Oesophageal cancer: risks, prevention, and diagnosis

### What you need to know Oesophageal cancer is currently the sixth commonest source of cancer-associated death across the world: 572 034 new cases and 508 585 mortalities were reported in 2018.1 Global disease incidence has increased significantly in the past four decades.23 Recent data from the World Health Organization suggest that age-standardised incidence is higher across eastern Asia than any other region, but the UK continues to harbour the highest incidence among individual countries.1 In this review, “oesophageal cancer” refers to adenocarcinoma of the oesophagus and that of the gastro-oesophageal junction, because their pathophysiological and clinical similarities allow them to be staged and managed as similar entities (gastric cancer is staged differently).4 Over the past decade, the increased uptake of early referral schemes across the UK, North America, and Western Europe has improved detection of early stage, curable disease.567 Coupled with novel endoscopic therapies and perioperative treatment strategies, overall survival rates have also improved.8 This review aims to guide generalists through the referral and early diagnosis processes of oesophageal cancer, as well as highlighting risk and current preventive strategies. Oesophageal cancer refers to tumours originating from the oesophageal mucosa that may progress locally to involve the underlying submucosa and muscular layer, eventually invading adjacent structures such as the tracheobronchial tree, recurrent laryngeal nerve, thoracic aorta, or diaphragm (fig 1). Fig 1 Layers of the oesophageal …