus. Adenocarcinomas arise from the columnar glandular cells that line the lower end of the oesophagus, and squamous cell carcinomas arise from the squamous epithelial lining. The epithelial cells lining the oesophagus are exposed directly to carcinogens in food. Repeated exposure, to burns from very high-temperature drinks or irritation from the direct action of alcohol, for instance, may cause inflammation. The role of irritation and inflammation in the development of oesophageal cancer is supported by the finding that gastro-oesophageal reflux (where stomach acid flows upwards to the oesophagus) increases the risk of adenocarcinomas as much as five-fold.
Barrett’s oesophagus, a probable intermediate stage between gastro-oesophageal reflux disease and oesophageal adenocarcinoma, is an acquired condition in which squamous cells are replaced by columnar epithelial cells; autopsy studies suggest that it usually remains undiagnosed. The increasing use of endoscopy to investigate abdominal symptoms has resulted in the earlier detection of a small proportion of adenocarcinomas in people with Barrett’s oesophagus.
In a condition called oesophageal achalasia, the lower oesophageal sphincter fails to relax and swallowed food is retained in the oesophagus. It is associated with a 16–28% increase in the risk of squamous cell carcinomas, which may be due to chronic irritation of the lining of the oesophagus or increased contact with food-borne carcinogens.
In addition, Tylosis A, a late-onset, inherited familial disease characterised by thickening of the skin of the palms and soles (hyperkeratosis), is associated with a 25% lifetime incidence of squamous cell cancer of the oesophagus.
Plummer Vinson syndrome is a rare condition associated with iron deficiency in which growths of tissue block part of the oesophagus, making swallowing difficult. Plummer Vinson syndrome is associated with an increased risk of oesophageal squamous cell carcinoma.
Helicobacter pylori infection, an established risk factor for non-cardia stomach cancer, is associated with a 41–43% decreased risk of oesophageal adenocarcinoma.
In 2018, World Cancer Research Fund International published Diet, Nutrition, Physical Activity and Cancer: a Global Perspective on behalf of AICR, WCRF and WKOF. This was the third in our series of major reports looking at the many ways in which our diets, and how active we are, affect our cancer risk. You can find out much more about oesophageal cancer by downloading a pdf of the relevant chapter in the 2018 report. Please note, however, that this webpage may have been updated since the report was published.
Published findings in peer-reviewed journals
Selected findings from this report have been published in peer-reviewed journals. Details of the papers and links to the abstract in PubMed are below:
An update of the WCRF/AICR systematic literature review and meta-analysis on dietary and anthropometric factors and esophageal cancer risk. S Vingeliene, DSM Chan, AR Vieira, E Polemiti, C Stevens, L Abar, D Navarro Rosenblatt, DC Greenwood, T Norat. Ann Oncol. 2017 Oct 1;28(10):2409-2419. Abstract