Esophageal Cancer Awareness Month: Recognizing the Signs and Advancing Treatment

April is Esophageal Cancer Awareness Month, a time to focus on a relatively rare type of cancer that makes up about 1% of cancer cases in the United States.

An estimated 22,000 people in the U.S. are diagnosed yearly, and, unfortunately, the disease will kill more than 16,000. The five-year survival rate is 22%, mainly because the disease can progress without symptoms until it is too advanced to treat effectively.

The keys to survival are early detection and finding quality care close to home once a diagnosis is made.

Types of Esophageal Cancer

The esophagus is a long, muscular passageway that carries food and liquids from the throat to the stomach. Esophageal cancer develops in the inner lining of this tube. The two primary types are adenocarcinoma, which forms in glandular cells, and squamous cell carcinoma, which forms in the squamous cells.

Esophageal Cancer Symptoms

Esophageal cancer is a silent killer because people generally don’t exhibit symptoms until the disease has progressed and tumors become large enough for symptoms to appear, which typically include:

• Unknown weight loss
• Trouble swallowing
• Hoarseness in the throat
• Hiccups
• Vomiting with streaks of blood
• Coughed-up lung secretions with blood
• Pain behind the breastbone
• Lump under the skin

What Causes Esophageal Cancer?

Like many cancers, the root causes of esophageal cancer can be traced to genetics and lifestyle habits. Smoking and heavy alcohol use are strongly linked to squamous cell carcinoma, which is more common in the middle and upper portions of the esophagus.

Adenocarcinoma is more common in the lower esophagus and can often be traced to chronic gastroesophageal reflux disease (GERD) or a genetic condition called Barrett’s esophagus. About 9% of esophageal adenocarcinoma cases can be linked to a family history of Barrett’s esophagus. People with a first-degree family member—a parent, full sibling, or child—with Barrett’s are 5.5 times more likely to contract esophageal adenocarcinoma themselves. Research continues into identifying the exact genes involved in Barrett’s esophagus.

Esophageal Cancer Treatments

Common treatments for esophageal cancer typically include some combination of surgery, chemotherapy, and radiation. But immune therapies are gaining prominence as researchers better understand the disease.

In the past few years, the U.S. Food and Drug Administration has approved several new medications that trigger immune responses. These include:

• Nivolumab (Opdivo) to treat unresectable advanced, recurrent, or metastatic esophageal squamous cell carcinoma
• Pembrolizumab (Keytruda) for PD-L1–positive squamous cell carcinoma of the esophagus
• Tislelizumab-jsgr (Tevimbra) for patients with surgically inoperable or metastatic squamous cell carcinoma of the esophagus that has progressed despite chemotherapy

Recent clinical data also show that the combination of radiation, chemotherapy, and immunotherapy can make tumors more amenable to surgery for patients with unresectable, locally advanced esophageal cancer. This combination of interventions was shown to significantly improve survival outcomes.

Head and Neck Cancer Awareness Month

April is also Head and Neck Cancer Awareness Month, and although esophageal cancer is classified separately from oral, head, and neck cancers, the two cancer types do share some risk factors.

Established risk factors include drinking alcohol, smoking, chewing tobacco or betel nuts, wood dust exposure, and radiation. Certain strains of human papillomavirus (HPV) and infection with the Epstein-Barr virus are also linked to specific head and neck cancers. These types of cancer occur more frequently in men than in women and more often in people over age 50. Asian populations have a higher incidence of head and neck cancers than those in other racial groups.

Head and neck cancers caused by HPV infections outpace cervical cancer caused by HPV. Cervical cancer can also be a silent killer, but a greater emphasis on screening has curbed deaths from the latter disease. Head and neck cancers comprise just under 4% of all cancer diagnoses in the U.S., with more than 72,000 cases in 2025 and an estimated 16,500 deaths.

Woodlands Cancer Institute

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