Esophageal cancer

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 (3,4,5,6,7):

• 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
  • is linked with alcohol, tobacco and opium use, environmental pollution, ingestion of high temperature beverages, nutritional deficiencies, and other dietary factors such as consumption of pickled foods and high nitrosamine exposure (8)
• 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)
  • in rare cases, human papillomavirus has also been linked to oesophageal adenocarcinoma development, although data remain uncertain (8)

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
• (8) Deboever N, Jones C M, Yamashita K, Ajani J A, Hofstetter W L. Advances in diagnosis and management of cancer of the esophagus BMJ 2024; 385 :e074962 doi:10.1136/bmj-2023-074962