Upper GI & Hepatobiliary Surgery

Oesophageal Cancer

Progressive dysphagia is an urgent cancer symptom: confirm oesophageal cancer with endoscopy and biopsy, stage it with CT and selected PET-CT, EUS or laparoscopy, then use histology, stage, fitness and MDT review to guide curative or palliative treatment.

Definition

Oesophageal cancer is a malignant tumour of the oesophagus, most often adenocarcinoma or squamous cell carcinoma. Progressive dysphagia is the cardinal symptom and requires urgent suspected-cancer investigation.

First principles

Squamous and adenocarcinoma have different precursor pathways

Squamous cell carcinoma arises from the native squamous mucosa and is associated with tobacco and alcohol exposure. Adenocarcinoma usually arises in the distal oesophagus or gastro-oesophageal junction through the metaplasia–dysplasia sequence of Barrett's oesophagus, which is associated with reflux and obesity. The distinction is clinically important because tumour location, histology and stage influence the treatment pathway.

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