Oesophageal cancer is the thirteenth commonest cancer and the seventh leading cause of cancer death worldwide, killing about 500,000 people a year. Population five-year survival has improved but still rarely exceeds 20%. This review covers epidemiology, risk factors, prevention and management.
The central point for a reader outside the West is that the two histological types are diverging geographically. Oesophageal adenocarcinoma has risen rapidly over four decades in many Western countries, particularly among White men, while squamous-cell carcinoma has fallen there. In most other populations the opposite holds, and squamous-cell carcinoma remains the dominant form.
That matters for what you look for and in whom. Adenocarcinoma follows reflux, Barrett's oesophagus and obesity, and surveillance strategies are built around that pathway. Squamous-cell carcinoma follows tobacco, alcohol, hot beverages, poor nutrition and — in parts of Asia including India — chewing tobacco and areca nut. A patient presenting with dysphagia in Indian practice is more likely to have the histology that Western-derived surveillance pathways are not designed to catch.
- Dysphagia in an adult is an urgent endoscopy, not a trial of a proton pump inhibitor.
- Ask specifically about tobacco chewing, areca nut and alcohol — the squamous risk profile, not the reflux one.
- Barrett's surveillance addresses adenocarcinoma and does nothing for squamous-cell carcinoma.
- Five-year survival rarely above 20% is a reminder that almost all the gain available here is in earlier presentation, not in later-line therapy.
- India carries a substantial share of the global squamous burden, concentrated in the north-east and in tobacco-chewing populations.
Why it matters
Surveillance and risk-factor thinking imported from Western data targets the histology that is becoming less common in most of the world.
Don't overread it
This is a narrative review, not new data — it describes trends rather than reporting them.
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