From the Guidelines
The main risk factor for oesophageal cancer is Barrett's oesophagus (option C). Barrett's oesophagus is a condition where the normal squamous epithelium of the lower oesophagus is replaced by columnar epithelium due to chronic acid reflux, as stated in the study by 1. This metaplastic change significantly increases the risk of developing adenocarcinoma of the oesophagus, with patients having approximately 30-40 times higher risk compared to the general population, as supported by the findings of 1. The condition develops as a complication of long-standing gastroesophageal reflux disease (GERD), where stomach acid repeatedly damages the lining of the oesophagus.
Key Points
- Barrett's oesophagus is the only known precursor to oesophageal adenocarcinoma, a cancer with very poor prognosis, as mentioned in the study by 1.
- The main risk factors for Barrett’s oesophagus are a history of gastro-oesophageal acid reflux symptoms and obesity, as well as smoking and a family history, according to 1.
- Patients with Barrett’s oesophagus need to be fully informed about the implications of this diagnosis and the benefits and risks of monitoring strategies, as recommended by 1.
- While smoking is indeed a risk factor for oesophageal cancer, particularly for squamous cell carcinoma, and longstanding achalasia also increases risk, Barrett's oesophagus represents the most significant and well-established risk factor, especially for adenocarcinoma which has become the predominant type of oesophageal cancer in Western countries, as discussed in 1.
Risk Factors
- Smoking: a moderate established risk factor for adenocarcinoma, as stated in 1.
- Longstanding achalasia: increases risk of oesophageal cancer, but to a lesser extent compared to Barrett's oesophagus.
- Obesity and high body mass index (BMI): strong risk factors for esophageal adenocarcinoma, as supported by the findings of 1.
From the Research
Main Risk Factors for Oesophageal Cancer
The main risk factors for oesophageal cancer include:
- Barrett's oesophagus, a condition characterized by partial replacement of the normal squamous epithelium of the lower oesophagus by a metaplastic columnar epithelium containing goblet cells (intestinal metaplasia) 2
- Gastro-oesophageal acid reflux, central obesity, and smoking are also risk factors for Barrett's oesophagus and subsequently oesophageal adenocarcinoma 2, 3
- Longstanding achalasia, a motility disorder of the oesophagus, can lead to functional oesophageal obstruction and increase the risk of oesophagitis, Barrett's oesophagus, and oesophageal cancer 4
Comparison of Options
Comparing the given options:
- A. Idiopathic: Not a specific risk factor mentioned in the studies
- B. Smoking: A risk factor for Barrett's oesophagus and oesophageal adenocarcinoma 2, 3
- C. Barrett’s oesophagus: A well-established risk factor for oesophageal adenocarcinoma 2, 3, 5, 6
- D. Longstanding achalasia: A risk factor for oesophageal cancer, but less common than Barrett's oesophagus 4
Conclusion of Main Risk Factor
Based on the studies, the main risk factor for oesophageal cancer among the given options is Barrett's oesophagus, as it is a well-established precursor to oesophageal adenocarcinoma 2, 3, 5, 6