The occurrence of esophageal cancer is a complex process involving the long-term effects and interactions of multiple factors.

I. Etiology

Smoking and Alcohol Consumption: Long-term smoking and excessive alcohol intake are significant risk factors for esophageal cancer. The incidence of esophageal cancer in smokers is markedly higher than in non-smokers, with heavy drinkers facing an even greater risk.

Dietary Habits: Frequent consumption of overly hot, hard, rough, or moldy foods may increase the risk of esophageal cancer. Additionally, a lack of fresh vegetables and fruits, along with excessive intake of nitrites from preserved foods, are also risk factors for esophageal cancer.

Chronic Irritation and Inflammation: Chronic inflammation of the esophagus, such as that caused by gastroesophageal reflux disease, may elevate the risk of developing esophageal cancer.

Genetic Factors: Esophageal cancer may cluster within certain families, suggesting that genetic factors may play a role in some cases.

Premalignant Lesions: Barrett's esophagus and esophageal epithelial dysplasia are premalignant lesions of esophageal adenocarcinoma, which may progress to malignant tumors over time.

Nutrient Deficiencies: A diet lacking essential vitamins and trace elements, such as vitamins A, C, and E, and selenium, may be associated with an increased risk of esophageal cancer.

Obesity: Obesity is currently considered a risk factor for esophageal adenocarcinoma.

Other Factors: Including certain viral infections, long-term consumption of contaminated water, chronic esophageal diseases, and other factors may also be associated with the development of esophageal cancer.

II. Pathogenesis Process

Influenced by the above factors, the esophageal mucosal epithelium is subjected to chronic adverse stimulation, leading to chronic injury of the esophageal mucosal epithelium. This chronic injury further progresses to dysplasia, which is the precancerous lesion stage of esophageal cancer. During the precancerous lesion stage, cell clones undergo low-grade intraepithelial neoplasia (LGIN) and high-grade intraepithelial neoplasia (HGIN), eventually developing into invasive esophageal cancer.

Throughout this process, genetic mutations play a key role. For example, the TP53 gene is one of the most frequently mutated genes in esophageal cancer. A significant number of TP53 mutations are already present in normal epithelium, and the frequency of TP53 mutations gradually increases as the severity of the lesions progresses. Additionally, mutations in genes such as PIK3CA, NFE2L2, FAM135B, and MIR548K may also be associated with the development of esophageal cancer.

In contrast to the TP53 gene, the mutation frequencies of the NOTCH1 and CDKN2A genes gradually decrease as the severity of the lesions increases.

These genetic changes cause normal epithelial cells to gradually transform into tumor cells, leading to the development of esophageal cancer.

3. Prevention

How can we prevent esophageal cancer? We can achieve this through the following aspects:

1. Quit smoking and limit alcohol consumption: Smoking and alcohol consumption are significant risk factors for esophageal cancer. Quitting smoking and limiting alcohol intake can significantly reduce the risk.

2. Healthy Diet: Avoid excessively hot, hard, rough, or moldy foods, reduce the intake of preserved foods, increase the consumption of fresh vegetables and fruits, and maintain good eating habits.

3. Avoid Chronic Irritation and Inflammation: Chronic esophageal inflammation, such as gastroesophageal reflux disease (GERD), may increase the risk of esophageal cancer. Therefore, timely treatment of related conditions is crucial.

4. Regular Check-ups: For individuals with a family history of esophageal cancer or those residing in high-incidence areas, regular esophageal cancer screenings, such as endoscopy, can aid in early detection and treatment.

5. Reduce Exposure to Carcinogens: Avoid consuming foods containing nitrites and minimize contact with known carcinogens.

6、Maintain a Healthy Weight: Obesity is associated with an increased risk of esophageal adenocarcinoma. Therefore, maintaining a healthy weight is also a preventive measure.

7、Treat Precancerous Lesions: If you have precancerous conditions such as Barrett’s esophagus or esophageal intraepithelial lesions, regular monitoring and timely treatment are essential.

By implementing these measures, you can reduce the risk of esophageal cancer to some extent. However, even with all preventive measures in place, the risk cannot be completely eliminated. Thus, regular health check-ups and screenings remain very important.