Esophageal

# Esophageal Cancer: Dual Pathology

## Introduction: Two Diseases, One Organ
Esophageal cancer manifests as two distinct entities: **squamous cell carcinoma (ESCC)** predominant globally, and **adenocarcinoma (EAC)** rising rapidly in Western nations. The "esophageal cancer belt" stretches from Northern Iran to North Central China, where ESCC incidence exceeds 100/100,000. EAC has increased 7-fold in Western countries since 1975 due to obesity and GERD epidemics.

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## Causes and Risk Factors: Squamous vs Adenocarcinoma

### ESCC Risk Factors
- **Thermal Injury**: Hot beverages (>65°C)
- **Tobacco/Alcohol**: Synergistic carcinogenesis
- **Nutritional Deficiencies**: Zinc, selenium
- **Achalasia**: 30× increased risk

### EAC Risk Factors
- **GERD**: Weekly symptoms double risk
- **Barrett's Esophagus**: 0.5% annual progression
- **Obesity**: Central adiposity increases intra-abdominal pressure

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## Prevention Strategies: Acid Control and Ablation

### Barrett's Management Protocol
```mermaid
graph TD
A[Diagnosis of Barrett's] --> B[PPI Therapy]
B --> C[Surveillance Endoscopy]
C --> D{Dysplasia?}
D -->|No| C
D -->|Low-grade| E[Radiofrequency Ablation]
D -->|High-grade| F[Endoscopic Resection + Ablation]