Oesophageal squamous cell carcinoma
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.
Overview
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.
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.
Anatomy and lymph node drainage
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.
- Upper and middle oesophagus (squamous)Upper and middle third squamous cell carcinoma · Early (T1a) squamous cell carcinoma (endoscopic resection)
- Lower oesophagus and junction (adenocarcinoma)
- Cardia and fundus
- Body (diffuse or intestinal type)Upper and middle third squamous cell carcinoma · Early (T1a) squamous cell carcinoma (endoscopic resection)
- Antrum and pylorus
- Muscle wall (GIST)
- perigastric (greater and lesser curve)
- coeliac and hepatic
- mediastinal
- cervical (upper oesophagus)
Same organ: Gastric & gastro-oesophageal junction cancer, Oesophageal and junctional adenocarcinoma, Oesophageal cancer, Gastrointestinal stromal tumour (GIST)
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 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.
- AI in radiologyEstablished
- cfDNA fragmentomicsEstablished
- Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)Standard of care
- DNA methylation profilingEstablished
- HCC surveillance in cirrhosis (ultrasound + AFP)Standard of care
- High-risk pancreatic surveillance (CAPS / PRECEDE)Established
- A 28-day national pathway for people with a positive multi-cancer blood test
- A breath test to rule out cancer in people with vague symptoms
- A cancer blood test for older people arriving at A&E with unexplained symptoms
- A legislated, publicly reported 28-day standard from urgent referral to diagnosis
- A live national dashboard of stage at diagnosis as the scorecard for early detection
- A single 'cancer check at 60' appointment bundling all screening tests
Background: Alpha-fetoprotein (AFP), Barrett's oesophagus, CA 19-9, Early detection, Faecal immunochemical test (FIT). Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
Endoscopic submucosal dissection; oesophagectomy or chemoradiation if deeper invasion is found.
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).
Nivolumab plus chemotherapy or nivolumab plus ipilimumab (CheckMate 648), or pembrolizumab plus chemotherapy (KEYNOTE-590).
Smoking cessation, alcohol reduction, avoiding very hot drinks; endoscopic screening in high-incidence regions of China.
Subtypes & biomarkers
top- 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)
How often this target appears
- 1992RTOG 85-01: chemoradiation beats radiotherapy alone
- 2012CROSS: chemoradiation before surgery doubles survival
- 2021CheckMate 577 and KEYNOTE-590 bring immunotherapy to oesophageal cancer
- 2022CheckMate 648: nivolumab combinations first line
What is in development for Oesophageal squamous cell carcinoma, drawn from the whole corpus: 0 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Nothing recorded in development for this cancer yet.
Open problems and what is being done
Whether surgery can be omitted after a complete response to chemoradiation.
Most cases worldwide present late without access to endoscopy.
and how the field plans to fix it →What is being done about thisCost and accessAvailable now- Alcohol reduction, pricing and cancer warning labelsEstablished
- HPV & HBV vaccinationStandard of care
- ImatinibApproved
- Trastuzumab biosimilarsApproved
In trials- Gefitinib vs gefitinib plus pemetrexed-carboplatin in EGFR-mutant lung cancer (Tata Memorial)Positive
- IARC India HPV vaccine dose study (one, two or three doses)Positive
- IMAGINE (varnimcabtagene autoleucel, Immuneel)Positive
- Low-dose nivolumab plus metronomic chemotherapy (Tata Memorial)Positive
- Low-dose olanzapine for cancer anorexia (Tata Memorial)Positive
- METRO PLUS (Tata Memorial Centre, Varanasi)Positive
Ideas and roadmaps- 90-day reliance approval for cancer drugs cleared by two stringent regulators
- A cheap old tablet to restore appetite
- A combination pricing rule so two-drug regimens are not priced as two monopolies
- A coordinated reserve and shared schedule for the world's medical isotope reactors
- A dedicated global financing window for cancer, modelled on the Global Fund
- A delinked market-entry reward paid by payers when a repurposed generic wins approval
Background: Accelerated approval, Biosimilar, Real-world evidence. Also on OnCo: Financial help · Coverage by country · HTA decisions.
Nutrition, swallowing and quality of life during and after treatment.
and how the field plans to fix it →What is being done about thisSide effects and quality of lifeAvailable now- Cardio-oncologyEstablished
- Exercise & lifestyle oncologyEstablished
- Geriatric assessmentEstablished
- IMRT / IGRT (modern external beam)Standard of care
- Oncology nutrition assessment and medical nutrition therapyEstablished
- Proton therapyEstablished
In trialsIdeas and roadmaps- A cheap old tablet to restore appetite
- A coordinated FLASH radiotherapy evidence programme with shared dose-rate standards
- A dedicated programme for cachexia and treatment toxicity research
- A dietitian in every gastrointestinal and head and neck tumour board
- A funded programme of organ-preservation trials to avoid radical surgery
- A lifelong late-effects registry linked to every treatment for adult survivors
Background: CTCAE toxicity grading (grade 3-4 adverse events), De-escalation, escalation and response-adapted therapy, Immune-related adverse events (irAEs), Quality of life, Toxicity grade. Also on OnCo: Side effects by symptom · Immune-related side effects · Toxicity compare · Survivorship planner.
Trials
topTrials recruiting now
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Landmark trials
Expert centres
topExpert centres
- Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer CenterBaltimore, USNewsweek oncology #10NCI comprehensivevia Pembrolizumab
- Alliance for Clinical Trials in OncologyChicago, IL, USvia Carboplatin, Pembrolizumab
- via Nivolumab, Ipilimumab
- via Nivolumab, Ipilimumab
- via Nivolumab, Ipilimumab
- via Nivolumab
- Cancer Research UKLondon, GBvia Alcohol reduction, pricing and cancer warning labels
- German Breast Group (GBG)Neu-Isenburg, DEvia Carboplatin
- German Hodgkin Study GroupCologne, DEvia Nivolumab
- GOG FoundationPhiladelphia, PA, USvia Pembrolizumab
- Indiana University Melvin and Bren Simon Comprehensive Cancer CenterIndianapolis, IN, USNCI comprehensivevia Cisplatin
- Institut Jules BordetBrussels, BEvia Pembrolizumab
- Institute of Oncology LjubljanaLjubljana, SIvia Carboplatin
- via Alcohol reduction, pricing and cancer warning labels
- Kyoto University HospitalKyoto, JPvia Nivolumab
- via Nivolumab
- via Pembrolizumab
- National Cancer Center Hospital EastKashiwa, Chiba, JPvia Nivolumab
- National Cancer Institute (NIH)Bethesda, MD, USvia Smoking cessation in cancer patients
- SWOG Cancer Research NetworkPortland, OR, USvia Nivolumab
Questions to ask
topQuestions to ask your oncologist about Oesophageal squamous cell carcinoma
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example PD-L1 combined positive score or tumour proportion score, TP53 and NOTCH1 mutations, Endoscopic Lugol staining for early lesions, Pathological response after chemoradiation), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Upper and middle third squamous cell carcinoma, Earlysquamous cell carcinoma, Locally advanced.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Early (T1a)
- For my situation (early (t1a)), which of the standard options do you recommend and why?Why: Guideline options include: Endoscopic submucosal dissection; oesophagectomy or chemoradiation if deeper invasion is found.
Locally advanced
- For my situation (locally advanced), which of the standard options do you recommend and why?Why: Guideline options include: 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).
- Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, Cisplatin or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of CROSS and CheckMate 577 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Metastatic, first line
- For my situation (metastatic, first line), which of the standard options do you recommend and why?Why: Guideline options include: Nivolumab plus chemotherapy or nivolumab plus ipilimumab (CheckMate 648), or pembrolizumab plus chemotherapy (KEYNOTE-590).
- Am I a candidate for Nivolumab, Ipilimumab, Pembrolizumab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of CheckMate 648 and KEYNOTE-590 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Prevention and screening
- For my situation (prevention and screening), which of the standard options do you recommend and why?Why: Guideline options include: Smoking cessation, alcohol reduction, avoiding very hot drinks; endoscopic screening in high-incidence regions of China.
Any stage
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Whether surgery can be omitted after a complete response to chemoradiation”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Most cases worldwide present late without access to endoscopy”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
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Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
6targets
2drugs
7companies
3trials
4Latest papers
topQuery for this cancer: (TITLE:"Oesophageal squamous cell carcinoma" OR ABSTRACT:"Oesophageal squamous cell carcinoma" OR TITLE:"Esophageal squamous cell carcinoma" OR ABSTRACT:"Esophageal squamous cell carcinoma" OR TITLE:"ESCC" OR ABSTRACT:"ESCC" OR TITLE:"Oesophageal SCC" OR ABSTRACT:"Oesophageal SCC") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Oesophageal squamous cell carcinoma, not a curated reading list.
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