Download Changing patterns of esophageal cancer

September 2013
Changing patterns of esophageal cancer: adenocarcinoma on
the rise
Adenocarcinoma of the
esophagus—one of the two main
types of esophageal cancer—is on
the rise. From 1981 to 2009, new
cases, or incidence, of adenocarcinoma rose steadily at 4% per
year, making it the most common
type of esophageal cancer in
Ontario.
This trend is in stark contrast to the
incidence for the other main type of
esophageal cancer—squamous cell
carcinoma—which dropped from
1981 to 2009 at 2% per year.
Similar trends have been reported
in a national study, as well as in the
United States, northern Europe,
Australia and New Zealand.1,2
These trends are likely due to
changes in the very different risk
factors for each esophageal cancer
type.
The increase in adenocarcinoma
may be related to the larger
● Adenocarcinoma and squamous cell carcinoma
number of people who are obese or
continue to show opposing trends.
who have gastroesophageal reflux
disease (GERD), a condition that
causes stomach acid to spill into
● Obesity, GERD and Barrett esophagus are major
the swallowing pipe, or esophagus.
risk factors for adenocarcinoma.
Obesity also plays a role in the
development of GERD, making
● Decreases in squamous cell carcinoma are
those who are very overweight
related to decreases in smoking rates.
even more vulnerable to developing
adenocarcinoma.2,3 GERD is a
cancer risk factor because when stomach acid comes into contact with the esophagus, it can
damage it and can cause a condition called Barrett’s esophagus, which can then lead to
adenocarcinoma.2 Evidence is less clear for other risk factors, such as medications that relax
the esophageal sphincter, gamma radiation from atomic detonation, and eating red meat and
processed meats.3,4,5
Squamous cell carcinoma, on the other hand, is most strongly associated with tobacco
smoke and alcohol, both of which act separately and together to increase risk. 1 Decreasing
smoking rates in Ontario probably explain the drop in number of new squamous cell
carcinoma cases.
Although esophageal adenocarcinoma continues to rise in Ontario, there are a few ways to
lower the risk of developing this cancer. Eating more vegetables and fruit may reduce not
only adenocarcinoma, but also squamous cell carcinoma.3 Exercising regularly and
maintaining a healthy diet can also help because they reduce the chances of gaining weight
and becoming obese, another adenocarcinoma risk factor. There is no strong evidence
showing that drugs used for controlling stomach acid to treat GERD and Barrett esophagus
reduce adenocarcinoma incidence, but certain acid-reducing medications have been proven
to prevent the abnormal cell growth that can become adenocarcinoma. 2
Esophageal cancer is a rare but highly fatal cancer, accounting for 1% of all cancers
diagnosed in Ontario in 2009, and its overall incidence has changed little over the past few
decades, despite the fluctuations in adenocarcinoma and squamous cell carcinoma. For
more information, talk to your healthcare provider or call the Cancer Information Service at
1-888-939-3333.
References
1.Ferlay J, Shin HR, Bray F, et al. GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality
Worldwide: IARC CancerBase No.10 [Internet]. Lyon, France: International Agency for
Research on Cancer. Available from http://globocan.iarc.fr. Accessed June 18, 2013.
2.Otterstatter MC, Brierley JD, De P, et al. Esophageal cancer in Canada: trends according
to morphology and anatomical location. Can J Gastroenterol 2012;26(10):723–27.
3.Cancer Care Ontario. Risk factors in Ontario: evidence summary. Toronto, Canada, 2013.
Available from http://www.cancercare.on.ca/riskfactor.
4.Lagergren J. Etiology and risk factors for oesophageal adenocarcinoma: possibilities for
chemoprophylaxis? Best Pract Res Clin Gastroenterol 2006;20(5):803–12.
5.Salehi M, Moradi‐Lakeh M, Salehi MH, et al. Meat, fish, and esophageal cancer risk: a
systematic review and dose‐response meta‐analysis. Nutrition Reviews 2013;71(5):257–67.
Citation: Material appearing in this Cancer Fact may be reproduced or copied without
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Cancer Care Ontario. Cancer Fact: Changing patterns of esophageal cancer: adenocarcinoma
on the rise. September 2013. Available at http://www.cancercare.on.ca/cancerfacts/.
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This Ontario Cancer Fact was prepared by staff in Prevention and Cancer Control.
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