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Oesophageal cancer

There are two types of cancer of the oesophagus; Squamous Cell Carcinoma (SCC) and Oesophageal Adenocarcinoma (OAC).

Squamous Cell Carcinomas are more prevalent in Asian countries whilst Oesophagel Adenocarcinomas are more prevalent in UK, Europe and America.

SCC is more likely to be found in the upper oesophagus and is heavily linked to drinking and smoking. Rates of SCC are remaining static.
OAC is more likely to be found in the lower oesophagus and is heavily linked to acid reflux and Barrett's Oesophagus. Rates of OAC are rising rapidly.

In UK, OAC is the 13th most commonly identified cancer, more common in men in whom it's the 8th most common cancer.

Deaths from oesophageal cancer in UK, however, are disproportionately higher with it being the fifth most common cancer killer amongst men and 7th amongst women accounting for one person an hour on average with mortality rates having increased by 65% in the last 40 years.

Treatment for Oesophageal cancer depends upon its stage at discovery.

Staging of Oesophageal Cancer.

Cross section of the Oesophagus showing cancer stages T1, T2, T3
(image courtesy of Cancer Research UK)

Cancers are staged using TNM codes as described below. T refers to the stage of the primary Tumour, N refers to Lymph Nodes and M to metastasis (ie whether it's spread to other organs).
Primary Tumour (T)
 TX Primary turmour cannot be assessed 
 T0 No evidence of primary tumour
 Tis High Grade Dysplasia  ("Tumour in situ")
 T1 Tumour has grown no further than the layer of supportive tissue
 T1a Tumour invades lamina propria or muscularis mucosae (ie the upper layers)
 T1b Tumour invades submucosa (ie the lower layer)
 T2 Tumour has grown into the muscle layer of the wall of the oesophagus
 T3 Tumour has grown into the membrane covering the outside of the oesophagus
 T4 Tumour invades adjacent structures
 T4a Cancer has grown into the tissue covering the lungs (pleura), the outer covering of the heart (pericardium), or  the muscle at the bottom of the rib cage (diaphragm)
 T4b Cancer has spread into other nearby structures such as the windpipe (trachea), a spinal bone (vertebra) or a  major blood vessel (the aorta)

Carcinoma in situ / High Grade Dysplasia

("High grade dysplasia" includes all noninvasive neoplastic epithelia that was formerly called "carcinoma in situ", a diagnosis that is no longer used for columnar mucosae in the gastrointestinal tract.)
N.B. Carcinoma in Situ is not cancer but has a high risk of becoming cancerous.

Regional Lymph Nodes (N)                                                Distant metastasis (M)
 NX Regional lymph node(s) cannot be assessed  
 N0 No cancer cells in nearby lymph nodess M0 No cancer in other parts of the body
 N1 Cancer cells in 1-2 nearby lymph nodes M1 Cancer has spread to other parts of the body
 N2 Cancer cells in 3-6 nearby lymph nodes  
 N3 Cancer cells in 7 or more nearby lymph nodes  

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