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 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.
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.
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.
History and exam
Key diagnostic factors
- presence of risk factors
- weight loss
Other diagnostic factors
- postprandial/paroxysmal cough
- 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
- obesity (adenocarcinoma)
- human papillomavirus (squamous cell carcinoma)
- vitamin and mineral deficiencies (squamous cell carcinoma)
- poor oral hygiene (squamous cell carcinoma)
1st investigations to order
- oesophagogastroduodenoscopy (OGD) with biopsy
- CT thorax and abdomen
- FDG-PET scan
Investigations to consider
- comprehensive metabolic profile
- MRI thorax and abdomen
- endoscopic ultrasound (EUS) ± fine needle aspiration (FNA)
- bronchoscopy ± FNA
- thoracoscopy and laparoscopy
- pulmonary function tests
- cardiac stress test
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
- Benign stricture
- Barrett's oesophagus
- ACR appropriateness criteria: staging and follow-up of oesophageal cancer
- NCCN clinical practice guidelines in oncology: esophageal and esophagogastric junction cancers
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