Overview
Oesophageal cancers tend to be aggressive and have a poor prognosis as when patients present with symptoms, the tumour is likely to be at an advanced stage. The two main histological subtypes are:
- Oesophageal adenocarcinoma (AC):
- Most common type in the developed world
- Arises from glandular cells in the lower third of the oesophagus
- Oesophageal squamous cell carcinoma (SCC):
- Most common type in the developing world
- Arises from the epithelial cells in the upper two-thirds of the oesophagus
Epidemiology
- Oesophageal cancer is the 14th most common cancer in the UK
- More common in ≥75 years and rare in patients <40 years
- Oesophageal cancer is more common in men
- AC is more common in the developed world
- SCC is more common in the developing world
Risk Factors
- Risk factors for adenocarcinoma:
- Smoking
- GORD and Barrett’s oesophagus
- Hiatus hernia
- Obesity
- Risk factors for squamous cell carcinoma:
- Smoking
- Excessive alcohol consumption
- High-temperature food and drink
- Vitamin and mineral deficiencies
- Poor dental hygiene
- Plummer-Vinson syndrome
Presentation
Red flag features are:
- Dysphagia – the most common symptom
- Usually occurs once more than two-thirds of the lumen is obstructed, suggesting locally advanced disease
- Odynophagia – pain when swallowing
- Weight loss
- Vomiting
- Anorexia
- Melaena
- Haemoptysis and haematemesis
Investigations
Referral
- See Dysphagia
Overview
- Oesophagogastroduodenoscopy (OGD) with biopsy:
- The first-line test
- CT/MRI of the chest and upper abdomen:
- For staging
- Fluorodeoxyglucose positron emission tomography (FDG–PET) scan:
- For staging
Management
Management is coordinated by a multidisciplinary team and may involve surgery (such as an oesophagectomy), chemotherapy, and radiotherapy.
Prognosis
- Oesophageal cancer often requires aggressive treatment and tends to carry a poor prognosis
- The disease can metastasise to the lungs, liver, and bone
