Aside from the fact that it’s a tricky word to say, few people know much else about Esophageal Cancer—a relatively rare cancer.

Esophageal cancer is cancer that impacts the 10-inch-long tube that connects the mouth to the stomach. That important track is vital to survive, and used daily, but esophageal cancer is shockingly referred to as a silent killer. Most people with esophageal cancer show no symptoms until after the cancer has spread.

Understanding more about this disease can help people identify early warning signs both in themselves and in their loved ones. In recognition of Esophageal Cancer Awareness Month, the National Foundation for Cancer Research has compiled 5 lifesaving facts you need to know.

1. Men are 3-4x more likely to develop esophageal cancer than women

Men are far more likely to be diagnosed with esophageal cancer than women. Additionally, people between the ages of 45 and 70 have the highest risk of esophageal cancer. Though there are less than 20,000 cases in the United States each year, the survival rate is tragically low at 20%.

2. Acid reflux, or esophageal reflux, may increase the risk of developing esophageal cancer

According to a recent study, people with esophageal reflux disease, which also causes heartburn symptoms, have a higher risk of various cancers of the larynx (or voice box) and esophagus. Esophageal reflux disease, which affects approximately 20% of US adults, occurs when stomach acid flows back into the esophagus and causes tissue damage. The research team estimated that approximately 17% of larynx and esophageal cancers were linked to esophageal reflux disease.

3. Esophageal spasms are not linked to cancer

Esophageal spasms are abnormal muscle spasms in your esophagus. Depending on the severity of the esophageal spasm, they may cause pain and may disrupt the movement of food to the stomach. As uncomfortable as esophageal spasms can be, however, they are not actually connected to cancer. Though not linked to cancer, they can cause other health complications. Symptoms of esophageal spasms also imitate those of a heart attack and confusing the two can be life threatening. Those who experience esophageal spasms should contact their doctor to discuss how to safely distinguish between a spasm and a heart attack, as well as potential treatment options.

4. Esophageal reflux can progress into a serious condition called Barrett’s Esophagus

If someone suffers from esophageal reflux for an extended period of time, it may advance to a condition called Barrett’s Esophagus. This is caused by esophageal cells being saturated in stomach acid for a long time. The cells eventually begin to thicken as a defense mechanism to withstand the acid. Barrett’s Esophagus is considered a precancerous condition and increases esophageal cancer risk. While not all people with Barrett’s Esophagus will develop cancer, it is important to monitor the condition.

5. A sponge may be the future of early esophageal cancer diagnosing

The Cytosponge is a minimally invasive tool that allows doctors to collect and assess esophageal cells. The mechanism is a tiny, compressed sponge packed inside a clear pill that is swallowed by the patient under the doctor’s supervision. The sponge then releases and expands. The doctor pulls the pill back up using an attached string, collecting esophageal cells along the way. By examining the collected cells, the medical team can assess whether the patient has Barrett’s Esophagus or other risk factors for esophageal cancer.