I was recently forced to retire from a 35+ year career as clinical medical scientist in academics and the biopharmaceutical and clinical diagnostics industries. Your statement that smoking and drinking are not usually associated with the pathogenesis of cancer is incorrect. There are a large number of peer reviewed experimental, clinical, epidemiologic, and meta-annalytical studies that conclusively establish the increased risk of developing Esophageal carcinoma. The evidence is stronger for squamous cell esophageal carcinoma but they also increase the risk for esophageal adenocarcioma.

Alcohol and nicotine decrease lower esophageal sphincter tone which increases acids reflux, exacerbates GERD and increases the risk of Barrett's esophagus. Also, the primary metabolite of alchohol, acid aldehyde, and the numerous carcinogens in tobacco smoke are cytotoxic to all of the esophageal cellular constituents. They have been shown to cause epigenetic changes in esophageal fibroblasts, smooth muscle, and epithelial cells. These include the production of genetic mutations, changes in methylation pattern cells, upregulation of various oncogenes and their associated signalling pathways, activation of inflammatory pathways and immune suppression.

I agree with you that an upper endoscopy and biopsy of suspicious lesions is the current gold standard for the diagnosis of esophageal cancer. There are newer less invasive techniques utilizing a novel collecting brush that are gaining wider use. Also, it's critical that you have molecular genetic analysis performed on any biopsies or cellular brushing that are obtained. This will provide actionable information to your oncologist and the tumor board as to your tumors oncogene expression, mutational burden/copy number, methylation patterns, and microsatillite instability. This informs the most effective radiotherapy, chemotherapy, immuno-oncology and targeted therapies for treating your tumor. They may also use less invasive liquid biopsies which detect circulating cell free DNA from lysed cancer cells to monitor your response to therapy, and residual disease burden or recurrence.