Oesophageal cancer

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Diagnóstico 
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Última revisão: 12 Dec 2025

Última atualização: 19 Nov 2025

Oesophageal cancer incidence is increasing across the developed world. Men are considerably more likely than women to develop the disease.

The two main histological types are squamous cell carcinoma and adenocarcinoma. In the developed world, adenocarcinomas predominate.

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 well-differentiated oesophageal cancer can be managed with an oesophagus-sparing approach utilising endoscopic resection and surveillance. Localised tumours that are not amenable to endoscopic resection, those with poor differentiation, lymphovascular invasion, or deeper submucosal invasion are often best treated by oesophagectomy.

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

Patients without a complete pathological response following resection may benefit from adjuvant immunotherapy.

Targeted therapies can be used in patients with metastatic oesophageal and oesophageal junction cancer.

Treatment decisions for patients with recurrent or refractory disease are informed by prior treatment history and multidisciplinary tumour board discussions.

Definição

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

Oesophageal cancers are usually squamous cell carcinomas or adenocarcinomas.

Rarely, other cancers, such as melanoma, sarcoma, small cell carcinoma, or lymphoma, can occur in the oesophagus.

História e exame físico

Principais fatores diagnósticos

presence of risk factors
dysphagia
odynophagia
weight loss

Detalhes completos

Outros fatores diagnósticos

hiccups
postprandial/paroxysmal cough

Detalhes completos

Fatores de risco

male sex
older age
tobacco use
excessive alcohol use (squamous cell carcinoma)
Barrett's oesophagus (adenocarcinoma)
GORD (adenocarcinoma)
hiatus hernia (adenocarcinoma)
family history of oesophageal or other cancer (squamous cell carcinoma)
low socioeconomic status
non-white race (squamous cell carcinoma)
high-temperature beverages and foods (squamous cell carcinoma)
drinking maté (squamous cell carcinoma)
low intake of fresh fruit and vegetables
hereditary cancer syndromes
obesity (adenocarcinoma)
human papillomavirus (squamous cell carcinoma)
achalasia
vitamin and mineral deficiencies (squamous cell carcinoma)
poor oral hygiene (squamous cell carcinoma)

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

oesophagogastroduodenoscopy (OGD) with biopsy
endoscopic ultrasound (EUS) ± fine needle aspiration (FNA)
CT thorax and abdomen
(18F)-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scan
molecular and pathological tests

Detalhes completos

Investigações a serem consideradas

comprehensive metabolic profile
MRI thorax and abdomen
bronchoscopy ± fine needle aspiration (FNA)
thoracoscopy and laparoscopy
liquid biopsy
pulmonary function tests
cardiac stress test
echocardiogram

Detalhes completos

Algoritmo de tratamento

AGUDA

limited disease (cT1, cN0, M0)

localised disease (cT2, cN0, M0): suitable for surgery

localised disease (cT2, cN0, M0): unsuitable for surgery

locally advanced disease (cT3-4, cN1-3, M0): suitable for surgery

locally advanced disease (cT3-4, cN1-3, M0): unsuitable for surgery

metastatic (M1) disease

CONTÍNUA

recurrent disease

Colaboradores

Autores

Ravi Rajaram, MD MSc FACS

Assistant Professor

Thoracic and Cardiovascular Surgery

University of Texas MD Anderson Cancer Center

Houston

Declarações

RR is a research consultant for Johnson & Johnson and an educational proctor for Intuitive Surgical.

Agradecimentos

Dr Ravi Rajaram would like to gratefully acknowledge Dr Naureen Starling, Dr Caroline Fong, Dr Mark J. Krasna, and Dr Ghulam Abbas, the previous contributors to this topic.

Declarações

MJK is an author of several references cited in this topic. GA declares that he has no competing interests. NS has received research funding from AstraZeneca, BMS, and Pfizer; travel and accommodation funding from AstraZeneca, BMS, Eli Lilly, Merck, Roche, and MSD Oncology; honoraria from Eli Lilly, Merck Serono, MSD Oncology, Pierre Fabre, Servier, GSK, and Amgen. She has been on the advisory board for Pfizer, AstraZeneca, Servier, and MSD (Merck). NS is an Honorary Clinical Senior Lecturer within the Division of Clinical Studies at the Institute of Cancer Research and serves on the UK National Cancer Research Institute (NCRI) oesophagogastric sub-group. NS has acted as a clinical expert in oesophagogastric cancer for NICE (guideline committee and technology appraisal) and is an upper GI expert for International Cancer Benchmarking Partnership. She is a Trustee for Pancreatic Cancer UK and a member of the EORTC General Assembly representing The Royal Marsden, as well as a member of the European Society for Medical Oncology (ESMO) Gastrointestinal Faculty. Educational roles include the NIHR Training Lead for NIHR Biomedical Research Centre, member of the Cancer Research Centre of Excellence training committee, Deputy Training Program Director (one of three) for South London Medical Oncology Training, member of the pan-London specialist Medical oncology training committee, and member of the Medical Oncology National Recruitment steering committee. CF declares that she has received honoraria from Bristol Myers Squibb.

Revisores

Peter McCulloch, MBChB, MA, MD, FRCS (Ed), FRCS (Glas)

Clinical Reader in Surgery

Nuffield Department of Surgery

University of Oxford

Oxford

Declarações

PM declares that he has no competing interests.

Nikhil I. Khushalani, MD

Assistant Professor of Oncology

Roswell Park Cancer Institute

Buffalo

Declarações

NIK has received funding for the conduction of clinical trials and associated translational studies from Merck, Pfizer, and Astra-Zeneca. NIK has a grant from the National Comprehensive Cancer Network (from research support by Roche).

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Referências

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Principais artigos

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: esophageal and esophagogastric junction cancers [internet publication].Texto completo

Obermannová R, Alsina M, Cervantes A, et al; ESMO Guidelines Committee. Oesophageal cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Oct;33(10):992-1004.Texto completo Resumo

van Hagen P, Hulshof MC, van Lanschot JJ, et al; CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012 May 31;366(22):2074-84.Texto completo Resumo

Shapiro J, van Lanschot JJ, Hulshof MC, et al; CROSS study group. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015 Sep;16(9):1090-8. Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Benign stricture
- Achalasia
- Barrett's oesophagus
Mais Diagnósticos diferenciais
Diretrizes
- NCCN clinical practice guidelines in oncology: esophageal and esophagogastric junction cancers
- NCCN clinical practice guidelines in oncology: management of immunotherapy-related toxicities
Mais Diretrizes
Folhetos informativos para os pacientes
Oesophageal cancer
Stopping smoking
Mais Folhetos informativos para os pacientes
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Oesophageal cancer

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

limited disease (cT1, cN0, M0)

localised disease (cT2, cN0, M0): suitable for surgery

localised disease (cT2, cN0, M0): unsuitable for surgery

locally advanced disease (cT3-4, cN1-3, M0): suitable for surgery

locally advanced disease (cT3-4, cN1-3, M0): unsuitable for surgery

metastatic (M1) disease

recurrent disease

Colaboradores

Autores

Ravi Rajaram, MD MSc FACS

Declarações

Agradecimentos

Declarações

Revisores

Peter McCulloch, MBChB, MA, MD, FRCS (Ed), FRCS (Glas)

Declarações

Nikhil I. Khushalani, MD

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice