Oesophageal tumours
How the squamous lining of the oesophagus gives rise to squamous cell carcinoma and Barrett metaplasia to adenocarcinoma, why these cancers narrow the gullet, invade the mediastinum and reach nodes early, and the benign tumours of its wall.
By the end, you can
- Describe the structure of the oesophageal wall and its lymphatic drainage, and relate them to how tumours spread.
- Compare squamous cell carcinoma and adenocarcinoma: precursors, sites, risk factors and microscopic appearance.
- Explain the sequence from reflux through Barrett metaplasia and dysplasia to adenocarcinoma.
- Relate progressive dysphagia, hoarseness, cough on swallowing and weight loss to growth and invasion.
- Explain what the stage of an oesophageal cancer measures and why depth matters so much.
- Recognise the classic appearances, staging tests and site rules of oesophageal cancer, and explain how endoscopic resection, oesophagectomy, chemoradiotherapy and stents act on it.
What it is
Oesophageal tumours are neoplasms of the oesophageal wall. Most are malignant: squamous cell carcinoma, from the squamous lining, and adenocarcinoma, which arises in the lower oesophagus from Barrett oesophagus (columnar metaplasia). Benign tumours are uncommon; the commonest is leiomyoma, a smooth muscle tumour of the muscle wall.
3 types to tell apart
- Squamous cell carcinoma
- From the squamous lining through squamous dysplasia, mostly in the middle third; linked to tobacco, alcohol and other surface injury; the commonest type worldwide.
- Adenocarcinoma
- From Barrett metaplasia through glandular dysplasia, in the lower third and at the gastro-oesophageal junction; linked to reflux and obesity; predominant in many Western countries.
- Benign tumours
- Leiomyoma (smooth muscle, within the wall), squamous papilloma (on the surface) and granular cell tumour (under the mucosa) are the main ones.
US spelling: oesophageal → esophageal, tumours → tumors, oesophagus → esophagus, tumour → tumor, coeliac → celiac.
Normal function
A squamous-lined tube with no serosa
The is a muscular tube about 25 cm long that carries food from the pharynx, behind the and the , through the of the diaphragm to the stomach. Its wall has a mucosa, a submucosa with mucous glands, a muscularis propria (skeletal muscle above, smooth muscle below) and, for most of its length, no serosa: only a loose outer adventitia.
The lining is non-keratinised stratified squamous epithelium, renewed from its basal cells and built to resist friction, not acid. At the gastro-oesophageal junction it meets the columnar lining of the stomach.
Lymphatics run in the lamina propria and submucosa, and many run lengthways along the tube. Lymph from the upper oesophagus drains to nodes in the neck, from the middle part to mediastinal nodes and from the lower part to nodes around the stomach and the coeliac trunk.
Underlying change · Step 1 of 5
Benign tumours of the wall
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Underlying change · Step 2 of 5
Squamous cell carcinoma: injury from the lumen
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Underlying change · Step 3 of 5
Adenocarcinoma: from reflux through Barrett oesophagus
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 4 of 5
Narrowing, invasion of the mediastinum and early spread
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 5 of 5
Depth, grade and the effects on the body
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 5 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .