# Oesophageal squamous cell carcinoma

Source: https://onco.cc/cancers/oesophageal-squamous-cell-carcinoma/  
OnCo record `oesophageal-squamous-cell-carcinoma` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Squamous cell carcinoma of the oesophagus, the world's commonest form, is linked to smoking, alcohol and very hot drinks and sits in the upper and middle gullet. It is treated with chemoradiation, with or without surgery, and immunotherapy has recently joined chemotherapy for advanced disease.

## Summary

Oesophageal squamous cell carcinoma arises from the squamous lining of the upper and middle oesophagus; tobacco, alcohol, scalding drinks, nutritional deficiency and achalasia are its causes, and TP53 and NOTCH1 mutations its genetics. Early lesions found by endoscopy, common in Japanese and Chinese screening programmes, are removed endoscopically. Locally advanced disease is treated either with neoadjuvant chemoradiation followed by surgery (CROSS) or with definitive chemoradiation alone, which cures a similar share in this histology; adjuvant nivolumab after chemoradiation and surgery lowers recurrence when residual disease remains (CheckMate 577). Advanced disease is treated with nivolumab plus chemotherapy or nivolumab plus ipilimumab (CheckMate 648) or pembrolizumab plus chemotherapy (KEYNOTE-590); Chinese trials with camrelizumab, tislelizumab, toripalimab and sintilimab have produced the same result.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: Esophageal squamous cell carcinoma; ESCC; Oesophageal SCC
- Tags: subtype-page
- Group: gastrointestinal
- Burden: About 85 percent of oesophageal cancers worldwide and the dominant type across the Asian oesophageal cancer belt, East Africa and South America; in high-income countries it is now outnumbered by adenocarcinoma, and five-year survival is around 20 percent overall.
- Subtypes: Upper and middle third squamous cell carcinoma; Early (T1a) squamous cell carcinoma (endoscopic resection); Locally advanced (chemoradiation with or without surgery); Metastatic (immunotherapy plus chemotherapy)
- Biomarkers: PD-L1 combined positive score or tumour proportion score; TP53 and NOTCH1 mutations; Endoscopic Lugol staining for early lesions; Pathological response after chemoradiation

## Standard of care

- Early (T1a): Endoscopic submucosal dissection; oesophagectomy or chemoradiation if deeper invasion is found. ([Endoscopic resection (EMR / ESD)](https://onco.cc/technologies/endoscopic-resection/))
- Locally advanced: Neoadjuvant carboplatin-paclitaxel chemoradiation and surgery (CROSS), or definitive cisplatin-fluorouracil chemoradiation with surgery reserved for persistent disease; adjuvant nivolumab after incomplete response (CheckMate 577). ([CROSS](https://onco.cc/trials/cross-trial/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [CheckMate 577](https://onco.cc/trials/checkmate-577/))
- Metastatic, first line: Nivolumab plus chemotherapy or nivolumab plus ipilimumab (CheckMate 648), or pembrolizumab plus chemotherapy (KEYNOTE-590). ([Nivolumab](https://onco.cc/drugs/nivolumab/), [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [CheckMate 648](https://onco.cc/trials/checkmate-648/), [KEYNOTE-590](https://onco.cc/trials/keynote-590/))
- Prevention and screening: Smoking cessation, alcohol reduction, avoiding very hot drinks; endoscopic screening in high-incidence regions of China. ([Smoking cessation in cancer patients](https://onco.cc/technologies/smoking-cessation-after-diagnosis/), [Alcohol reduction, pricing and cancer warning labels](https://onco.cc/technologies/alcohol-reduction-labelling/))

## State of the art

- Immunotherapy added to chemotherapy improved survival in every first-line trial, including several run entirely in China.
- Organ preservation with definitive chemoradiation and surveillance is an accepted alternative to surgery in this histology.
- Endoscopic screening in China detects a large share of cancers at a curable stage.

## Open problems

- Whether surgery can be omitted after a complete response to chemoradiation.
- Most cases worldwide present late without access to endoscopy.
- Nutrition, swallowing and quality of life during and after treatment.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Esophageal_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Esophageal_cancer

## Connected records

- trials: [CheckMate 577](https://onco.cc/trials/checkmate-577/), [CheckMate 648](https://onco.cc/trials/checkmate-648/), [CROSS](https://onco.cc/trials/cross-trial/), [KEYNOTE-590](https://onco.cc/trials/keynote-590/)
- drugs: [Carboplatin](https://onco.cc/drugs/carboplatin/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Tislelizumab](https://onco.cc/drugs/tislelizumab/)
- technologies: [Alcohol reduction, pricing and cancer warning labels](https://onco.cc/technologies/alcohol-reduction-labelling/), [Endoscopic resection (EMR / ESD)](https://onco.cc/technologies/endoscopic-resection/), [Smoking cessation in cancer patients](https://onco.cc/technologies/smoking-cessation-after-diagnosis/)
- cancers: [Oesophageal cancer](https://onco.cc/cancers/esophageal/)

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