Esophageal cancer

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

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Última revisión: 4 Oct 2025

Última actualización: 16 Jul 2025

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

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

Low socioeconomic status, smoking, excessive alcohol use, GERD, Barrett esophagus, and obesity are some of the main risk factors.

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

Superficial intramucosal well-differentiated esophageal cancer can be managed with an esophagus-sparing approach utilizing endoscopic resection and surveillance. Localized tumors that are not amenable to endoscopic resection, those with poor differentiation, lymphovascular invasion, or deeper submucosal invasion are often best treated by esophagectomy.

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

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

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

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

Definición

Most esophageal cancers are neoplastic mucosal lesions that originate in the epithelial cells lining the esophagus.

Esophageal cancers are usually squamous cell carcinomas or adenocarcinomas.

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

Anamnesis y examen

Principales factores de diagnóstico

dysphagia
odynophagia
weight loss

Todos los datos

Otros factores de diagnóstico

hiccups
postprandial/paroxysmal cough

Todos los datos

Factores de riesgo

male sex
older age
tobacco use
excessive alcohol use (squamous cell carcinoma)
Barrett esophagus (adenocarcinoma)
GERD (adenocarcinoma)
hiatal hernia (adenocarcinoma)
family history of esophageal or other cancer (squamous cell carcinoma)
low socioeconomic status
nonwhite 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)

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

esophagogastroduodenoscopy (EGD) 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 pathologic tests

Todos los datos

Pruebas diagnósticas que deben considerarse

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

Todos los datos

Algoritmo de tratamiento

Agudo

limited disease (cT1, cN0, M0)

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

localized 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

En curso

recurrent disease

Colaboradores

Autores

Ravi Rajaram, MD MSc FACS

Assistant Professor

Thoracic and Cardiovascular Surgery

University of Texas MD Anderson Cancer Center

Houston

Divulgaciones

RR is a research consultant for Johnson & Johnson and Cook Medical.

Agradecimientos

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.

Divulgaciones

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) esophagogastric sub-group. NS has acted as a clinical expert in esophagogastric 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 por pares

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

Clinical Reader in Surgery

Nuffield Department of Surgery

University of Oxford

Oxford

Divulgaciones

PM declares that he has no competing interests.

Nikhil I. Khushalani, MD

Assistant Professor of Oncology

Roswell Park Cancer Institute

Buffalo

Divulgaciones

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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Divulgaciones

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Referencias

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Artículos principales

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 Resumen

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 Resumen

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. Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Benign stricture
- Achalasia
- Barrett esophagus
Más Diferenciales
Guías de práctica clínica
- NCCN clinical practice guidelines in oncology: esophageal and esophagogastric junction cancers
- NCCN clinical practice guidelines in oncology: management of immunotherapy-related toxicities
Más Guías de práctica clínica
Folletos para el paciente
Quitting smoking
Esophageal cancer
Más Folletos para el paciente
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Esophageal cancer

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

limited disease (cT1, cN0, M0)

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

localized 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

Divulgaciones

Agradecimientos

Divulgaciones

Revisores por pares

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

Divulgaciones

Nikhil I. Khushalani, MD

Divulgaciones

Agradecimiento de los revisores por pares

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Folletos para el paciente

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice