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Review
. 2025 Aug;40(8):1861-1875.
doi: 10.1111/jgh.16990. Epub 2025 Jun 24.

Carcinoma of Esophagus

Joseph Sung  1 , Dongxin Lin  2 , Rebecca Fitzgerald  3 , Prateek Sharma  4 , Simon Law  5 , David Ilson  6   7
Affiliations
Review

Carcinoma of Esophagus

Joseph Sung et al. J Gastroenterol Hepatol. 2025 Aug.

Abstract

Carcinoma of esophagus is one of the most common cancer worldwide, but its epidemiology is changing. Squamous cell carcinoma is declining in the East, but adenocarcinoma is rising in the West, probably related to the pandemic of obesity and changing lifestyle. Screening of esophageal cancer (both endoscopic and nonendoscopic methods) is recommended in patients suffering from long-term acid reflux symptoms associated with high-risk factors and surveillance in patients with Barrett's esophagus. Endoscopy with virtual chromoendoscopy, endoscopic ultrasound, and CT scan is essential for diagnosis and staging of the disease. Endoscopic therapy can be used to treat early diseases. Surgery remains a mainstay treatment. Multimodality treatment strategies involving combinations of chemotherapy, radiotherapy, and more recently immunotherapy and target therapies are gaining momentum.

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Conflict of interest statement

D.I. reports consultancy for AMGEN, Bayer, Lilly, Roche, Astra‐Zeneca, Bristol Myers Squibb, Astellas, Merck, Daiichi Sankyo, and Taiho as well as research funding from Taiho, Astellas; is supported by Memorial Sloan Kettering Cancer Center Support Grant (Core Grant P30 CA008748). P.S. reports consultancy for Olympus Corporation, Boston Scientific, Salix Pharmaceuticals, Cipla, Medtronic, Takeda, Samsung Bioepis, and CDx as well as research funding from ERBE and Fujifilm. R.F. receives research fundings from Roche, Medtronic and Astra Zeneca; has filed a patent of The Cytosponge technology (device and associated assays) and licensed by the Medical Research Council to Covidien (now Medtronic); is supported by the Medical Research Council (MR/W014122/1, G111260) and the Cancer Research UK–funded Experimental Cancer Medicine Center; is co‐founder and shareholder in Cyted Ltd < 3% with no paid role and board role in the company. J.S. was the former editor‐in‐chief of JGH and a co‐author of this article. To minimize bias, he was excluded from all editorial decision‐making related to the acceptance of this article for publication. The other authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Multiple stage development of two subtypes of esophageal cancer, ESC (squamous cell carcinoma, upper panel), and EAC (adenocarcinoma, lower panel), from normal esophagus. ESC and EAC have their specific risk factors and genomic alterations, but share some of these factors and alterations.
FIGURE 2
FIGURE 2
Nonendoscopic capsule sponge‐TFF3 test and inflatable balloon capsule for Barrett's esophagus. (A) Capsule on a thread is swallowed; after 7–8 min in the stomach, the capsule dissolves and the sponge is released, which can be drawn back out through the mouth. (B) Inflated balloon capsule. (C) Cells from the retrieved sponge are processed to a pseudo‐biopsy and stained for TFF3 a specific IM marker.
FIGURE 3
FIGURE 3
Esophagogastroduodenoscopy (EGD) image that shows a large exophytic, ulcerated lesion at 44 cm from the incisors measuring 2.5 cm extending to the gastroesophageal junction (GEJ).
FIGURE 4
FIGURE 4
This image depicts a narrow band imaging (NBI) of the distal esophagus, which shows a 2‐cm lesion (red arrows) arising within a background of Barrett's mucosa (yellow arrows). The histological analysis revealed poorly differentiated adenocarcinoma.
FIGURE 5
FIGURE 5
Cross‐sectional imaging (CT scan) showing large peri gastric lymph nodes measuring 2–2.5 cm in the setting of esophageal cancer.
FIGURE 6
FIGURE 6
Endoscopic ultrasound (EUS) for esophageal cancers. (A) Image showing a 2.8 × 2.4‐cm hypoechoic mass (yellow arrows) arising from mucosa and extending to the submucosa (layer 3) without extension to muscularis propria (layer 4). (B) EUS image with lymph nodes—this image shows two lesions that are hypoechoic, with sharply demarcated borders and rounded contours (yellow arrows). These lesions were consistent with malignant‐appearing lymph nodes per EUS criteria.
FIGURE 7
FIGURE 7
Management for locally advanced esophageal cancer.
See this image and copyright information in PMC

References

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