Synopsis
Contrast squamous carcinoma with adenocarcinoma by site and risk, obtain tissue and complete stage, and choose curative or palliative treatment through the specialist oesophago-gastric team.
- Squamous carcinoma predominates in the upper and mid oesophagus and is associated with tobacco, alcohol, chronic mucosal injury and some nutritional exposures.
- Adenocarcinoma usually arises distally or at the junction, commonly through Barrett metaplasia linked to reflux, central adiposity and smoking.
- Histology matters because tumour distribution, nodal fields and the balance between surgery and definitive chemoradiotherapy differ.
Key red flags
Progressive dysphagia and weight loss require urgent endoscopy even when long-standing reflux or alcohol exposure offers a familiar benign explanation.
Cough with swallowing, recurrent pneumonia or airway symptoms can indicate aspiration or a malignant fistula and needs urgent cross-sectional and endoscopic planning.
Cough on swallowing, haemoptysis, hoarseness or recurrent pneumonia can signal invasion or fistulation.
Investigation priorities
Locate the tumour, assess obstruction and establish histology.
Management branches
Biopsy confirms distal oesophageal adenocarcinoma and CT shows no metastases in a fit patient.
- Complete PET-CT and selective EUS according to the specialist staging question.
- Review histology, junctional classification, nutrition, cardiopulmonary reserve and frailty at the MDT.