Contrast the two main types of oesophageal carcinoma by site and risk factors.

Squamous cell carcinoma: commoner worldwide, affects the upper two-thirds; risk factors are smoking, betel, alcohol, achalasia, strictures, and tylosis. Adenocarcinoma: commoner in the West and rising, affects the lower third; arises from GORD and Barrett's oesophagus.

Clinical relevance. Type and site predict risk-factor counselling and surveillance strategy.

More Detail

Types of oesophageal carcinoma

The two histological types differ in geography, site, and aetiology, which matters for prevention and treatment.

Comparison

Feature	Squamous cell carcinoma	Adenocarcinoma
Frequency	Commoner worldwide	Commoner in the West, rising fast
Site	Upper two-thirds	Lower third
Main risk factors	Smoking, betel, alcohol, achalasia, strictures, tylosis	GORD, Barrett's oesophagus, obesity
Precursor	Dysplasia of squamous mucosa	Intestinal metaplasia (Barrett's)

Key points

• Tylosis (palmoplantar keratosis) is an inherited squamous-cancer risk factor.
• Squamous-cancer risks are largely preventable (smoking, betel, alcohol).
• The rise in adenocarcinoma parallels rising obesity and GORD, with a similar rise in cancer of the gastric cardia.