cancer (oesophagus)

Last edited 07/2023 and last reviewed 08/2023

Oesophageal cancer usually originates in the lining of the oesophagus and can develop in the upper, middle, or lower section of the organ (1).

• epithelial tumours are responsible for more than 95% of cases oesophageal carcinomas
• non epithelial cell carcinomas are rare e.g. - metastatic tumour, lymphomas, sarcomas (2)

Epithelial tumour has two main subtypes:

• oesophageal squamous-cell carcinoma (SCC)
• is the most common oesophageal cancer subtype - responsible for 87% of all cases of oesophageal cancer in 2012
• usually affects the upper two thirds of the oesophagus
• occurs most commonly in the middle third of esophagus
• males and females are affected equally
• oesophageal adenocarcinoma
• more common in the lower third of the oesophagus
• three to four times as common in men as it is in women (3,4,5)                     

Tumours tend to arise in areas of partial narrowing, i.e. at the pharyngo-oesophageal junction (40%); the junction of the upper and middle third (40%); and where the oesophagus passes through the diaphragm (20%) (6).

Notes (7):

• there are around 13,000 new cases of oesophago-gastric cancer diagnosed in England each year
  • mortality rates are high, with over 10,000 deaths annually, and over the last 30 years the incidence of these cancers has continued to increase

Reference:

• (1) National Institute for Health and Care Excellence (NICE) 2006. Photodynamic therapy for early-stage oesophageal cancer
• (2) Layke JC, Lopez PP. Esophageal cancer: a review and update. Am Fam Physician. 2006;73(12):2187-94. 
• (3) Rustgi AK, El-Serag HB. Esophageal carcinoma. N Engl J Med. 2014;371(26):2499-509.
• (4) Kulendran M   et al. Oesophageal cancer: diagnosis and management. Trends in Urology & Men's Health 2016; Vol 7, Issue 6
• (5) Jain S, Dhingra S. Pathology of esophageal cancer and Barrett’s esophagus. Ann Cardiothorac Surg. 2017; 6(2): 99–109.  
• (6) Spechler, SJ. et al. (1994). Prevalence of metaplasia at the gastro-oesophageal junction. Lancet, 344, 1533-6.
• (7) NICE (July 2023). Oesophago-gastric cancer: assessment and management in adults