Most of the esophageal cancers are squamous cell (SCC) or adenocarcinomas. Worldwide, the most common cause of esophageal cancer is squamous cell carcinoma (SCC), but the most common in the USA is adenocarcinoma.
While the incidence of SCC is decreasing in the United States, the incidence of adenocarcinoma arising due to increase Barrett’s esophagus in the rise.
As we have mentioned earlier, there are generally 2 most common types of esophageal cancer: Squamous cell carcinoma (SCC) and Adenocarcinoma:
Squamous cell carcinoma:
This is the most common type in the world especially in Asian countries and african americans. They typicalu occur in the upper two-thirds of the esophagus (middle and upper). The most common cause of squamous cell carcinoma include
Lifestyles/Diet – Smoking, Alcohol, Nitrite contaminate, hot liquid, pickled food.
Esophageal disease – Achalasia (Chagas), Plummer-Vinson Syndrome, Zenker diverticulum, Chronic Esophagitis injury from hot beverage
Polypoid exophytic: mass lesion most common, protrude to lumen need 2/3 obstruction to cause pain.
Infiltrative: cause thickening and rigidity of the wall and narrowing the wall
Ulcerative/Necrotizing/excavated: extend deeply possibly into aorta, respiratory tree etc.
Adenocarcinoma: (arise from glandular cells like columnar cells)
Most common type in the USA (more common in whites) and usually occur after 20 years of GERD. Occurs in the Lower esophagus associated with Barrett Esophagus and Dysplasia. The most common causes of Adenocarcinoma of esophagus include the following
Chronic GERD causing metaplasia of cells near the gastroesophageal junction (GEJ) → Barrett’s Esophagus develops which is a precancerous lesion → dysplasia occurs and columnar cells transform into esophageal Carcinoma (Adenocarcinoma type);
Fatty diet in the western world and obesity are strong risk factors for adenocarcinoma development.
Other risk factors common to squamous cell carcinoma include: smoking, alcohol (although the cause of esophageal adenocarcinoma due to alcohol has raised controversy, it is best advised to avoid alcohol.
The same 3 pattern of tumor is present in adenocarcinoma like quamous cell carcinoma (SCC).