Oesophageal cancer

Incidence is increasing across the Western world.

Men are twice as likely as women to develop the disease.

The 2 main histological types are squamous cell carcinoma and adenocarcinoma. In the US, adenocarcinomas now account for 80% of cases overall.

Low socioeconomic status, smoking, excessive alcohol use, GORD, Barrett's oesophagus, and obesity are some of the main risk factors.

Tumours are often locally advanced at the time of diagnosis. Accurate staging is important for prognosis and treatment planning.

Superficial intramucosal oesophageal cancer is best managed by endoscopic resection and surveillance.

Early stage cancers in surgical candidates are best treated by oesophagectomy.

For locally advanced disease, combined modality therapy is considered the current standard. This involves chemotherapy or chemoradiotherapy followed by surgery.

High-risk patients should be treated with a combination of chemotherapy and radiotherapy for best results, but local recurrence rates remain high.

Most oesophageal cancers are mucosal lesions that originate in the epithelial cells lining the oesophagus.