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Oesophageal cancer and Barrett's oesophagus
Oesophageal cancer comes in two types — squamous in the upper and middle oesophagus (smoking and alcohol) and adenocarcinoma in the lower oesophagus (reflux, Barrett's and obesity); a superficial tumour is treated endoscopically, and a locally advanced one with treatment before surgery followed by oesophagectomy.
Why it matters in the exam
The exam first asks about risk factors and site: squamous cancer in the upper and middle oesophagus, with smoking, alcohol, achalasia and caustic ingestion; adenocarcinoma in the lower oesophagus, with long-standing reflux, Barrett's and obesity — and it is now the more common type in the West. The typical presentation is progressive dysphagia, first to solids, with weight loss, and sometimes hoarseness when the tumour involves the recurrent nerve.
The second topic is Barrett's: endoscopic surveillance according to the degree of dysplasia, and endoscopic treatment (resection of a visible lesion and radiofrequency ablation) for high-grade dysplasia or intramucosal cancer. For a diagnosed tumour, CT, PET-CT and EUS define depth and nodes. A superficial tumour (T1a) is treated by endoscopic resection; a locally advanced tumour is treated by chemoradiation before surgery (or peri-operative chemotherapy) and then oesophagectomy; for squamous cancer of the cervical oesophagus definitive chemoradiation is the main treatment. Candidates are also asked about complications of oesophagectomy: anastomotic leak, chylothorax and recurrent nerve injury.
Key points
- Squamous — upper and middle, smoking and alcohol; adenocarcinoma — lower, reflux, Barrett's and obesity.
- Barrett's without dysplasia — surveillance every 3–5 years; high-grade dysplasia — endoscopic treatment.
- Staging: CT, PET-CT and EUS.
- T1a — endoscopic resection; locally advanced — treatment before surgery and oesophagectomy.
- Complications after resection: leak, chylothorax, recurrent nerve injury.
Summary table
| Situation | Finding | Treatment |
|---|---|---|
| Barrett's without dysplasia | Columnar epithelium above the gastro-oesophageal junction | PPI and endoscopic surveillance every 3–5 years |
| Barrett's with low-grade dysplasia | Confirmed by a second pathologist | Endoscopic treatment (radiofrequency ablation) or surveillance every 6–12 months |
| High-grade dysplasia or T1a tumour | Confined to the mucosa | Endoscopic resection of a visible lesion and ablation of the remaining Barrett's |
| Locally advanced tumour (T2 or higher or positive nodes) | CT, PET-CT and EUS | Chemoradiation before surgery or peri-operative chemotherapy, then oesophagectomy |
| Squamous cancer of the cervical oesophagus | Close to the pharynx | Definitive chemoradiation instead of surgery |
| Metastatic disease | Distant metastases | Systemic therapy and a stent to relieve dysphagia |
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Sources
- ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus, 2022 — Surveillance intervals and endoscopic eradication
- ESMO Clinical Practice Guidelines: Oesophageal cancer, 2022 — Staging and multimodal treatment
- Sabiston Textbook of Surgery, 21st edition (2022) — Esophagus
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.