A new Review published in The New England Journal of Medicine provides an updated overview of oesophageal cancer, highlighting recent advances in understanding its causes, prevention, and treatment, written by Shaohua Xie and Jesper Lagergren at Karolinska Institutet and Elizabeth Smyth at the University of Oxford.
Oesophageal cancer is the seventh leading of cancer-related death worldwide. The two main histological types, adenocarcinoma and squamous cell carcinoma, differ greatly in occurrence patterns and risk factors. The occurrence of oesophageal adenocarcinoma has rapidly increased while squamous cell carcinoma has decreased over the past few decades in Sweden and many other western countries.
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“Although the two main types of oesophageal cancer arise in the same organ, they should be regarded distinct diseases,” says Shaohua Xie , Principal Researcher and Docent at the Department of Molecular Medicine and Surgery , Karolinska Institutet, and first author of the article. “This distinction is important for understanding the causes, enable prevention strategies, and for improving the treatment.”
“For oesophageal adenocarcinoma, obesity and gastro-oesophageal reflux disease may explain the majority of cases, but important questions remain, including its striking male predominance”, says Xie. “Our group examines if sex hormones may explain this sex difference”.
Tumour stage at diagnosis is the strongest determinant of survival in oesophageal cancer, highlighting the value of early detection. However, population-wide endoscopic screening is not feasible because of the low incidence and the healthcare resources needed.
“A more cost-effective strategy would be identifying a small proportion of the population at sufficiently high risk to benefit from targeted screening and surveillance,” says Xie. “We have models for this purpose, but they require refinement and validation
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The article also covers recent developments in the treatment of oesophageal cancer. The addition of immunotherapy in addition to surgery, chemotherapy and radiotherapy is under rapid development.
This commissioned review builds on long-standing and successful research activity on oesophageal cancer at Karolinska Institutet. The research group Upper Gastrointestinal Surgery at Department of Molecular Medicine and Surgery, led by Professor Jesper Lagergren , has worked in the field for more than three decades.
Publication
Esophageal Cancer Xie S, Smyth E, Lagergren J. The New England Journal of Medicine. 2026;395(11):1100-1111. DOI: 10.1056/NEJMra2516631
