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Practice Clinical updates

Oesophageal cancer: risks, prevention, and diagnosis

BMJ 2019; 366 doi: (Published 09 July 2019) Cite this as: BMJ 2019;366:l4373
  1. Sri G Thrumurthy, specialist registrar1 2,
  2. M Asif Chaudry, consultant surgeon2,
  3. Sasha S D Thrumurthy, specialist registrar3,
  4. Muntzer Mughal, honorary clinical professor4
  1. 1Department of Surgery, Epsom and St Helier University Hospitals, Sutton SM5 1AA, UK
  2. 2Department of Surgery, Royal Marsden Hospital, London SW3 6JJ, UK
  3. 3Department of Gastroenterology, Tan Tock Seng Hospital, Singapore
  4. 4Department of Surgery, University College Hospital London, London, UK
  1. Correspondence to: S G Thrumurthy sri.thrumurthy{at}

What you need to know

  • Incidence of oesophageal cancer continues to increase in developed countries

  • Men are more than twice as likely to be affected than women

  • The two main histological subtypes are adenocarcinoma (linked to obesity and gastro-oesophageal reflux) and squamous cell carcinoma (linked to alcohol and tobacco use)

  • Reflux is common in early disease; dysphagia and odynophagia are common in locally advanced or late disease

  • The optimal investigation is upper gastrointestinal endoscopy with biopsy of suspicious tissue

Oesophageal cancer is currently the sixth commonest source of cancer-associated death across the world: 572 034 new cases and 508 585 mortalities were reported in 2018.1 Global disease incidence has increased significantly in the past four decades.23 Recent data from the World Health Organization suggest that age-standardised incidence is higher across eastern Asia than any other region, but the UK continues to harbour the highest incidence among individual countries.1 In this review, “oesophageal cancer” refers to adenocarcinoma of the oesophagus and that of the gastro-oesophageal junction, because their pathophysiological and clinical similarities allow them to be staged and managed as similar entities (gastric cancer is staged differently).4

Over the past decade, the increased uptake of early referral schemes across the UK, North America, and Western Europe has improved detection of early stage, curable disease.567 Coupled with novel endoscopic therapies and perioperative treatment strategies, overall survival rates have also improved.8

This review aims to guide generalists through the referral and early diagnosis processes of oesophageal cancer, as well as highlighting risk and current preventive strategies.

What is oesophageal cancer?

Oesophageal cancer refers to tumours originating from the oesophageal mucosa that may progress locally to involve the underlying submucosa and muscular layer, eventually invading adjacent structures such as the tracheobronchial tree, recurrent laryngeal nerve, thoracic aorta, or diaphragm (fig 1).

Fig 1

Layers of the oesophageal …

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