Esophageal cancer is a malignant tumor of the esophagus, the muscular tube that carries food from the throat to the stomach. Two histological types account for almost all cases, and they behave as two different diseases. Esophageal squamous cell carcinoma (ESCC) arises from the squamous epithelium that lines the upper and middle esophagus. Esophageal adenocarcinoma (EAC) arises in the distal esophagus from Barrett’s metaplasia, the intestinal-type change produced by chronic reflux. The two share symptoms but differ in their risk factors, their geographic distribution and their treatment. A small remainder are rarer tumors: small cell carcinoma, melanoma, lymphoma, sarcoma, and a range of benign lesions.
Choose a route through this family
Begin with how common the disease is and where it occurs, then take the two main types in turn, followed by the clinical course, the investigations and the treatment.
- Epidemiology: how often esophageal cancer occurs, where the two types cluster, who is affected, and how lethal it is.
- Squamous Cell Carcinoma: the type that arises from the squamous lining — its risk factors, how it develops, and its clinically relevant genetic changes.
- Esophageal Adenocarcinoma: the type that arises from Barrett’s metaplasia — reflux, obesity, the factors that protect against it, and the molecular changes behind it.
- Clinical Manifestations: how both types present, and the features of local invasion and metastatic spread.
- Diagnosis: endoscopic biopsy and what the tumor looks like, the imaging that adds information, chromoendoscopy, and screening.
- Staging and Prognosis: the TNM system, the depth of invasion and nodal spread that predict survival.
- Treatment: how stage, type and fitness decide between endoscopic resection, surgery, chemoradiotherapy and palliation.
- Small Cell and Melanoma: the rare malignant tumors of the esophagus and why they are usually diagnosed late.
- Benign and Non-Epithelial Tumors: benign epithelial lesions and the non-epithelial tumors, from leiomyoma to lymphoma and metastatic disease.