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Epidemiology, pathobiology, and clinical manifestations of esophageal cancer

Michael K Gibson, MD, PhD, FACP
Section Editors
Kenneth K Tanabe, MD
Richard M Goldberg, MD
Deputy Editor
Diane MF Savarese, MD


The majority of esophageal cancers are squamous cell or adenocarcinomas. Although the incidence of squamous cell carcinoma (SCC) is decreasing in the United States, the incidence of adenocarcinoma arising out of Barrett's esophagus is rising dramatically, although less so in the last few years [1]. When stratified according to anatomic location, most of the increased incidence involves tumors at the esophagogastric junction (EGJ) and gastric cardia (figure 1) [2].

The epidemiology, etiologic factors, and clinical manifestations of adenocarcinoma and SCC of the esophagus will be reviewed here. Small cell carcinoma and sarcomas arising in the esophagus and EGJ as well as the diagnosis, staging, and treatment of esophageal cancer are discussed separately. (See "Extrapulmonary small cell cancer" and "Local treatment for gastrointestinal stromal tumors, leiomyomas, and leiomyosarcomas of the gastrointestinal tract", section on 'Esophagus' and "Diagnosis and staging of esophageal cancer".)


In the United States, an estimated 16,940 cases of esophageal cancer will be diagnosed each year, and 15,690 deaths are expected from the disease [3]. Worldwide, an estimated 455,800 new esophageal cancer cases and 400,200 deaths occurred in 2012 [4].

Incidence rates vary internationally by nearly 16-fold, with the highest rates found in Southern and Eastern Africa and Eastern Asia, and the lowest rates in Western and Middle Africa and Central America in both males and females [5]. In the highest-risk area, stretching from Northern Iran through the central Asian republics to North-Central China (often referred to as the "esophageal cancer belt"), 90 percent of cases are squamous cell carcinomas (SCC) [6,7]. Major risk factors in these areas are not well understood, but are thought to include poor nutritional status, low intake of fruits and vegetables, and drinking beverages at high temperatures. In contrast, in low-risk areas such as the United States and several Western countries, smoking and excessive alcohol consumption account for about 90 percent of the total cases of esophageal SCC [8]. Country-specific rates of incidence and mortality are available in the World Health Organization GLOBOCAN database. (See 'Smoking and alcohol' below.)

Temporal trends in incidence vary for the two major histologic types of esophageal cancer. Incidence rates for adenocarcinoma of the esophagus have been increasing dramatically in several Western countries, in part due to increases in known risk factors such as overweight and obesity [1]. When stratified according to anatomic location, most of the increased incidence involves tumors at the esophagogastric junction (EGJ) and gastric cardia (figure 1) [2].

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Literature review current through: Dec 2017. | This topic last updated: Feb 10, 2017.
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