Intended for healthcare professionals

Clinical Review

Oesophageal cancer

BMJ 2010; 341 doi: (Published 26 November 2010) Cite this as: BMJ 2010;341:c6280
  1. Jesper Lagergren, professor and consultant of surgery12,
  2. Pernilla Lagergren, associate professor and senior lecturer in healthcare science1
  1. 1Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm SE-171 76, Sweden
  2. 2Division of Cancer Studies, King’s College London, UK
  1. Correspondence to: jesper.lagergren{at}
  • Accepted 28 October 2010

Summary points

  • The incidence of oesophageal adenocarcinoma has increased during the past few decades, particularly among white men in the UK

  • Oesophageal adenocarcinoma is associated with gastro-oesophageal reflux and obesity, whereas squamous cell carcinoma is associated with use of tobacco and alcohol

  • Diagnosis is confirmed by endoscopy with biopsies, precise tumour stage is defined by more sophisticated radiological examinations

  • A multidisciplinary approach is recommended in decision making and treatment

  • Curatively intended treatment usually includes chemotherapy or radiochemotherapy followed by extensive surgery

  • The overall prognosis for oesophageal cancer patients remains poor and several palliative options are available where cure is not possible

The incidence of oesophageal cancer is increasing. While the incidence of squamous cell carcinoma of the oesophagus has recently been stable or declined in Western societies, the incidence of oesophageal adenocarcinoma has risen more rapidly than that of any other cancer in many countries since the 1970s, particularly among white men.1 The UK has the highest reported incidence worldwide, for reasons yet unknown.2 Overall, the prognosis for patients diagnosed with oesophageal cancer is poor, but those whose tumours are detected at an early stage have a good chance of survival. We outline strategies for prevention and describe presenting features of oesophageal cancer to assist generalists in diagnosing and referring patients early. Treatment is often highly invasive and alters patients’ quality of life. We review the evidence from large randomised clinical trials, meta-analyses, and large cohort and case-control studies (preferably those of population based design, since they carry a lower risk of selection bias).

Sources and selection criteria

We searched PubMed to identify peer reviewed original articles, meta-analyses, and reviews. Search terms were oesophageal cancer, cancer of the oesophagus, oesophageal adenocarcinoma, oesophageal squamous cell carcinoma, neoplasm and oesophagus, and oesophageal neoplasm. Only papers written in English were considered. We mainly included studies published during …

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