Causes of esophageal cancer

The exact causes of esophageal cancer are unknown. However, some risk factors raise the likelihood of acquiring esophageal cancer.

Studies have shown that cigarette smoking and chronic alcohol consumption are the best known risk factors for esophageal cancer.

Risk factors for esophageal cancer

There are many risk factors for esophageal cancer, these include tobacco, excessive alcohol consumption, age, gastroesophageal reflux disorder and so forth. (1-5)


Any form of tobacco may raise the risk of esophageal cancer.

This includes cigarette smoking, cigars, pipes, chewing tobacco or snuff use. This raises risk of squamous cell carcinoma.

Excessive alcohol consumption

People who have more than 3 alcoholic drinks each day are more likely to get esophageal cancer.

In addition, heavy drinkers who smoke are at a higher risk as drinkers who do not smoke.

Long term heavy drinking leads to irritation and inflammation in the lining of the esophagus. This inflammation may eventually lead to cancer.

Gastroesophageal reflux disorder

Acid reflux disorder called Gastroesophageal reflux disorder (GERD) may be the commonest predisposing factor for adenocarcinoma of the esophagus.

The acid and bile from the stomach regurgitates into the lower part of the esophagus and causes constant irritation.

This leads to thickening and cellular changes in the lower esophagus called Barrett’s esophagus in 10 to 15% patients. Adenocarcinoma may develop in these patients.

The risk of adenocarcinoma among patients with Barrett metaplasia has been estimated to be 30-60 times higher than in general population.


Achalasia is a disorder where the lower esophageal sphincter or muscle ring that partitions the stomach from esophagus remains tight and does not relax.

This condition causes stagnation of food in the esophagus and raises risk of squamous cell carcinoma.

Other risk factors for esophageal cancer

Other risk factors include:

  • Age - Those between the ages of 45 and 70 have the highest risk of esophageal cancer
  • Sex - Men are three to four times more likely to be affected than women. The male to female ratio is 3.4 to 1.
  • Race - African Americans are at a greater risk of esophageal cancers than whites.
  • Poor diet that is low on fruits and vegetables and certain vitamins and minerals like vitamins A, C, B1 or zinc may also raise risk of esophageal cancers.
  • Obesity
  • Chemical pollutants exposure may also raise risk of esophageal cancer. These include soot, metal dust particles, vehicle fumes, silica dust (from sandstone, granite and slate) etc.
  • Lye found in some drain cleaners etc. if accidentally ingested may raise risk of squamous cell carcinoma.
  • Human papillomavirus (HPV) infection – May be one of the risk factors. This viral infection has been implicated in cervical cancer causation among women and oral cancers in general.
  • Helicobacter pylori infection is related to stomach cancer and may or may not be associated with esophageal cancer.
  • Tylosis palmaris et plantaris is implicated in esophageal cancer.

Having a risk factor doesn't mean that a person will develop cancer of the esophagus. There are many who have one or more of these risk factors but do not develop esophageal cancer.

Further Reading

Last Updated: Jun 8, 2023

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.


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