Alcohol and Esophageal Cancer: What Is the Relation and How Does It Happen?

Many of us remember when Robert Kardashian — O.J. Simpson’s notorious lawyer and Kris Kardashian’s first husband — was diagnosed with esophagus cancer. It seemed to take hold with lightning speed, leaving him unable to talk and eat within weeks. Kardashian passed away only two months after his diagnosis, at age 59.

No matter what you might think of Robert Kardashian — or the whole Kardashian clan for that matter — we can agree that esophagus cancer is a serious, devastating problem. It is estimated that 22,370 new cases will be diagnosed and 16,130 lives will be lost to the disease in 2024. 

The good news is that esophageal cancer can be prevented by avoiding two of the main causes: smoking and alcohol use. How does alcohol affect the esophagus? And how can we protect ourselves from the risk? In this article, we will explore the connection between drinking and esophageal cancer and how we can minimize our risks.

What Is Esophageal Cancer?

Esophageal cancer, or cancer of the esophagus, forms when cells in the lining of the esophagus begin to grow out of control. The esophagus, also known as the “food pipe,” allows everything we chew and swallow to slide down into our stomach to be digested. While esophagus cancer can start anywhere along this 10-13 inch-long tube, it falls into one of two basic types:

• Squamous cell carcinoma. This type of esophagus cancer starts in the inner lining of the esophagus, known as the mucosa. At one point, it was the most common type of esophagus cancer in the U.S.; now, it makes up less than a third of the total.
• Adenocarcinoma. This type of esophagus cancer is usually found in the lower third of the “food pipe” and starts in the mucus-making glands. A major risk factor is the so-called Barrett’s esophagus — a condition in which the inner lining gets damaged by stomach acid over time.

Though it originates in the esophagus, esophageal cancer can spread to other parts of the body in three ways: through body tissue, via the lymphatic system, and through blood. When a doctor makes a diagnosis, the rate at which the cancer has spread will be marked by “stage” numbers ranging from 1 to 4. The lower the number, the better the prognosis — in earlier stages, it might be possible to remove the cancer completely! 

What Are the Symptoms of Esophageal Cancer?

Because its symptoms often overlap with other diseases, esophageal cancer tends to sneak up on its victims. What seems like an innocent cough or bout of indigestion could be something more, especially if it persists and comes with other symptoms. Check with your doctor if you have any doubts! 

Here are some of the most common symptoms:

• Pain or difficulty swallowing. Also known as dysphagia, this is the trademark symptom of esophageal cancer. It can feel like there’s something stuck in the back of our throat or chest and can even make us feel like we’re choking. This symptom tends to start out fairly mild, getting stronger over time. Unless there’s an obvious cause, it’s best to have it checked out if it persists. 
• Weight loss. Esophagus cancer can make it harder to swallow, so people might change their diet without realizing it. Eating might take longer, bites tend to get smaller, and certain foods become too much trouble to deal with. At some point, solid foods might be difficult to tackle at all, causing people to switch to a liquid diet. Naturally, these changes might lead to unexpected, and possibly unhealthy, weight loss. 
• Pain behind the breastbone. In addition to causing a sensation of a “burning throat,” cancer of the esophagus can cause persistent pain or discomfort in the middle of the chest. It can feel like pressure or burning, much like heartburn, but it doesn’t go away. 
• Hoarseness and cough. A hoarse or husky voice might be a remnant of a lingering cold (or even something we’re born with!), but when it’s new or coupled with other symptoms, it’s important to check out the cause. 
• Indigestion and heartburn. Persistent heartburn, especially when coupled with other symptoms, is also worth investigating.
• Lumps under the skin. Occasionally, lumps can be felt or even seen from the outside, depending on the exact location.
• Bleeding from the throat. One of the more severe signs — coughing up or throwing up blood — definitely warrants a closer look.

While some of these symptoms are a clear sign of a problem, others are more subtle and are not necessarily a sign that something is seriously wrong. However, it’s always best to err on the side of caution and have concerns checked out to catch any problems before they get worse (or just to put our minds at ease!).

What Causes Esophageal Cancer?

The tissues of our digestive tract are sensitive, and many things can irritate them, damaging cells and causing potentially cancerous mutations over time. Here are a few common causes:

• Tobacco use. This one’s major — smoking and other forms of tobacco are strong irritants and their use is a huge risk factor as far as esophagus cancer is concerned.
• Heavy alcohol use. Drinking too much irritates the esophagus — among other effects, which we’ll discuss in a lot more detail later on!
• Barrett’s esophagus. As previously mentioned, irritation to the esophagus lining known as Barrett’s esophagus can pose a risk.
• Obesity. Obesity is another contributing factor.
• Aging. As we get older, our bodies can lose the ability to fight off invaders — including malignant cells in our body — making us more vulnerable.

How Is Esophageal Cancer Diagnosed?

What happens if we go to the doctor and they suspect esophagus cancer? They will run several tests to make a diagnosis or rule it out:

• Physical exam and health history overview. The doctor will perform a physical exam and go over previous illnesses and current lifestyle habits. They’ll want to know about our alcohol use and other substances, so it is important to be completely honest with them for the best course of treatment. 
• Imaging tests. To get a closer look, a doctor might perform a chest x-ray with a barium swallow test. The thick barium liquid coats the esophagus, providing an image of what’s inside. Depending on the situation, they might also order a CT, MRI, or PET scan.
• Endoscopy. If imaging shows something concerning, they might schedule an endoscopy to get an even better view. For this test, they use anesthesia to keep us asleep and comfortable while they send a tube with a camera down our throat.

• Biopsy. If they find an abnormality during the endoscopy, they will take a small sample of cells from our esophagus to examine more closely in a lab. This is how they can ultimately and officially confirm or rule out cancer. 

All these tests can seem overwhelming, but your medical team won’t run any that aren’t necessary. Either way, it’s worth it to have peace of mind and, if necessary, early treatment. 

How Is Esophageal Cancer Treated?

Treatment for esophageal cancer depends on the stage (how much the cancer has spread), the size of the tumor, and whether or not the lymph nodes have been affected. While earlier stages can be treated and sometimes cured, the situation gets increasingly difficult in later stages. This is why it’s so important to get tested as soon as we suspect something is wrong.

Treatment usually involves a combination of radiation, chemotherapy, or surgery. Because these methods often come with some severe side effects of their own, we may need additional help maintaining proper nutrition. It’s a challenging time, but staying hopeful is crucial! Recovery is possible, and being in the right mindset is critical when it comes to giving ourselves the best possible chance. The body’s ability to heal is amazing, and we’re stronger than we think!

Now that we have an idea of what esophageal cancer is and how it’s treated, let’s take a closer look at one of its potential triggers — alcohol.

Alcohol and Esophagus Cancer: The Basics

Alcohol is a carcinogen, meaning it is a cancer-causing substance. It is responsible for many types of cancer, including liver cancer, breast cancer, head and neck cancer, colorectal cancer (or cancer in the colon and/or rectum), and, yes, esophageal cancer. 

The CDC makes it clear: “The less alcohol you drink, the lower your risk for cancer.” The type of alcohol doesn’t matter, either: “All alcoholic drinks, including red and white wine, beer, and liquor, are linked with cancer. The more you drink, the higher your cancer risk.”

How Does Alcohol Cause Cancer?

According to the WHO, as many as 4% of all cancers diagnosed around the world in 2020 could be linked to drinking. In the U.S., alcohol-related cancers add up to about 75,000 cases and claim up to 19,000 lives each year.

But what is it about alcohol that makes it carcinogenic? There are a few different mechanisms behind alcohol’s cancer-causing properties, but all of them come down to how alcohol interacts with the cells in our body. 

• Metabolism. Our body treats alcohol like poison; as soon as it enters our system, the liver starts working to usher it out. That said, it can only do so much at a time — one standard drink (1 ounce of alcohol) per hour. The process of alcohol metabolism produces acetaldehyde —- a toxic compound that’s more dangerous than ethanol. While it eventually gets converted to harmless acetic acid, if we drink a lot, acetaldehyde can build up, damaging DNA and proteins.
• Nutrition. With alcohol in the picture, the body puts other metabolic processes on hold. The result? We end up absorbing fewer of the vitamins and minerals that keep our body healthy and functioning well. Moreover, as we get more focused on booze, our diet often falls by the wayside, depriving us of cancer-fighting antioxidants found in foods like fruits and vegetables.
• Hormones. This one is particularly relevant to breast cancer: alcohol increases the levels of estrogen in our blood, amping up the risk.
• Oral microorganisms. As for esophageal cancer, oral microorganisms could be a contributing factor. One study found that the presence of acetaldehyde in the saliva could be the culprit, encouraging cell proliferation. Microbes present in the oral cavity, in turn, tend to boost the process.

Does Quitting or Cutting Back Change Our Cancer Risk?

So is it all doom and gloom, or is there something we can do to minimize our risk? The good news is that by staying away from booze, we are much less likely to develop esophagus cancer (assuming we don’t continue or pick up smoking and other risky habits). 

The process of getting to “low risk” status can take time, but it’s certainly worth it. One pooled analysis showed that after not drinking alcohol for 20 years, people who used to drink regularly had the same risk of esophageal cancer as those who never drank at all. That’s reassuring!

Alcohol-related risk of other cancers also decreases over time as we stop using or cut back on alcohol. Even if the cancer risk doesn’t vanish immediately, our body will begin to heal the moment we make a change. We can also look at it this way: while we can’t guarantee a life without illness if we quit or cut back on drinking, we can guarantee that our risk for cancer continues to rise by continuing to drink too much.

Tips for Reducing Cancer Risk 

Is there anything else we can do to minimize our risk of esophageal cancer? Absolutely! Some relatively small lifestyle modifications can work wonders when it comes to improving our chances of living a long, happy life:

• Watch your intake. First and foremost, it’s important to take a close look at our habits around alcohol. Cut back on alcohol use and avoid binge drinking.
• Nourish your body. Eat a healthy diet rich in whole grains, proteins, and healthy fats. Make sure you are getting the right vitamins and minerals. 
• Consider cauliflower. Studies show that cruciferous vegetables in particular help lower esophagus cancer risk, so load up on cauliflower and cabbage!
• Keep active. Exercise works wonders for reducing cancer risk, including esophageal cancer. As a bonus, the natural rush of feel-good chemicals will help keep cravings at bay.

Summing Up

Esophagus cancer is a heavy topic, but it’s encouraging to know there are ways to decrease our risk. Let’s thank our bodies for the incredible work they do by giving them the care they deserve! In the words of author Jess C. Scott, “The human body is the best work of art.” It’s never too late to give this work of art a bit of extra attention and love.