Oesophageal Cancer
Squamous cell carcinoma arises from chronic mucosal irritation of the upper/mid oesophagus, while adenocarcinoma arises from Barrett's metaplasia driven by chronic acid reflux in the lower oesophagus, and both narrow the lumen from within to produce progressive dysphagia, solids before liquids.
First principles
Two cancers, two distinct mechanisms
Squamous cell carcinoma develops when chronic mucosal irritants (smoking, alcohol, very hot drinks) cause repeated injury and dysplasia of the native squamous epithelium, typically in the upper or mid oesophagus. Adenocarcinoma develops through an entirely different route: chronic gastro-oesophageal reflux exposes the lower oesophagus to acid and bile, driving metaplasia of squamous epithelium into acid-resistant columnar epithelium (Barrett's oesophagus), which can progress through dysplasia to adenocarcinoma. Adenocarcinoma is now the more common subtype in the UK, reflecting rising obesity and reflux disease, and occurs at or near the gastro-oesophageal junction.
Educational content pending clinical review. Not medical advice.