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Oesophageal cancer is really two diseases sharing one organ: squamous cell carcinoma, which dominates in Asia, and adenocarcinoma, which dominates in the West and is treated like gastric cancer. Immunotherapy is now standard, and the bispecific ADC iza-bren posted a positive phase 3 in the squamous type in 2026.
Oesophageal cancer is two diseases: squamous cell carcinoma (ESCC, ~85% globally, driven by tobacco, alcohol, hot beverages, and nutritional factors along a belt from Iran through Central Asia to China) and adenocarcinoma (EAC, dominant in the West, arising from Barrett's oesophagus through reflux and obesity). Japan and parts of China screen high-risk populations endoscopically and cure early squamous cancers with endoscopic resection; elsewhere most patients present with dysphagia and locally advanced or metastatic disease. It causes about 510,000 new cases a year (the seventh most common cancer) and, because of late presentation, 445,000 deaths (sixth among cancers); five-year survival is about 20% overall.
Localised disease is treated with multimodality therapy. CROSS chemoradiation followed by oesophagectomy gives 10-year survival of 38% versus 25% for surgery alone; perioperative FLOT is the alternative for adenocarcinoma (ESOPEC favoured it). Definitive chemoradiation is used for cervical tumours and unfit patients. CheckMate 577 added a year of adjuvant nivolumab for residual disease after chemoradiation (DFS 22.4 vs 11.0 months), and SANO showed that patients with a clinical complete response can be watched rather than operated on with non-inferior survival. Advanced disease is treated with chemotherapy plus PD-1 blockade: pembrolizumab (KEYNOTE-590, both histologies), nivolumab ± ipilimumab (CheckMate 648, squamous), tislelizumab (RATIONALE-306, squamous PD-L1 ≥1%), and camrelizumab or sintilimab in China. HER2-positive adenocarcinoma follows the gastric pathway (trastuzumab, zanidatamab after HERIZON-GEA-01, T-DXd second line). In 2026 the EGFR×HER3 bispecific ADC izalontamab brengitecan became the first agent to improve overall survival in second-line ESCC after immunotherapy (PANKU-Esophagus01).
Open fronts: whether PD-1 blockade added to definitive chemoradiation raises cure rates (KEYNOTE-975, SKYSCRAPER-07 and Chinese trials), how far organ preservation can be pushed, non-endoscopic screening for Barrett's (BEST4), the absence of targets in squamous disease beyond PD-1 and now EGFR/HER3, and the persistent gap between Asian and Western outcomes that early detection explains.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
~510,000 cases per year; ~85% squamous cell carcinoma globally, adenocarcinoma dominant in North America, Western Europe, and Australia. Endoscopic screening, where it exists, cures most early disease.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Squamous cancers sit in the upper and middle oesophagus, adenocarcinomas at the junction and in the stomach; the stomach wall also gives rise to GIST from its pacemaker cells.
Same organ: Gastric & gastro-oesophageal junction cancer, HER2-positive gastric cancer, Claudin 18.2-positive gastric cancer, PD-L1-high gastric cancer, Microsatellite-unstable (MSI-high) gastric cancer, Early gastric cancer, Oesophageal squamous cell carcinoma, Oesophageal and junctional adenocarcinoma, Gastrointestinal stromal tumour (GIST), KIT exon 11-mutant GIST, PDGFRA D842V-mutant GIST, Imatinib-resistant GIST
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
What helpsChemotherapy plus PD-1 blockade first line, HER2-directed drugs for adenocarcinoma, and the bispecific ADC iza-bren, the first to improve survival after immunotherapy in squamous disease.
Nothing recorded yet.
Also on OnCo: Atlas of advanced disease · How cancer spreads: the metastasis stages.
Background: Barrett's oesophagus. Also on OnCo: Symptoms and red flags · Early detection roadmap.
Neoadjuvant chemoradiation (CROSS) or perioperative FLOT → surgery → nivolumab if residual disease.
Chemotherapy + pembrolizumab/nivolumab; iza-bren in trials.
Tobacco and alcohol control; endoscopic screening of high-risk populations in China and Japan (Lugol chromoendoscopy); surveillance of Barrett's oesophagus with ablation or resection of dysplasia; non-endoscopic capsule-sponge screening in trials (BEST4).
Endoscopic resection (EMR/ESD) with radiofrequency ablation of residual Barrett's; oesophagectomy for T1b with high-risk features.
CROSS chemoradiation (carboplatin/paclitaxel + 41.4 Gy) then oesophagectomy for squamous and adenocarcinoma; perioperative FLOT for adenocarcinoma/GEJ (ESOPEC). Adjuvant nivolumab for residual disease after chemoradiation (CheckMate 577).
Active surveillance with surgery on regrowth is a non-inferior option (SANO); requires intensive endoscopic and PET surveillance.
Definitive chemoradiation (50-50.4 Gy with cisplatin/5-FU or carboplatin/paclitaxel); PD-1 blockade added in trials.
Chemotherapy + pembrolizumab (KEYNOTE-590), nivolumab (CheckMate 648), or tislelizumab (RATIONALE-306, PD-L1 ≥1%); nivolumab + ipilimumab chemotherapy-free option; camrelizumab/sintilimab/toripalimab in China.
As for gastric cancer: chemotherapy + pembrolizumab or nivolumab (PD-L1 CPS ≥5 or ≥1); trastuzumab-based therapy if HER2-positive; zolbetuximab if CLDN18.2-positive (GEJ eligible in SPOTLIGHT/GLOW).
Izalontamab brengitecan after PD-(L)1 + platinum (PANKU-Esophagus01, OS and PFS benefit, 2026; approval pending); otherwise taxane or irinotecan; nivolumab/pembrolizumab if IO-naive.
T-DXd if HER2-positive (DESTINY-Gastric04); ramucirumab + paclitaxel; CLDN18.2 ADC after CLARITY-Gastric 01.
Self-expanding metal stent, brachytherapy, or external beam radiation; nutritional support; early palliative care.
Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Sudden severe abdominal pain, a hard or very tender abdomen, or abdominal pain with vomiting and fever. Boxed warning for gastrointestinal perforation on bevacizumab.
Temperature of 38 C or higher, or feeling shivery and unwell even without a fever. Antibody-drug conjugates suppress the bone marrow, and several carry a boxed warning for severe neutropenia.
Any new or worsening cough, breathlessness or fever. The label says to interrupt treatment for any suspected ILD and to permanently discontinue for grade 2 or higher.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
See all on the product pages:CamrelizumabFLOT (5-FU, leucovorin, oxaliplatin, docetaxel)IpilimumabIzalontamab brengitecanNivolumabPembrolizumabRamucirumabTislelizumabTrastuzumab deruxtecan·Printable cards in the navigator
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