[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Gastrointestinal tract](https://durgical.com/en/general-pathology/areas/gi/) › Oesophageal squamous cell carcinoma

# Oesophageal squamous cell carcinoma

- Lesion

A cancer of the flat lining cells of the mid oesophagus, linked to tobacco, alcohol, hot drinks and poor diet.

Updated Nov 12, 2026

## Key points

- Risk factors: tobacco and alcohol (synergistic), very hot drinks, diets poor in fruit and vegetables, nitrosamines, caustic injury, achalasia, Plummer–Vinson syndrome, prior mediastinal radiation, tylosis.
- Half arise in the middle third of the oesophagus.
- Precursor: squamous dysplasia (intraepithelial neoplasia).
- Nodal spread depends on level: upper third to cervical nodes, middle to mediastinal and tracheobronchial, lower to gastric and coeliac nodes.
- Can invade the airway (fistula, pneumonia), aorta (exsanguination) or pericardium.

## What it is

Squamous cell carcinoma is the commonest oesophageal cancer worldwide. Its incidence varies more than a hundredfold between regions, with belts of very high risk in parts of Asia, Africa and South America (including southern Brazil, where hot mate is drunk). It arises from squamous dysplasia, usually in the middle third, and spreads early through the dense lymphatics of the wall.

## Structure

- Early: small grey-white plaque-like thickenings.
- Later: exophytic masses, ulcerated tumours, or diffusely infiltrating lesions that stiffen and narrow the wall.
- Micro: nests of malignant squamous cells, mostly moderately or well differentiated, with keratin pearls and intercellular bridges.
- Satellite tumour nodules in the wall may lie centimetres away from the main mass.

## The two oesophageal carcinomas compared

| Feature | Squamous cell carcinoma | Adenocarcinoma |
| --- | --- | --- |
| Worldwide | Commonest; very high-risk regions | Rising in Western countries |
| Site | Middle third mostly | Distal third and cardia |
| Precursor | Squamous dysplasia | Barrett oesophagus with dysplasia |
| Main risks | Tobacco, alcohol, hot drinks, poor diet, caustic injury, achalasia | Reflux, obesity, tobacco |
| Alcohol | Strong risk factor | Not a risk factor |
| Histology | Nests of squamous cells, keratin | Mucin-producing glands, sometimes signet-ring cells |

## Clinical notes

- Insidious onset: dysphagia first to solids, then liquids, with weight loss; patients may quietly change to a soft diet.
- Survival is good only for superficial tumours; endoscopic screening in high-risk regions finds them earlier.

## Memory aid

Squamous sits in the middle and drinks hot and hard; adeno sits low and refluxes.

## Test yourself

Think of the answer, then tap the question to see it.

## In which part of the oesophagus does squamous cell carcinoma most often arise?

The middle third.

## What are three risk factors for oesophageal squamous cell carcinoma?

Tobacco, alcohol and very hot beverages; also caustic injury, achalasia and Plummer–Vinson syndrome.

## Where do cancers of the lower third of the oesophagus usually spread first?

To gastric and coeliac lymph nodes.

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## Connections

## Related 6

- [Oesophageal adenocarcinoma: from Barrett to invasive cancer](https://durgical.com/en/general-pathology/oesophageal-adenocarcinoma-from-barrett-to-invasive-cancer/)
- [Achalasia and other motor disorders: loss of the inhibitory neurons](https://durgical.com/en/general-pathology/achalasia-and-other-motor-disorders-loss-of-the-inhibitory-neurons/)
- [Oesophageal obstruction: stenosis, webs, rings, diverticula](https://durgical.com/en/general-pathology/oesophageal-obstruction-stenosis-webs-rings-diverticula/)
- [Tobacco: how smoking injures tissue](https://durgical.com/en/general-pathology/tobacco-how-smoking-injures-tissue/)
- [Alcohol: how it injures the liver, brain, heart and fetus](https://durgical.com/en/general-pathology/alcohol-how-it-injures-the-liver-brain-heart-and-fetus/)
- [Chemical carcinogens: initiation, promotion and the table to know](https://durgical.com/en/general-pathology/chemical-carcinogens-initiation-promotion-and-the-table-to-know/)

## Related conditions 4

- [Oesophageal cancer](https://durgical.com/en/conditions/oesophageal-cancer/)
- [Achalasia](https://durgical.com/en/conditions/achalasia/)
- [Head and neck squamous cell carcinoma (oral cavity and oropharynx, HPV)](https://durgical.com/en/conditions/head-and-neck-squamous-cell-carcinoma/)
- [Iron deficiency anaemia](https://durgical.com/en/conditions/iron-deficiency-anaemia/)

## Microorganisms 1

- [Human papillomavirus](https://durgical.com/en/microbiology/human-papillomavirus/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Esophageal Cancer](https://www.ncbi.nlm.nih.gov/books/NBK459267/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/oesophageal-squamous-cell-carcinoma/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/oesophageal-squamous-cell-carcinoma/