A Snapshot of Esophageal Cancer
Incidence and Mortality
Esophageal cancer consists of two primary cancer types, esophageal adenocarcinoma and esophageal squamous cell carcinoma. Esophageal adenocarcinoma is more common in the United States. Men of all racial and ethnic groups have higher esophageal cancer incidence and mortality rates than women. Historically, African American men have had higher esophageal cancer incidence and mortality rates than white men; however, increasing incidence and mortality rates in white men and a steady decline among African American men in the past decade have reversed this trend. A downward trend in mortality has not been observed for any other racial/ethnic group.
Risk factors for esophageal cancer include tobacco use, alcohol use, having Barrett's esophagus or gastric reflux disease, and increasing age. Common signs of esophageal cancer include painful or difficult swallowing and unexplained weight loss. There are no standard or routine screening tests for esophageal cancer. Tests and procedures that are used to detect and diagnose esophageal cancer include a physical examination, upper endoscopy, chest x-ray, and a barium swallow test. Standard treatment options for esophageal cancer include surgery, radiation therapy, chemotherapy, chemoradiation therapy, laser therapy, and electrocoagulation.
Assuming that incidence and survival rates follow recent trends, it is estimated that $1.6 billion1 will be spent on esophageal cancer care in the United States in 2014.
Examples of NCI Activities Relevant to Esophageal Cancer
- Barrett’s Esophagus Translational Research Network (BETRNet) is a consortium of three translational research centers studying the origins and pathogenesis of esophageal cancer, with the ultimate goal of improving patient outcomes and decreasing the burden of the disease. One center is studying the genetic basis of Barrett's esophagus and esophageal adenocarcinoma and the role of environmental factors in their development and progression.
- The Epidemiology of Esophageal Cancer Consortia, including the Asian Barrett’s Consortium and the International Barrett’s and Esophageal Adenocarcinoma Consortium (BEACON), were formed to enhance international collaborations to investigate the etiology and prevention of Barrett esophagus and esophageal adenocarcinoma.
- The Esophagus Cancer Modeling project, conducted by the Cancer Intervention and Surveillance Modeling Network, is modeling the incidence and mortality of esophageal adenocarcinoma to establish common inputs for current and hypothetical screening strategies, chemoprevention and endoscopic therapy. One project aims to advance the understanding of esophageal cancer and the impact of cancer control interventions through a collaborative and comparative modeling project.
- The Early Detection Research Network (EDRN) is identifying and testing new biomarkers to improve cancer detection and risk assessment. One EDRN project, a nested case-control study, seeks to identify abnormalities in DNA methylation and chromosome structure that represent biomarkers of risk for progression to esophageal adenocarcinoma in individuals with Barrett esophagus.
- The phase I trial Tumor Cell Vaccines with ISCOMATRIX Adjuvant and Celecoxib in Patients Undergoing Resection of Lung and Esophageal Cancers and Malignant Pleural Mesotheliomas is assessing the safety and effectiveness of combining ISCOMATRIX —an experimental drug that can be added to a vaccine to elicit a stronger immune response in the body—and the anti-inflammatory drug celecoxib with tumor cell vaccines in the treatment of lung and esophageal cancers.
- Five gastrointestinal-cancer-specific Specialized Programs of Research Excellence (SPOREs) are focusing on translational research on cancers of the gastrointestinal system, including esophageal cancer.
Selected Advances in Esophageal Cancer Research
- A genome-wide association study of esophageal adenocarcinoma and Barrett's esophagus identified three new susceptibility loci for their development. Published October 2013. [PubMed Abstract]
- HER2 protein expression and gene amplification are highly concordant in patients with esophageal adenocarcinoma. HER2 expression was also positively associated the expression of its partner, HER3, in esophageal adenocarcinoma supporting ongoing therapeutic efforts to target this interaction. Published October 2013. [PubMed Abstract]
- In a retrospective case-control study, statin use was associated with a reduced risk of Barrett's esophagus, especially in obese patients. Published May 2014. [PubMed Abstract]
- A comprehensive genomic comparison of two potential precursor tissues for esophageal adenocarcinoma—intestinal metaplasia (IM) and nongoblet cell metaplasia— (NGM), showed that IM has a much higher frequency of cancer-associated mutations than NGM. Published July 2014. [PubMed Abstract]
Trends in NCI Funding for Esophageal Cancer Research
NCI’s investment2 in esophageal cancer research was $26.5 million in fiscal year (FY) 2013. In addition to the funding described in the graph, NCI supported $6.0 million in esophageal cancer research in FYs 2009 and 2010 using funding from the American Recovery and Reinvestment Act.
Additional Resources for Esophageal Cancer
What You Need To Know About™ Cancer of the Esophagus
Describes treatment options, types of cancer doctors, second opinion, follow-up care, and sources of support for someone recently diagnosed with esophageal cancer.
Esophageal Cancer Home Page
NCI's gateway for information about esophageal cancer.
Esophageal Cancer Treatment (PDQ®)
Expert-reviewed information summary about the treatment of esophageal cancer.
- 1 Cancer Prevalence and Cost of Care Projections, in 2010 dollars.
- 2 The estimated NCI investment is based on funding associated with a broad range of peer-reviewed scientific activities. For additional information on research planning and budgeting at the National Institutes of Health (NIH), see About NIH.