From the Guidelines
Achalasia is a significant risk factor for developing esophageal squamous cell carcinoma (ESCC), with a 5-fold higher risk compared to the general population. The relationship between achalasia and the risk of developing ESCC is well-established, with chronic inflammation and stasis of food in the esophagus contributing to the increased risk 1. Key factors that contribute to this risk include:
- Chronic inflammation
- Stasis of food in the esophagus
- Impaired relaxation of the lower esophageal sphincter
- Repeated irritation of the esophageal lining
The risk of developing ESCC in patients with achalasia is thought to be related to the duration of symptoms and the degree of food retention 1. Regular endoscopic surveillance is strongly recommended for patients with achalasia to monitor for precancerous changes or early cancer development, although the specific intervals for endoscopy have not been established 1. Treatment of achalasia, such as peroral endoscopic myotomy (POEM), may help reduce but does not eliminate the cancer risk, making ongoing surveillance necessary even after successful treatment 1.
From the Research
Risk Factors for Esophageal SCC
The question of which is a risk for esophageal squamous cell carcinoma (ESCC) can be answered by examining the relationship between achalasia and the development of ESCC.
- Achalasia is indeed associated with an increased risk of esophageal carcinoma, including ESCC 2, 3, 4, 5.
- Studies have shown that patients with achalasia have a higher risk of developing ESCC compared to the general population, with some studies suggesting a risk 14.5 times higher 3 and others indicating a risk 50 times higher 5.
- The incidence of ESCC in achalasia patients has been reported to be around 312.4 cases per 100,000 patient-years at risk 2 and 88 per 100,000 population 3.
- The prevalence of ESCC in subjects with esophageal achalasia is estimated to be around 26 in every 1,000 cases 5.
Comparison of Options
Comparing the options provided:
- Achalasia (c) is a risk factor for esophageal SCC, as supported by the evidence 2, 3, 4, 5.
- Barrett's esophagus (a) is a risk factor for esophageal adenocarcinoma, not specifically SCC.
- GORD (b) is a risk factor for esophageal adenocarcinoma, particularly through its association with Barrett's esophagus, but its link to ESCC is less direct compared to achalasia.
Therefore, based on the evidence, achalasia is a risk factor for esophageal SCC.