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The esophagus is also known as the gullet. It’s part of the digestive system and is sometimes called the gastro-intestinal tract (GI tract). The esophagus is a long, muscular tube that connects your mouth to your stomach and is around 25cm (10in) long in adults. When you swallow food, the walls of the esophagus contract to move the food down the esophagus to the stomach.

The esophagus (gullet) and surrounding areas
The upper part of the esophagus lies behind, but is separate from, the windpipe (trachea). The windpipe connects your mouth and nose with your lungs, enabling you to breathe.
The area where the esophagus joins the stomach is called the gastro-esophageal junction.
There are a number of lymph nodes close to the esophagus.

The esophagus has four layers:

  • The mucosa – the inner layer or lining, which is moist to help food pass down into the stomach.
  • The submucosa – this contains glands that produce mucus (phlegm), which keeps the esophagus moist.
  • The muscularis – the muscle layer, which pushes food down to the stomach.
  • The adventitia – the outer covering, which attaches the esophagus to surrounding structures.

Types of esophageal cancer (cancer of the gullet)

There are two main types of esophageal cancer.

The two types of esophageal cancer are:

  • Squamous cell carcinoma – this develops in the thin, flat cells of the mucosa, which line the esophagus.
  • Adenocarcinoma  – this develops in the glandular cells of the submucosal lining of the esophagus, which produce mucus.

A cancer can occur anywhere along the length of the esophagus. Squamous cell cancers occur more commonly in the upper and middle regions. Adenocarcinomas tend to be more common at the lower end, including the junction where the esophagus joins the stomach. Over 95% of (95 out of 100) esophageal cancers are squamous cell carcinomas or adenocarcinomas.

There are other rarer types of cancer of the esophagus. These include soft tissue sarcomas such as gastrointestinal stromal tumors (GISTs). The tests and treatments for these rarer types of cancer are different from those covered in this section.

Cancer of the esophagus is becoming more common in Europe and North America. The exact causes of esophageal cancer aren’t fully understood. It appears to be more common in people who have long-term acid reflux (backflow of stomach acid into the esophagus). This can occur when people have conditions such as gastro-esophageal reflux disease (GERD). Damage to the esophagus caused by acid reflux can lead to a condition called Barrett’s esophagus. In this condition, abnormal cells develop in the lining of the lower end of the esophagus. It’s not a cancer, but a small number of people (around 1 in 200) with Barrett’s esophagus may go on to develop cancer.

Risk factors

There are other factors that can affect the risk of developing cancer of the esophagus:

Gender

It’s more common in men than in women.

Age

The risk of developing esophageal cancer increases as we get older. It occurs most commonly in people over 45.

Smoking

The longer a person smokes for and the more tobacco they smoke, the greater their risk of developing esophageal cancer. All types of smoking are harmful, but it’s more damaging to smoke cigarettes than a pipe or cigars. We have information that might help you to give up smoking.

Alcohol

Drinking a lot of alcohol over a long period of time increases your risk. People who drink alcohol, and who also smoke, may have a greater risk of developing cancer of the esophagus.

Diet

Having a diet high in animal fats and low in fresh fruit and vegetables is linked to an increased risk of esophageal cancer.

Obesity

Being overweight is associated with a higher risk of esophageal cancer. This is thought to be because long-term acid reflux is more common in people who are overweight.

Previous cancer treatment

Radiotherapy to the chest area can increase your risk, although this is a very rare cause of esophageal cancer.

Other conditions affecting the esophagus may also increase the risk of cancer:

Achalasia

This is a condition where the muscle that controls the opening between the esophagus and the stomach doesn’t relax properly. This condition increases the risk of esophageal cancer.

Tylosis

This is a rare inherited skin condition. People with tylosis have a high risk of developing esophageal cancer.

In most people, cancer of the esophagus isn’t caused by an inherited faulty gene. Therefore it’s unlikely that your children will develop esophageal cancer as a result of you having it.

Esophageal cancer is not infectious and can’t be passed from one person to another.

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