Etiology and Pathogenesis
The cause of carcinoma of the esophagus is not known, but there are certain important associations. The incidence varies widely geographically as noted above, but the presumed environmental factors have not been established with certainty. The incidence of esophageal carcinoma is increased in those who smoke or drink alcohol to excess and in those who have or have had squamous cell tumors of the head and neck. Injury due to lye ingestion, irradiation, or long-term stasis (usually achalasia) increases the incidence. Adenocarcinoma is strongly associated with columnar (Barrett’s) epithelium, a complication of long-term gastric reflux. A rare inherited disorder with thickened skin in the palms and soles (tylosis) and gluten-sensitive enteropathy are both associated through unknown mechanisms with an increased incidence of esophageal carcinoma.