Esophageal Cancer: Survival Rates and Prognosis

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Esophageal cancer remains the seventh-highest cause of cancer death in American men, even though overall it makes up only about 1% of all cancers. One reason for the discrepancy is that esophageal cancer often isn't caught until it is at a relatively advanced stage. Still, treatment advances and changes in the type of esophageal cancer that Americans get have resulted in greater long-term survival rates than in the past. Also, promising new treatments are in clinical trials that may make a difference in esophageal cancer survival in the future, while lifestyle changes you can make right now can also help prevent the development of this disease.

Esophageal cancer survival rates have improved in recent years.

About 16,000 people were expected to die from esophageal cancer in the United States in 2019. Of these patients, the majority—13,020—were men. The number of new cases diagnosed in 2019 was estimated at 17,650 adults, again with men the majority at 13,750. 

The five-year survival rate for esophageal cancer overall is about 19%, which is an improvement on the 5% rate seen from 1975 to 1977 and 9% from 1987 to 1989.

Use caution when interpreting cancer survival rates. Esophageal cancer survival rates are averages, based on all types of esophageal cancer in patients of all races. Also, survival rates are based on data from the past, from people who had the disease and died from it. They don’t reflect current survival rates. There are many people with esophageal cancer who survive past the five-year mark. 

Here are some of the factors that affect a patient’s esophageal cancer prognosis:

  • How advanced the cancer is when it is found. If the cancer is confined entirely to the esophagus (stage I, or 1), the five-year rate jumps to 45%; if it has spread to surrounding organs, tissues and regional lymph nodes (stages II, or 2 and III, or 3), the survival rate is 24%. If the cancer isn't diagnosed until it has spread to organs or lymph nodes distant from the primary tumor (stage IV, or 4), the five-year survival rate falls to 5%.

  • The type of esophageal cancer. Two main types exist: Adenocarcinoma, which primarily occurs in the lower part of the esophagus, and which is linked to obesity; and squamous cell carcinoma, which is associated with tobacco and alcohol use. Squamous cell esophageal cancer tends to have a lower survival rate than adenocarcinoma.

  • The patient's race. Black people with esophageal cancer had a 13% five-year survival rate overall in the most recent data collection, which is based on 2008 to 2014 research. By comparison, white people had a 22% five-year survival rate overall. One reason for the disparity may be that squamous cell carcinoma, which is deadlier, is more common in African Americans, while adenocarcinoma is the most common type of esophageal cancer among whites. Also, a discouraging fact is that treatment disparities exist. A 2018 study found that 36% of white patients received surgery for esophageal cancer, compared to just 8% for black patients.

There are ways to prevent esophageal cancer or improve your prognosis. 

Some risk factors for esophageal cancer are out of your control, such as being male or being older than 50. However, there are some lifestyle changes you can make that can help you avoid this cancer or find it at an earlier, more successfully treated stage:

  • Don't smoke or quit smoking: Half of esophageal cancer deaths are attributed to cigarette smoking. Regular cigar smokers also have an increased risk.

  • Manage your weight: Avoid becoming overweight or obese, or lose weight if you need to. About 5% of esophageal cancers in men and 11% in women are attributable to excess body weight.

  • Avoid excess alcohol consumption: When alcohol and tobacco are combined, your risk of esophageal cancer rises more than either drinking or smoking alone.

  • See your doctor if you have gastric reflux: Long-term irritation of the lining of the esophagus may contribute to developing esophageal cancer. Such irritation can be caused by reflux as well as several medical conditions, including Barrett's esophagus, achalasia or Plummer-Vinson syndrome. Your doctor may recommend medications to block stomach acid or other measures to reduce your symptoms, and may also test for precancerous changes in your esophagus or early-stage cancer.

  • Get regular medical care: Bring other warning signs to your doctor's attention as well. Common symptoms of esophageal cancer include difficulty or pain when swallowing; frequent choking on food; unexplained weight loss; pain behind your breastbone or in your throat; vomiting; coughing or hoarseness; and symptoms of reflux, such as heartburn and indigestion. If you are the type of person who avoids calling the doctor with problems, getting regularly scheduled physicals can help you and your doctor address unusual or bothersome symptoms earlier.

  • Eat a healthy diet with plenty of fruits and vegetables: A nutritious diet will help you avoid vitamin deficiencies. Researchers have linked esophageal cancer to insufficient vitamin E, selenium, iron, or beta-carotene in your body.

Keep in mind that published five-year survival rates reflect treatments practiced more than five years ago, before newer treatments became available. In addition, it's important to remember that cancers respond differently from one person to the next. Your doctor is your best resource in helping sort out your or your loved one's prognosis, and the next best steps you can take. If you are interested, talk with your doctor about trends in esophageal cancer survival.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Jan 15
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