High-yield map
Key points before the detail
- 01
SCC commonly affects upper/mid oesophagus; adenocarcinoma commonly affects distal oesophagus/GO junction.
- 02
Dysphagia alone meets the suspected cancer pathway threshold.
- 03
OGD diagnoses; CT and PET-CT stage selected radical candidates.
- 04
T1a adenocarcinoma is usually treated endoscopically.
- 05
Nutrition and prehabilitation are part of radical-treatment fitness.
1. Histology and risk pattern
| Type | Typical location | Associations |
|---|---|---|
| Squamous cell carcinoma | Upper/middle oesophagus | Smoking, alcohol, chronic mucosal injury, achalasia and previous caustic injury. |
| Adenocarcinoma | Distal oesophagus/GO junction | Barrett oesophagus, chronic GORD, central obesity, smoking and male sex. |
2. Presentation
- Progressive solids-first dysphagia.
- Weight loss, anorexia and sarcopenia.
- Odynophagia, regurgitation or aspiration.
- Anaemia, haematemesis or melaena.
- Hoarseness, chest/back pain or metastatic signs in advanced disease.
3. Diagnostic and staging sequence
- 1. OGD with multiple biopsies to confirm histology and tumour level.
- 2. Whole-body contrast CT.
- 3. PET-CT for radical-treatment candidates beyond suspected T1a disease.
- 4. Use EUS only when local/nodal detail will change management.
- 5. Consider staging laparoscopy selectively, especially for distal/junctional adenocarcinoma with peritoneal risk.
- 6. Discuss in a specialist oesophago-gastric MDT.
4. Treatment logic by stage
| Disease | Treatment direction |
|---|---|
| T1a adenocarcinoma | Endoscopic resection first-line, then ablate residual Barrett mucosa. |
| High-risk T1b adenocarcinoma | Oesophagectomy if fit; non-surgical oncological treatment if not. |
| T1bN0 SCC | Choice of definitive chemoradiotherapy or surgical resection. |
| Resectable non-metastatic disease | Multimodal treatment with surgery and systemic/radiation therapy according to histology and MDT strategy. |
5. Oesophagectomy principles
Oesophagectomy removes the tumour-bearing oesophagus with lymphadenectomy and usually reconstructs continuity using a gastric conduit in a specialist centre.
- Major complications include pulmonary morbidity, anastomotic leak, conduit ischaemia, bleeding, arrhythmia, chyle leak and recurrent laryngeal nerve injury.
| Approach | Outline |
|---|---|
| Ivor Lewis | Abdominal mobilisation and intrathoracic anastomosis; common for distal tumours. |
| McKeown | Abdominal and thoracic mobilisation with cervical anastomosis. |
| Transhiatal | Abdominal/cervical dissection without formal thoracotomy in selected cases. |
6. Advanced disease
- Use biomarker-informed systemic therapy through current oncology pathways.
- Stents can provide rapid relief of malignant dysphagia in selected patients.
- Radiotherapy and systemic therapy may also palliate dysphagia.
- Specialist dietetics and tumour-safe enteral access planning are essential.
Active recall
Close the notes and answer these
Try each question from memory before revealing the answer. These public prompts are a small preview of the integrated retrieval system inside SurgAtlas.
01What are the two main oesophageal cancer histologies?
Squamous cell carcinoma and adenocarcinoma.
02What is the first diagnostic test for suspected oesophageal cancer?
Upper-GI endoscopy with biopsy.
03What staging test is added for many radical-treatment candidates after CT?
FDG PET-CT.
04How is T1a oesophageal adenocarcinoma usually treated?
Endoscopic resection first-line, with eradication of residual Barrett mucosa when appropriate.
05Name three major complications of oesophagectomy.
Examples include pulmonary complications, anastomotic leak, conduit ischaemia, chyle leak, bleeding, arrhythmia and recurrent laryngeal nerve injury.
Sources & editorial basis
References & editorial basis
- SurgAtlas production source. General Surgery — Oesophageal Cancer. Public lesson curated from the corresponding production chapter.
- NICE NG83. Oesophago-gastric cancer: assessment and management in adults.
- NICE NG12. Suspected cancer recognition and referral — dysphagia pathway.
This lesson is derived from the corresponding SurgAtlas production teaching material. Where the source makes current management or guideline claims, the public lesson uses the cited contemporary guidance. It is written for education and examination preparation, not as patient-specific clinical advice.
Editorial details
Medical Doctor (MD) · MRCS Part A · Physician · Surgical Educator
SurgAtlas is an educational resource. For patient care, verify current national guidance, local antimicrobial and transfusion policies, specialty pathways and individual patient factors.
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