Can you prevent esophageal cancer? What risk factors for esophageal cancer? How to screen for esophageal carcinoma? Gastroesophageal acid reflux disease increases cancer risk. Genetics and lifestyle increase risks for middle esophagus cancer and upper esophagus cancer. What could people do to prevent esophageal cancer? Dr. Anton Titov, MD. Esophageal cancer is diagnosed in almost half a million people globally. In the United States the esophageal cancer rate is not very high. But esophageal cancer rate could be 30x higher in certain areas of China and Middle East. Because esophageal carcinoma is a very aggressive cancer. There is only 18% five-year survival rate in esophageal cancer. Dr. Anton Titov, MD. Esophageal cancer is usually discovered at a late stage. Yes. So esophageal cancer clearly is a cancer that has high mortality. And prevention of esophageal cancer is important. It depends on where you are in the world. Dr. Michael Lanuti, MD. So in the Western world a lot of the esophageal cancers are from acid reflux. So the repetitive injury of having untreated acid reflux can injure the lower esophagus. And then over time that injury pattern can transition into an invasive esophageal cancer. Dr. Anton Titov, MD. How you prevent acid reflux? You treat reflux symptoms. You get endoscopy if you have chronic reflux symptoms. There is a pharmacological therapy for esophageal acid reflux disease. And then if medicines are not working then there are surgical operations. We can do surgery to treat acid reflux disease. And some of them are laparoscopic operations. Dr. Michael Lanuti, MD. We call them fundoplications. We wrap the stomach around the lower esophagus. We create a new esophageal sphincter. Sometimes you are in the Asian continent. Then the risk factors for esophageal cancer are very different there. We see more esophageal cancers in the middle or upper esophagus in that part of the world. It's unclear what exactly is causing esophageal cancer in middle and upper esophagus. We think it's diet and environment. We think it could be perhaps their diets. Hot tea and something in the diet could increase esophageal cancer risk. And because risk is so high, there's a screening program for esophageal cancer. It is much like we have screening colonoscopy in the US. They have screening upper endoscopy in the Asian continent. Dr. Michael Lanuti, MD. It is hard for me to answer how do you prevent esophageal cancer in Asian continent. I don't know the answer to that. That's a different type of esophageal cancer, where the intervention to prevent it is not understood well. Dr. Anton Titov, MD. How do you define "hot" in a hot drink and hot tea? Or any hot liquid that could be a risk factor for esophageal cancer. What tea temperature is considered hot? So there is this theory about it. When people drink tea in the temperature range that burns to the tongue, that would be clinically hot. And so what is that in Fahrenheit? I don't know. It is not close to a hundred degrees Celsius. But it is hot enough to burn your tongue. We think that hot liquid probably can injure the esophagus as the liquid going down. Maybe that's why we see more upper esophageal cancers in that population. Dr. Michael Lanuti, MD. But it is controversial. Because you can look at people in India. They who also drink a lot of hot tea. But we are not seeing the same amount of upper esophageal cancers in those patients. So it's a weak argument. Ultimately, the answer is "we are not entirely clear why esophageal cancer happens". We think it's their diet and perhaps genetics. There is a genetic background that predisposes some patients to the upper esophageal cancers. Upper and middle level esophageal cancer happens more often than in the US. We see in the Western world more lower esophageal cancers. Dr. Anton Titov, MD. Do you think irritation by alcoholic drinks is a risk factor for esophageal cancer? For example, is there a difference between drinking or sipping wine, or sipping whiskey, or having a shot of vodka? Shot of vodka supposedly goes through esophagus faster but nevertheless is irritating to esophagus. Dr. Michael Lanuti, MD. It's an interesting question. I think that any of those that you mentioned in moderation should not increase your risk of getting esophageal cancer. On the other hand, we clearly know this. If you have alcohol dependency and alcohol abuse, those patients tend to get more squamous cell cancers that are in the upper upper esophagus. It does not matter what alcohol you drink. Dr. Anton Titov, MD. That's understood.