Definition
Esophageal cancer is a malignant tumor that develops in the esophageal wall. There are two main types: squamous cell carcinoma, commonly found in the middle and upper esophagus, and adenocarcinoma, mostly affecting the lower esophagus.

Pathogenesis
Cancer development is associated with risk factors:

  • Squamous cell carcinoma: Smoking, excessive alcohol consumption, hot beverages, and chronic irritation.
  • Adenocarcinoma: Gastroesophageal reflux disease (GERD), obesity, and Barrett’s esophagus linked to chronic reflux.

Chronic inflammation and cellular mutations play a key role in carcinogenesis.

Diagnosis
Diagnosis involves:

  • Endoscopy: Allows direct visualization of the tumor and biopsy for histological confirmation.
  • Imaging studies: CT, MRI, PET-CT, and endoscopic ultrasound for staging.

Treatment
Treatment depends on the cancer stage and type:

  • Surgical intervention: Esophagectomy is the main treatment for localized disease.
  • Chemotherapy and radiotherapy: Used pre-surgery (neoadjuvant) or for unresectable cases.
  • Immunotherapy: Administered in advanced or resistant stages, particularly in patients with specific biomarkers.
  • Supportive care: Endoscopic interventions or stent placement may be required to improve swallowing and nutrition.

Prevention
Prevention includes:

  • Quitting smoking and reducing alcohol consumption.
  • Managing obesity and GERD.
  • Regular monitoring for Barrett’s esophagus.

Early diagnosis and comprehensive treatment approaches are critical for improving prognosis and patient quality of life.

Adenocarcinoma usually arises in a Barrett oesophagus. Dysphagia should also be distinguished from oesophageal motility disorders.

Frequently asked questions

What is the first symptom?

Almost always dysphagia, initially for solids and progressively for softer food and liquids. Because the oesophagus dilates and patients adapt how they eat, the symptom is noticed only once the lumen has already narrowed considerably. Any new, progressive difficulty swallowing requires prompt endoscopy.

Does Barrett oesophagus lead to cancer?

It is the main risk factor for oesophageal adenocarcinoma, but the absolute risk for an individual patient is low. The value of scheduled surveillance lies in detecting dysplasia, which can then be treated endoscopically and completely before invasive cancer develops.

Is the oesophagus always removed?

No. When the lesion is early and confined to the superficial layers of the wall, it is removed endoscopically and the oesophagus is preserved. Endoscopic ultrasound is decisive here, as it assesses depth of invasion. Oesophagectomy is reserved for deeper, locally advanced disease.

Sources


Content last updated: September 2026 (14/09/2026).