6. Oesophageal Cancer

đź“„ Definition

Oesophageal cancer is a malignancy of the oesophagus, most commonly occurring in the lower third. It includes two major histological types:

  • Adenocarcinoma – typically affects the lower oesophagus; strongly linked to Barrett’s oesophagus and GORD

  • Squamous cell carcinoma (SCC) – more common in the upper/mid-oesophagus; associated with smoking and alcohol

🛡️ Risk Factors (Mnemonic: BARRETT’S)

  • Barrett’s oesophagus (precursor for adenocarcinoma)

  • Alcohol use (especially for SCC)

  • Reflux (chronic GORD)

  • Race (higher adenocarcinoma risk in White males)

  • Excess weight (obesity)

  • Tobacco smoking

  • Tylosis (rare genetic disorder)

  • Squamous dysplasia or achalasia (for SCC)

đź“‹ Clinical Features (Mnemonic: PROGRESSIVE)

  • Progressive dysphagia (solids → liquids)

  • Retrospective weight loss

  • Odynophagia (painful swallowing)

  • GORD symptoms

  • Reflux unresponsive to PPIs

  • Epigastric/chest discomfort

  • Signs of anaemia (fatigue, pallor, SOB)

  • Suspected bleeding (melaena/haematemesis)

  • Iron-deficiency anaemia (especially in males)

  • Voice hoarseness (recurrent laryngeal nerve involvement)

  • Enlarged supraclavicular node (Virchow’s node)

⚠️Red Flag Features – 2WW Urgent Oesophago-Gastric Cancer Referral

Refer for OGD within 2 weeks if:

  • Dysphagia

  • Aged ≥55 with weight loss and:

    • Upper abdominal pain

    • Dyspepsia

    • Reflux

  • Unexplained iron-deficiency anaemia

  • Persistent vomiting or GI bleeding

  • Upper abdominal mass

🔬 Investigations

  • Upper GI endoscopy (OGD) with biopsy – gold standard

  • CT chest–abdomen–pelvis – staging

  • Endoscopic ultrasound (EUS) – assess local invasion

  • PET-CT – for staging in potentially curable cases

  • FBC / LFTs / U&Es / clotting – baseline and staging

  • Nutritional assessment – weight loss and cachexia common

 

Management

🎯 Multidisciplinary Approach

  • Curative intent for early-stage disease

  • Palliative care for advanced/metastatic disease

âś… Curative treatment options

  • Endoscopic mucosal resection (EMR) – early-stage tumours

  • Oesophagectomy – surgery for fit patients

  • Neoadjuvant chemoradiotherapy – standard in locally advanced disease

  • Definitive chemoradiotherapy – alternative to surgery in some squamous tumours

🤝 Palliative options

  • Oesophageal stenting – for dysphagia relief

  • Palliative chemotherapy or radiotherapy

  • Nutritional support – e.g. PEG or jejunostomy feeding

  • Pain and symptom management (palliative care)

 

âť— Complications (Mnemonic: BLOOM)

  • Bleeding

  • Local invasion (tracheoesophageal fistula, mediastinum)

  • Obstruction of oesophagus (progressive dysphagia)

  • Oesophageal perforation (rare, post-intervention)

  • Metastasis (liver, lung, nodes, bone)

Last updated in line with NICE NG151 (Oesophago-gastric cancer: diagnosis and management)
Published: January 2023 • Last updated: January 2023 Last reviewed: July 2025
PASSMAP ensures all content is NICE-aligned and reviewed for Physician Associate Registration Assessment (PARA) success.

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