Oesophageal Cancer

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This blog is for informational purposes only and should not be taken as medical advice. Content is sourced from third parties, and we do not guarantee accuracy or accept any liability for its use. Always consult a qualified healthcare professional for medical guidance.

What is Oesophageal Cancer?

Oesophageal cancer is a malignancy that develops in the oesophagus, the muscular tube connecting the throat to the stomach, responsible for transporting food and liquids. It is classified into two main types: squamous cell carcinoma (SCC, originating in the flat cells lining the oesophagus, often in the upper part) and adenocarcinoma (arising from glandular cells, typically in the lower oesophagus near the stomach). Rare types include small cell carcinoma and sarcomas. In 2025, oesophageal cancer ranks as the 8th most common cancer globally, with approximately 21,000 new US cases annually, predominantly affecting men (3:1 ratio) over age 60. It is aggressive, with high mortality due to late diagnosis, as the oesophagus can stretch to accommodate tumors without early symptoms.

Symptoms

Symptoms usually appear in advanced stages when the tumor obstructs the oesophagus, including difficulty swallowing (dysphagia, starting with solids then liquids), painful swallowing (odynophagia), unintentional weight loss (from reduced intake), chest pain or burning sensation behind the breastbone, chronic cough or hoarseness (from laryngeal nerve involvement), regurgitation of food, vomiting blood (hematemesis), black stools (melena from bleeding), and fatigue or anemia from chronic blood loss. Advanced disease may cause aspiration pneumonia, fistula formation (abnormal connections to trachea), or symptoms from metastases (e.g., liver pain, bone ache). Symptoms often mimic gastroesophageal reflux disease (GERD), delaying diagnosis by months.

Causes

Oesophageal cancer results from chronic irritation and inflammation leading to cellular changes (dysplasia to carcinoma). For SCC, major causes include smoking (increases risk 5-10 fold), heavy alcohol use (synergistic with smoking), HPV infection (types 16/18 in 20-30% of cases), poor nutrition (low fruits/vegetables), and hot beverage consumption. Adenocarcinoma is linked to Barrett’s oesophagus (intestinal metaplasia from chronic GERD), obesity (increases GERD risk), hiatal hernia, and Helicobacter pylori infection. Genetic factors (e.g., TP53 mutations) and family history play roles. In 2025, microbiome alterations and epigenetic changes are recognized as contributors to progression.

Diagnosis

Diagnosis begins with endoscopy (upper GI endoscopy with biopsy) to visualize and sample tumors. Barium swallow X-ray detects strictures. Staging uses endoscopic ultrasound (EUS) for depth invasion and lymph nodes, CT/PET-CT for distant metastases, and bronchoscopy/laparoscopy for local spread. Molecular testing identifies HER2, PD-L1, or MSI for targeted therapy. In 2025, AI-enhanced endoscopy improves detection of early lesions by 25%, and liquid biopsies aid in monitoring.

Treatment

Treatment depends on stage, type, and patient fitness. Early-stage (I-II) uses endoscopic resection or surgery (oesophagectomy with lymph node dissection, often minimally invasive). Locally advanced (II-III) combines neoadjuvant chemoradiation (cisplatin + 5-FU + radiation) to shrink tumors, followed by surgery, improving 5-year survival to 40-50%. Advanced (IV) focuses on palliation with chemotherapy, targeted therapy (trastuzumab for HER2+), immunotherapy (pembrolizumab for PD-L1+ or MSI-high), or stents for obstruction. In 2025, ramucirumab + paclitaxel extends survival in refractory cases, and robotic surgery reduces complications.

Future Outlook

In 2025, oesophageal cancer’s 5-year survival is 20% overall, 47% for localized, but 5% for distant disease. Advances in immunotherapy and targeted therapies (e.g., for NTRK fusions) improve advanced survival to 12-18 months. Research on HPV vaccines for SCC prevention and AI screening could reduce incidence by 30%. By 2030, biomarker-driven therapies and early detection may raise overall survival to 30%, with focus on minimizing surgical morbidity.

Sources

The information for oesophageal cancer is sourced from the National Cancer Institute’s “Oesophageal Cancer Treatment (PDQ®)” for understanding, symptoms, causes, diagnosis, and treatment; Cleveland Clinic’s “Esophageal Cancer: Symptoms, Causes & Treatment” for symptoms and treatment updates; Mayo Clinic’s “Esophageal cancer – Symptoms and causes” for causes and symptoms; OncoDaily’s “Esophageal Cancer: Symptoms, Causes, Diagnosis, and Treatment” for diagnostic methods; and PMC’s “Oesophageal cancer: advances in systemic therapy” for 2025 advancements and future outlook.