Esophageal cancer is often referred to as the “cancer caused by eating,” as many common dietary habits—such as excessive alcohol consumption, a preference for hot beverages, and frequent intake of spicy or irritating foods—can unknowingly increase the risk of developing the disease.

On the “Health 1+1” program, Shih-Fang Kuo, director of the Department of Integrative Medicine at Taiwan’s Chi Mei Medical Center, discussed the risk factors for esophageal cancer along with strategies for prevention.

Esophageal cancer is also sometimes called the “short-life cancer,” Kuo said. It primarily develops when the cells of the esophageal lining become damaged. Early-stage esophageal cancer often goes unnoticed because the esophageal lining lacks sensory receptors. Therefore, by the time symptoms appear, the disease has typically advanced to the middle or late stages, at which point the prognosis is poorer.

Risk Factors

Several key risk factors have been identified that significantly increase the likelihood of developing esophageal cancer, Kuo noted.

1. Alcohol

Alcohol can severely damage the esophagus, especially when there is insufficient mucosal protection or excessive intake of high-concentration alcohol, according to Kuo.

A 2014 meta-analysis found that heavy drinkers had approximately five times the risk of developing esophageal squamous cell carcinoma (cancer that develops in the flat, thin cells that line the inside of the esophagus) compared to nondrinkers and occasional drinkers.

The metabolism of alcohol (ethanol) in the liver produces acetaldehyde, a toxic compound that, when not efficiently metabolized—due to a deficiency in the enzyme aldehyde dehydrogenase—can accumulate in the body. Elevated levels of acetaldehyde can lead to liver damage and irritate mucosal tissues, thereby increasing cancer risk.

Most guidelines recommend limiting daily alcohol intake to no more than 0.71 ounces (20 grams), meaning consuming two bottles of beer or strong spirits could easily exceed this limit.

2. Hot Beverages

Research shows that drinking beverages at high temperatures is associated with an increased risk of esophageal cancer.

Water above 140 degrees Fahrenheit (60 degrees Celsius) can cause protein denaturation, damaging the esophageal lining, Kuo said. Water hotter than 149 degrees Fahrenheit (65 degrees Celsius) may feel scalding when consumed. He recommends keeping beverage temperatures below 104 to 122 degrees Fahrenheit (40 to 50 degrees Celsius) to prevent damage.

3. Irritating Foods

Sour, sweet, and spicy foods can stimulate gastric acid secretion, potentially harming the esophagus during acid reflux episodes. Spicy foods, in particular, can directly irritate the esophageal lining, causing discomfort. A 2022 meta-analysis found that consuming highly spicy foods may increase the risk of esophageal cancer.

Kuo pointed out that prolonged exposure of esophageal lining cells to stomach acid can lead to Barrett’s esophagus, increasing cancer risk. People with Barrett’s esophagus have an estimated risk of approximately 0.5 percent per year for developing esophageal cancer.

Kuo shared his personal experience of being diagnosed with Barrett’s esophagus. In the past, while working at a hospital, his busy schedule often left him resting at his desk. His low, slouched posture, however, compressed his esophagus and stomach, contributing to acid reflux. Kuo eventually resolved his condition by making lifestyle adjustments, including improving his sleeping posture, modifying his diet, and restructuring his daily routine.

4. Carcinogens

Certain potential carcinogens may increase the risk of esophageal cancer, Kuo said. These include Group 1 carcinogens—substances confirmed to cause cancer—such as betel quid, processed meat, smoking, and air pollution. Group 2A carcinogens, classified as probable carcinogens, include foods that can produce nitrosamines and banned pesticides like 4,4'-dichlorodiphenyltrichloroethane (DDT) and also raise esophageal cancer risk.

Foods That Can Produce Nitrosamines

Nitrosamines form when nitrites or nitrates interact with amino acids, typically under high temperatures (e.g., during cooking or curing processes). These are associated with the following processed foods:

• Processed Meats: Bacon, sausages, hot dogs, and ham often contain added nitrates or nitrites as preservatives.
• Smoked or Cured Fish: Foods like smoked salmon or cured anchovies may form nitrosamines during preparation.
• Pickled Foods: Some pickled vegetables, especially those made with nitrite-containing preservatives, produce nitrosamines.
• Beer: During the brewing process, certain reactions may produce nitrosamines.
• Cheese: Aged cheeses may contain trace amounts of nitrosamines.

Foods Associated With DDT Exposure

While DDT is banned in many countries, it persists in the environment and may still contaminate certain foods, such as:

• Fatty Fish: Fish like salmon, tuna, or mackerel from polluted waters may accumulate DDT residues.
• Dairy Products: Milk, butter, and cheese from livestock exposed to contaminated feed or water may carry traces of DDT.
• Meat and Poultry: Animals grazing on contaminated lands or eating tainted feed could have DDT residues in their fat.
• Imported Produce: Fruits and vegetables from regions where DDT use has not been entirely banned.

Symptoms and Diagnosis

The main symptoms of esophageal cancer include difficulty swallowing and weight loss, Kuo noted. Patients may initially have trouble swallowing solid foods, which can gradually worsen to the point where even liquids become hard to swallow. This difficulty eating often results in weight loss.

It is important to note that other conditions can also cause difficulty swallowing, including:

• Scleroderma and Polymyositis: These autoimmune diseases can affect the striated muscles in the upper esophagus, resulting in swallowing difficulties.
• Esophagitis: For instance, patients with Barrett’s esophagus may experience a loss of appetite and difficulty swallowing.
• Neurological Conditions: Brainstem strokes can disrupt the swallowing center, causing difficulty swallowing and increasing the risk of choking.

Due to the esophagus’s lack of a protective serosal layer, cancer cells can spread easily to adjacent structures like the trachea and blood vessels, Kuo said.

This underscores the importance of early screening. Early-stage esophageal cancer can often be treated with endoscopic submucosal dissection (ESD). This minimally invasive procedure removes abnormal growths, while mid-to-late-stage esophageal cancer typically requires chemotherapy and reconstructive surgery.

Gastroscopy is the most effective method for diagnosing esophageal cancer. With a gastroscope, doctors can directly examine the esophageal lining. They may perform a biopsy to confirm the diagnosis if any abnormalities are detected.

Once esophageal cancer is confirmed, doctors will conduct additional tests, such as chest X-rays or CT scans, to check whether the cancer has spread to the lymph nodes or other organs and to determine its stage.

Prevention Methods

Repairing the esophageal lining through diet can help reduce cancer risk, Kuo said. He recommended foods such as okra, cabbage, seaweed, and kelp.

Evidence has indicated that polysaccharides found in algae can protect the esophageal mucosa, stomach, and intestines from various toxins. These compounds exhibit anti-tumor and anti-metastatic properties and play a role in regulating programmed cell death and proliferation.

Kuo also recommends tea seed oil, which helps protect the mucosa and reduce mucosal damage. One study showed that extracts from Camellia flowers exhibit anti-proliferative effects on esophageal squamous cell carcinoma by inducing apoptosis (cell death), highlighting their potential to prevent this type of cancer.

In traditional Chinese medicine, Dendrobium (shi hu) and Chinese yam (shan yao) are common ingredients used to protect the mucosa.

Suggested Recipes for Prevention

Kuo shared two recipes that may contribute to esophageal cancer prevention:

Black Fungus Tea

Ingredients:

• 0.53 ounce (15 grams) black fungus
• 0.32 ounce (9 grams) fresh ginger

Preparation:

1. Soak the black fungus until softened.
2. Add both ingredients to a pot and cook thoroughly.
3. Blend the cooked mixture in a blender until smooth.
4. Pour the tea into a bottle and sip as needed.

Note: This tea is rich in polysaccharides and is best consumed fresh. It should not be stored for long periods, as its nutrients may degrade over time.

8-Treasure Congee

Ingredients:

• 3.53 ounces (100 grams) organic soybeans
• 3.53 ounces (100 grams) organic corn
• 1.76 ounces (50 grams) snow fungus
• 9 red dates
• 9 shiitake mushrooms
• 1.76 ounces (50 grams) lotus seeds
• 1.06 ounces (30 grams) goji berries
• 0.35 ounce (10 grams) honey

Preparation:

1. Chop the snow fungus and shiitake mushrooms into small pieces, then soak them in hot water.
2. Rinse all other ingredients.
3. Combine everything in a pot and simmer until thickened.
4. Add water and simmer over low heat until the mixture thickens to a congee-like consistency.
5. Stir in the honey and divide the congee into three portions.

Consume one portion each morning. This congee can help boost immunity and support cancer prevention.

While some herbs and ingredients mentioned may not be familiar to everyone, they are usually available at health food stores and Asian grocery stores.

It is important to note that treatment methods may vary depending on the individual. Please consult a healthcare professional for a specific treatment plan.