Carcinoma of the esophagus represents 1% of all cancers in the United States and causes 1.8% of cancer deaths. The two principal histologies are adenocarcinoma and squamous cell carcinoma.
Risk factors for squamous cell esophageal cancer
include African American race, alcohol and cigarette use, tylosis, achalasia, caustic esophageal injury, Plummer-Vinson syndrome, nutritional deficiencies, and ingestion of nitrosamines and fungal toxins. Geographic location also represents a risk factor, likely as a result of local dietary customs, with a high incidence noted in certain areas of China, South Africa, Iran, France, and Japan.
Risk factors for adenocarcinoma of the esophagus include white race, GER, Barrett esophagus, obesity, and cigarette smoking.
Squamous cell carcinoma was previously the most common type of esophageal carcinoma. It tends to be multicentric and most frequently involves the middle third of the esophagus.
Adenocarcinoma now constitutes the majority of malignant esophageal tumors and is the carcinoma with the greatest rate of increase in the United States. It is less likely to be multicentric, but it typically exhibits extensive proximal and distal submucosal invasion. Adenocarcinoma most commonly involves the distal esophagus.