Esophageal Cancer

In 2020, Esophageal Cancer (EC) ranked seventh in incidence and sixth in overall mortality globally [1]. In the United States, the incidence (5.6/100,000) is lower than the global average (9.3/100,000) [2]. Among the two histological subtypes, esophageal squamous cell carcinoma (ESCC), which occurs most frequently in the proximal two-thirds region of the esophagus, constitutes 87%, while esophageal adenocarcinoma (EAC), mostly observed in the distal one-third of the esophagus, accounts for 11% of all cases [1, 2]. While ESCC was more prevalent in the past, the increased incidence of EAC in recent years has been reported as a result of increased occurrence of EAC-associated risk factors that include obesity and GERD combined with reduced ESCC risk factors such as lowered use of alcohol and tobacco [3]. The incidence of EC increases with aging: in the United States, the average age of diagnosis is 68 years, and 88% of all cases occur after the age of 55 years [2]. According to the SEER database for the year 2016, the age-adjusted incidence rates were 0.3, 8.0, 20.3, and 24.9 per 100,000, and mortality rates were 0.3, 6.9, 17.5, and 25 per 100,000 for the age groups 20–49, 50–64, 65–74, and 75 or above, respectively [2]. The highest risk of incidence is reported in the area between central Asia and North-Central China, which is considered the EC belt; approximately half of the deaths occur in China [4]. Least incidence rate of 0.98/100 was reported in Central America [2, 5]. Males make up to 70% of all cases, with a two- to threefold increased incidence and mortality rates compared to females [1, 5]. For men, incidence and mortality rates are higher in developed countries than in developing countries; however, for women, rates are comparable [1]. Moreover, white men have a high prevalence of EAC, which has increased by threefold between the years 1976 and 1990 [6].