Oesophagus Neoplasms

Oesophageal Neoplasms

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | Referral

Definition

Oesophageal neoplasms are abnormal growths in the oesophagus, most commonly presenting as oesophageal cancer, which can be either squamous cell carcinoma (SCC) or adenocarcinoma.

Aetiology

Oesophageal neoplasms are classified into:

  • Squamous cell carcinoma (SCC): this affects the upper/mid aspect of the oesophagus.
  • Adenocarcinoma: affects in the lower oesophagus (linked to Barrett’s oesophagus).
  • Benign tumours: rare, usually leiomyomas.

Pathophysiology

  • Chronic irritation > metaplasia > dysplasia > malignant transformation.
  • SCC arises from squamous epithelium, often due to smoking and alcohol.
  • Adenocarcinoma > from Barrett’s oesophagus (intestinal metaplasia due to acid reflux).
  • Tumour progression > dysphagia, weight loss, and potential metastasis.

Risk factors

  • Squamous Cell Carcinoma:
    • Smoking.
    • Excessive alcohol consumption.
    • Achalasia (poor movement of food/liquid through oesophagus).
    • Plummer-Vinson syndrome (rare condition linked to iron deficiency > swallowing difficulty).
    • Diet low in fruits and vegetables.
  • Adenocarcinoma:
    • Gastro-oesophageal reflux disease (GORD).
    • Barrett’s oesophagus.
    • Obesity.
    • Male sex.

Signs and symptoms

  • Progressive dysphagia: first for solids > later liquids.
  • Unintentional weight loss.
  • Odynophagia (painful swallowing).
  • Regurgitation and food sticking in the oesophagus.
  • Hoarseness: due to recurrent laryngeal nerve involvement.
  • Chronic cough: if tracheo-oesophageal fistula develops.

Investigations

  • Upper GI endoscopy (gold standard): for direct visualisation and biopsy.
  • CT thorax/abdomen: for staging and assessing local spread.
  • Endoscopic ultrasound (EUS): it determines tumour depth and lymph node involvement.
  • PET-CT scan: it assesses distant metastases.
  • Barium swallow: might show narrowing but is less commonly used.

Management (done by specialist but you should be aware of)

1. Early-Stage Disease:

  • Endoscopic resection: for T1 lesions confined to the mucosa.
  • Oesophagectomy: surgical removal of the oesophagus with gastric pull-up.

2. Locally Advanced Disease:

  • Neoadjuvant chemoradiotherapy: used before surgery to shrink tumours.
  • Surgical resection: if operable.
  • Palliative stenting: if non-resectable disease causes dysphagia.

3. Metastatic Disease:

  • Palliative chemotherapy: improves survival but is not curative.
  • Radiotherapy: for symptom control in advanced cases.
  • Supportive care: nutritional support, pain management, and speech therapy.

Referral

  • Urgent 2-week wait referral: if patient reports dysphagia or other red-flag symptoms.
  • Gastroenterology referral: for suspected Barrett’s oesophagus and surveillance (genearlly done after endoscopy).
  • Oncology referral: for staging and treatment planning.
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