Currently, the most common histologic type of esophageal cancer in the United States is adenocarcinoma, which is related to Barrett’s esophagus and heartburn. This is unexpected because more than a decade ago it was believed that the esophagus did not commonly develop adenocarcinoma. Adenocarcinoma was thought to involve only 2% to 4% of esophageal cancers and even these were suspect because they were thought to be related to gastric cancers that had migrated proximally. Case control epidemiologic studies of nutritional factors have implicated less-than-average intake of fresh fruits and vegetables in the pathogenesis of esophageal adenocarcinoma. Specific nutrients that have been found to be important in the development of esophageal cancers include vitamins A, B6, C, E, and folate. Also, fiber is protective against the development of esophageal adenocarcinoma. Even though adenocarcinoma is now the most common cancer of the esophagus in the United States, cancers of the esophagus are not common. The incidence of cancer within Barrett’s esophagus is thought to be approximately 0.4% to 0.5% per patient-year. This is far less than the previously suspected cancer incidence of 10% to 15%.
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