Squamous cell carcinoma of the esophagus: Understanding Your Pathology Report

by Jason Wasserman MD PhD FRCPC
July 29, 2026

Squamous cell carcinoma of the esophagus is a type of cancer that begins in squamous cells, the flat, overlapping cells that line the inside of the esophagus. The esophagus is the muscular tube that carries food and liquid from the mouth to the stomach. These squamous cells form a thin protective layer called the epithelium, which shields the wall of the esophagus from irritation during swallowing. In squamous cell carcinoma, these cells grow in an uncontrolled way and form a tumor that can grow into the deeper layers of the esophageal wall and spread to other parts of the body.

Squamous cell carcinoma is one of the two main types of esophageal cancer, along with adenocarcinoma of the esophagus. Worldwide, it is by far the more common of the two, accounting for the large majority of esophageal cancers, although in North America, Europe, and Australia adenocarcinoma is now more frequently diagnosed. Squamous cell carcinoma most often develops in the upper or middle part of the esophagus, while adenocarcinoma typically arises in the lower part near the stomach.

This article will help you understand the findings in your pathology report, what each term means, and why it matters for your care.

What causes squamous cell carcinoma of the esophagus?

Squamous cell carcinoma of the esophagus develops after years of injury or irritation to the squamous cell lining of the esophagus. The two most important causes are tobacco use and heavy alcohol consumption. Each raises the risk on its own, and when they are combined, the risk rises far more than either would produce alone, because alcohol makes the lining more permeable to the cancer-causing chemicals in tobacco smoke.

Other factors that increase risk include the habit of drinking very hot beverages over many years, a diet low in fruits and vegetables, poor oral health, exposure to smoke from indoor cooking or heating fires, achalasia (a condition in which the esophagus does not empty properly, so its contents sit against the lining), scarring from swallowing a caustic substance such as lye, and previous radiation therapy to the chest or neck. People who have had a squamous cell carcinoma of the mouth, throat, or voice box are at higher risk of developing one in the esophagus as well, because the same exposures affect the entire lining of the upper airway and digestive tract. A small number of cases are linked to an inherited condition called tylosis, in which thickened skin on the palms and soles is accompanied by a substantially increased lifetime risk of esophageal squamous cell carcinoma.

Human papillomavirus (HPV) has been studied as a possible contributor in some parts of the world, but the evidence remains conflicting, and unlike in cancers of the throat and cervix, HPV is not an established cause of esophageal squamous cell carcinoma. Rates of this cancer are much higher in parts of eastern Africa and central and eastern Asia than in Western countries, reflecting regional differences in diet, environmental exposures, and tobacco and alcohol use.

Squamous cell carcinoma is usually preceded by a precancerous change called squamous dysplasia, in which abnormal squamous cells replace part of the normal lining without yet growing into the deeper layers. When the abnormal cells replace the full thickness of the lining, the change is called squamous cell carcinoma in situ, also known as high-grade squamous dysplasia. If this change is present next to your tumor, it will be described in your pathology report.

What are the symptoms of squamous cell carcinoma of the esophagus?

Many people with squamous cell carcinoma of the esophagus notice nothing until the tumor has grown large enough to narrow the inside of the esophagus. The most common symptom is difficulty swallowing, called dysphagia, which usually begins with solid foods such as bread or meat and gradually extends to softer foods and liquids.

Other symptoms include pain on swallowing, discomfort in the chest or between the shoulder blades, and unexplained weight loss, which is common once eating becomes difficult or painful. Because squamous cell carcinoma often arises in the upper or middle esophagus, it can affect nearby structures: pressure on the nerve that controls the voice box can cause hoarseness, and a tumor lying against the windpipe can cause a persistent cough or coughing during swallowing. Slow bleeding from the tumor surface may lead to anemia, a low red blood cell count that can cause tiredness and shortness of breath.

How is the diagnosis made?

The diagnosis of squamous cell carcinoma of the esophagus is made only after tissue from the esophagus is examined under a microscope by a pathologist. The tissue is obtained during an upper endoscopy, also called a gastroscopy, in which a thin flexible tube with a camera is passed through the mouth to inspect the lining of the esophagus and take small tissue samples called biopsies. Because early squamous cancers can be flat and easy to miss, a dye called Lugol’s iodine or a special light setting is sometimes used to make abnormal areas stand out. Very early tumors may instead be removed in one piece by endoscopic resection, which both treats the lesion and shows how deeply it has grown.

Under the microscope, squamous cell carcinoma appears as abnormal squamous cells growing downward from the surface lining into the deeper layers of the esophageal wall, usually in rounded clusters called nests or in broad sheets. In many tumors the cells produce keratin, the tough protein normally found in skin and nails, a process called keratinization, which can form rounded structures known as keratin pearls. The cells may also show intercellular bridges, fine visible connections between neighboring squamous cells. Keratin pearls and intercellular bridges are hallmarks of squamous differentiation and help confirm the diagnosis. In tumors whose cells have departed furthest from normal, these features may be sparse or absent.

When the tumor cells look very abnormal or the diagnosis is not straightforward on a small biopsy, the pathologist may use immunohistochemistry, a test that uses antibodies to detect specific proteins inside cells. Squamous cell carcinoma of the esophagus typically shows p40, p63, and cytokeratin 5/6, which are found in squamous cells, and is usually negative for CK7 and CDX2, markers of gland-forming cancers. This pattern separates squamous cell carcinoma from adenocarcinoma and from other tumor types that can arise in this location. These stains identify what the tumor is; they are different from the biomarker tests described later, which guide the choice of drug therapy.

Once cancer is confirmed, imaging determines how far it has spread before treatment is planned. This usually includes a CT scan of the chest and abdomen, a PET scan, and endoscopic ultrasound, which uses sound waves from inside the esophagus to estimate depth and to look at nearby lymph nodes. For tumors in the upper or middle esophagus, a bronchoscopy may be performed to check whether the tumor has reached the airway, and an examination of the mouth, throat, and voice box is often done because a second squamous cancer is sometimes found there.

Histologic subtypes

Most squamous cell carcinomas of the esophagus are described simply as conventional squamous cell carcinoma. A small number are recognized as distinct subtypes based on how the tumor looks under the microscope. If your report names one of the following, here is what it means:

Verrucous squamous cell carcinoma — A rare, slow-growing form. “Verrucous” means warty, and these tumors form thick, raised, cauliflower-like growths. Under the microscope, the cells look remarkably close to normal, which can make the diagnosis difficult on a small biopsy. This subtype tends to grow locally and rarely spreads to distant organs, although it can become large and cause severe blockage if left untreated.
Spindle cell (sarcomatoid) squamous cell carcinoma — This subtype contains both recognizable squamous cancer cells and elongated spindle cells that resemble those seen in cancers of connective tissue. Because of this unusual appearance, immunohistochemistry is usually needed to confirm that it is a carcinoma. These tumors often grow as a polyp-like mass projecting into the esophagus, which means they can cause swallowing symptoms while still relatively superficial.
Basaloid squamous cell carcinoma — In this subtype, the cancer cells are small and dark and resemble the basal cells of the deepest layer of the normal lining. They grow in solid sheets and often contain areas of dead tissue called necrosis. This subtype tends to grow quickly and is more often found at a higher stage at the time of diagnosis. Additional testing is often needed to distinguish it from other high-grade cancers.

Rarer possibilities include adenosquamous carcinoma, which contains both squamous and gland-forming cancer, and lymphoepithelioma-like carcinoma, in which the cancer cells are surrounded by dense sheets of immune cells. Every one of these is still a form of squamous cell carcinoma or a closely related carcinoma, and identifying the subtype adds information about how the tumor is likely to behave.

Histologic grade

Histologic grade describes how closely the cancer cells in a squamous cell carcinoma of the esophagus resemble normal squamous cells. The pathologist assigns the grade based on how much squamous differentiation the tumor still shows, including keratin production and intercellular bridges.

Grade 1 (well differentiated) — The cancer cells closely resemble normal squamous cells and usually produce abundant keratin. These tumors tend to grow more slowly and are less likely to have spread.
Grade 2 (moderately differentiated) — The cells are more abnormal and less organized, but squamous features such as keratin and intercellular bridges are still recognizable.
Grade 3 (poorly differentiated) — The cells look markedly different from normal squamous cells and grow in a disorganized pattern with little or no keratin. These tumors tend to grow faster and are more often associated with spread to lymph nodes.
GX — The grade could not be assessed, usually because the sample was too small or too altered by previous treatment.

Grades 1 and 2 are often grouped together as low grade, and grade 3 as high grade. Some subtypes carry a grade by definition: verrucous carcinoma is considered well differentiated, while basaloid and spindle cell carcinomas are treated as high grade. For early squamous cell carcinomas that have not spread to lymph nodes, grade is also used in assigning the final stage group, so the same depth of invasion can produce a different stage depending on grade. Grading a small biopsy can be difficult, and the grade is sometimes revised once the full surgical specimen is examined.

Depth of invasion

Depth of invasion describes how far a squamous cell carcinoma has grown into the wall of the esophagus, and it is one of the most important findings on the report. The esophageal wall is built in layers:

Mucosa — The innermost lining, where squamous cell carcinoma begins. It contains the surface epithelium, the lamina propria (a thin supportive layer), and the muscularis mucosae (a thin band of muscle at its base).
Submucosa — A supportive layer beneath the mucosa carrying the larger blood vessels and lymphatic channels.
Muscularis propria — The thick muscle layer that contracts to move food toward the stomach.
Adventitia — The outermost connective tissue anchoring the esophagus within the chest.

Unlike most of the digestive tract, the esophagus has no serosa, the smooth outer membrane that elsewhere acts as a barrier. This is one reason esophageal cancers can grow into neighboring structures such as the windpipe, the aorta, or the lining around the heart. The deepest layer the tumor reaches determines the pathologic tumor stage (pT), described below.

When a very early tumor is removed endoscopically, the report often describes the depth in finer steps: within the surface epithelium or lamina propria (m1 and m2), reaching the muscularis mucosae (m3), or extending into the upper, middle, or lower third of the submucosa (sm1, sm2, and sm3). This detail matters because the risk of spread to lymph nodes rises sharply once a squamous cell carcinoma reaches the muscularis mucosae, and rises further with each step into the submucosa. Squamous cell carcinomas carry a higher risk of nodal spread at the same depth than adenocarcinomas do, which is why the threshold for treating a squamous tumor endoscopically alone is stricter.

Lymphovascular invasion

Lymphovascular invasion means that cancer cells from the squamous cell carcinoma were seen inside a small blood vessel or lymphatic channel within or around the esophageal wall. It is reported as present or absent.

These channels carry fluid and cells away from the esophagus, so cancer cells inside them may travel to nearby lymph nodes or, through the bloodstream, to distant organs. Lymphovascular invasion is one of the strongest predictors of lymph node involvement. Its presence may influence whether chemotherapy or radiation is considered alongside surgery, and in a very early tumor it usually moves the discussion away from endoscopic treatment alone.

Perineural invasion

Perineural invasion means that cancer cells were seen surrounding or growing into a nerve. Nerves run through the tissue in and around the esophageal wall, and cancer cells that reach them can use them as a pathway to extend beyond the main tumor mass. Your report will state whether perineural invasion is present or absent.

Perineural invasion is associated with a higher risk that cancer will return near the original site and with poorer outcomes overall. It is one of several findings the treatment team weighs when deciding whether treatment in addition to surgery should be discussed.

Treatment effect

Most people with squamous cell carcinoma of the esophagus that has grown beyond the earliest stages receive chemotherapy combined with radiation before surgery. This is called neoadjuvant chemoradiation, and it is given to shrink the tumor, treat cancer cells that may have already spread, and improve the chance that surgery removes everything. When the esophagus is removed afterward, the pathologist assesses how much living cancer remains and assigns a treatment response score, most often using the modified Ryan scheme:

Score 0 (complete response) — No living cancer cells remain anywhere in the specimen. This is the most favorable result and is associated with the best long-term outcomes.
Score 1 (near-complete response) — Only single cancer cells or rare small clusters remain.
Score 2 (partial response) — Residual cancer is present, but there is clear evidence that treatment shrank the tumor, such as scarring where the tumor used to be.
Score 3 (poor or no response) — Extensive cancer remains with little or no evidence of response.

Squamous cell carcinoma responds to chemoradiation better than adenocarcinoma does. In the large trial that established this approach, roughly half of people with squamous cell carcinoma had no living cancer remaining in the surgical specimen, compared with about a quarter of those with adenocarcinoma. Because treatment can leave scattered surviving cells behind, the pathologist examines the entire area where the tumor was, called the tumor bed, and often takes additional tissue sections before concluding that none remains. When the specimen was removed after neoadjuvant therapy, the stage on the report is written with a “y” in front, as ypT and ypN.

Surgical margins

A margin is the cut edge of the tissue removed during surgery for squamous cell carcinoma of the esophagus. The pathologist inks these edges and examines them under the microscope to determine whether cancer cells reach the cut surface. Several margins are examined and reported separately:

Proximal margin — The upper cut end of the removed esophagus, closest to the mouth. This margin is examined closely because squamous dysplasia can extend beyond the visible tumor.
Distal margin — The lower cut end, closest to the stomach.
Radial (circumferential) margin — The outer soft tissue surface surrounding the esophagus. This is the margin most often involved by tumors that have grown deeply through the wall, and it is most closely linked to cancer returning at the surgical site.

The results are reported as follows:

Negative margin (clear or uninvolved) — No cancer cells reach the inked edge. The report usually also gives the distance in millimeters between the tumor and the closest margin.
Positive margin (involved) — Cancer cells are present at the inked edge, meaning cancer may remain in the body. This is one of the factors the team weighs when considering additional treatment after surgery.

Two different conventions are used internationally for calling the radial margin positive. Some laboratories require tumor to touch the inked surface, while others call the margin positive when tumor lies within 1 mm of it. Your report will state which was used, and the distance in millimeters is given so the result can be interpreted either way.

Lymph nodes

Lymph nodes are small immune organs found throughout the body, including alongside the esophagus, in the neck, and in the upper abdomen. Cancer cells that enter lymphatic channels can become trapped in them, and cancer found in a lymph node is a form of metastasis. During surgery for squamous cell carcinoma of the esophagus, the surgeon removes the nearby lymph nodes so the pathologist can examine them.

Your report will state how many lymph nodes were examined and how many contained cancer. A node is described as positive if cancer is found in it and negative if it is not. Examining an adequate number matters for accurate staging, and current guidelines suggest at least 15 nodes be assessed when surgery is performed without prior chemotherapy or radiation. Fewer nodes are often recovered after chemoradiation, because treatment shrinks them.

Squamous cell carcinoma of the upper and middle esophagus can spread to nodes over a wide area, including the neck as well as the chest and upper abdomen, so the nodes listed on your report may come from several regions. If cancer is present, the report may also describe extranodal extension, meaning cancer cells have broken through the outer capsule of a node into the surrounding fat, and tumor deposits, which are separate collections of cancer cells in the surrounding tissue without a recognizable lymph node. Both are associated with poorer outcomes. The number of positive nodes determines the nodal stage (pN) and is among the strongest predictors of outcome.

Biomarker and molecular testing

Biomarkers are proteins or genetic changes measured in tumor tissue that predict whether a squamous cell carcinoma of the esophagus is likely to respond to a particular drug. Biomarker testing matters most when the cancer is advanced, recurrent, or has spread, because the results determine which drugs can be offered. For a small early tumor removed and cured surgically, some or all of these tests may not be performed.

The biomarkers tested in squamous cell carcinoma are not the same as those tested in adenocarcinoma of the esophagus. HER2 and claudin 18.2, which guide treatment for adenocarcinoma, are not relevant here, so their absence from your report is expected and not an oversight.

PD-L1

PD-L1 is a protein that some tumors display on their surface to switch off immune cells that would otherwise attack them. Immunotherapy drugs called checkpoint inhibitors, including pembrolizumab and nivolumab, block this signal. PD-L1 is measured by immunohistochemistry. In squamous cell carcinoma of the esophagus, two different scoring systems are used, and your report may give one or both:

Tumor Proportion Score (TPS) — The percentage of cancer cells showing PD-L1. A result of 1% or higher is the threshold used for nivolumab-based treatment of advanced squamous cell carcinoma, whether nivolumab is combined with chemotherapy or with ipilimumab. Roughly half of advanced squamous cell carcinomas meet this threshold.
Combined Positive Score (CPS) — Counts both the cancer cells and the nearby immune cells showing PD-L1 for every 100 cancer cells. A CPS of 10 or higher is the threshold most often applied to pembrolizumab combined with chemotherapy in squamous cell carcinoma.
PD-L1 negative — The tumor falls below the relevant threshold. Since 2025, the approvals for pembrolizumab and nivolumab in esophageal cancer exclude PD-L1-negative tumors, because trials showed no meaningful added benefit in that group. Chemotherapy and clinical trial options remain.

Because the two scores measure different things, a tumor can be positive by one and negative by the other. Which score applies depends on which drug is being considered. PD-L1 also guides decisions after surgery: for people who received chemoradiation before surgery and still had cancer remaining in the specimen, adjuvant nivolumab is an option when the tumor is PD-L1 positive.

Mismatch repair (MMR) and microsatellite instability (MSI)

Mismatch repair is the system a cell uses to correct copying errors in its DNA. Four proteins do most of this work: MLH1, PMS2, MSH2, and MSH6. Immunohistochemistry is used to check whether each protein is present in the tumor cells.

MMR proficient (pMMR) — All four proteins are present. Your report may describe them as retained, intact, preserved, or showing no loss of nuclear expression. The equivalent molecular result is microsatellite stable (MSS). This is the normal result and is what nearly all squamous cell carcinomas of the esophagus show.
MMR deficient (dMMR) — One or more of the four proteins is absent, described as loss of expression. The equivalent molecular result is microsatellite instability-high (MSI-high).

Mismatch repair deficiency is rare in squamous cell carcinoma of the esophagus, but when it is found, it carries two implications. First, it indicates eligibility for immunotherapy: pembrolizumab is approved for dMMR or MSI-high cancers regardless of where in the body the cancer started. Second, it raises the possibility of Lynch syndrome, an inherited condition that increases the lifetime risk of colorectal, endometrial, and several other cancers and that affects blood relatives. When MLH1 and PMS2 are the proteins lost, testing for MLH1 promoter methylation is usually performed first, because that non-inherited change explains most cases. If an inherited cause remains possible, referral for genetic counseling is offered.

Other findings on molecular testing

When comprehensive molecular testing is performed on a squamous cell carcinoma of the esophagus, the report may list additional genetic changes. Most do not currently change treatment for this cancer, but some open the door to tumor-agnostic drugs or clinical trials:

TP53 mutations — Found in the large majority of esophageal squamous cell carcinomas. There is no drug that targets this change, and its presence is expected rather than surprising.
Tumor mutational burden (TMB) — A count of how many mutations the tumor carries. A high result, usually defined as 10 or more mutations per megabase of DNA, indicates eligibility for pembrolizumab across cancer types.
NTRK gene fusions — Very rare in this cancer, but a positive result indicates eligibility for larotrectinib or entrectinib, approved for NTRK-fusion cancers regardless of where they started.
CDKN2A, NOTCH1, PIK3CA, and CCND1 changes — Common in squamous cell carcinoma. These are mainly of interest for clinical trials at present.

Not every case requires every one of these tests. A report that lists only some of them is not incomplete; which tests are ordered depends on the stage of the cancer and the decisions being made. You can read more about these and other tests in our Biomarkers and Genetic Testing section.

Pathologic stage (pTNM)

Pathologic stage describes how far a squamous cell carcinoma of the esophagus has grown and whether it has spread. It uses the TNM system of the American Joint Committee on Cancer (AJCC), 8th edition, which remains the current edition for cancers of the esophagus. T describes how deeply the tumor has grown into the wall, N describes how many nearby lymph nodes contain cancer, and M describes spread to distant organs. The letter p means the stage was determined by examining tissue under the microscope, and M is usually determined by imaging rather than by pathology. If chemotherapy or radiation was given before surgery, the stage is written with a “y” in front, as ypT and ypN.

Tumor stage (pT)

pTis — High-grade dysplasia, also called carcinoma in situ. Abnormal cells replace the lining but have not begun to invade.
pT1a — The tumor has grown into the lamina propria or the muscularis mucosae, the thin layers just beneath the surface lining.
pT1b — The tumor has grown into the submucosa.
pT2 — The tumor has grown into the muscularis propria, the main muscle layer of the esophageal wall.
pT3 — The tumor has grown through the muscle layer into the adventitia, the outermost connective tissue.
pT4a — The tumor has grown into a neighboring structure that can usually still be removed surgically, such as the pleura lining the lung, the pericardium around the heart, the azygos vein, the diaphragm, or the peritoneum.
pT4b — The tumor has grown into a structure that generally cannot be removed, such as the aorta, a vertebral body, or the airway.

Nodal stage (pN)

pN0 — No cancer was found in any of the lymph nodes examined.
pN1 — Cancer was found in one or two lymph nodes.
pN2 — Cancer was found in three to six lymph nodes.
pN3 — Cancer was found in seven or more lymph nodes.
pNX — No lymph nodes were submitted or they could not be assessed.

The pT and pN results are combined into an overall stage group from I to IV. For squamous cell carcinoma removed without prior treatment, two additional pieces of information feed into the stage group for early, node-negative tumors: the histologic grade, and where along the esophagus the tumor is located, since upper and middle tumors are grouped separately from lower ones. This use of location is specific to squamous cell carcinoma and does not apply to adenocarcinoma. Specimens removed after chemoradiation use a separate set of stage groupings, which is one reason the stage given before treatment may differ from the one on the final report.

What is the prognosis for squamous cell carcinoma of the esophagus?

The prognosis for squamous cell carcinoma of the esophagus depends most of all on the pathologic stage, particularly how deeply the tumor grew into the esophageal wall and how many lymph nodes contain cancer. For esophageal cancer overall in the United States, five-year relative survival is approximately 49% when the cancer is still confined to the esophagus, 28% when it has reached nearby lymph nodes or tissues, and 5% when it has spread to distant organs, with all stages combined at approximately 22%. At comparable stages, squamous cell carcinoma tends to do somewhat less well than adenocarcinoma in North American series. Because these figures come from people diagnosed several years ago, they do not yet reflect the immunotherapy regimens now in use.

Outcomes at the earliest end of the spectrum are considerably better. A tumor confined to the surface layers of the mucosa with no lymphovascular invasion, removed completely by endoscopic resection, is often cured.

The following findings on your pathology report are associated with poorer outcomes:

Deeper invasion into the esophageal wall — Outcomes worsen at each step from pT1 through pT4.
A greater number of positive lymph nodes — The strongest predictor of outcome after depth of invasion.
Positive surgical margin — Particularly the radial margin, which is linked to cancer returning at the surgical site.
Lymphovascular or perineural invasion — Both raise the risk of recurrence.
Poorly differentiated (grade 3) tumor — Associated with faster growth and a higher chance of lymph node involvement.
Basaloid or spindle cell subtype — Both tend to present at a higher stage than conventional squamous cell carcinoma.
Poor response to chemoradiation — A treatment response score of 2 or 3 carries a less favorable outlook than a score of 0 or 1.
Extranodal extension or tumor deposits — Both indicate more extensive local spread.

Two factors within a person’s control also matter. Continuing to smoke or drink heavily after diagnosis is associated with worse survival and with a higher chance of developing a second, separate cancer in the esophagus, mouth, throat, or voice box, because the same exposures affected the entire lining. Stopping both is one of the most useful things a person can do after this diagnosis, and support for doing so is available through the treatment team. Your team will weigh all of these findings together, alongside your age, overall health, and how the cancer responds to treatment, when discussing what to expect.

What happens after this diagnosis?

Once squamous cell carcinoma of the esophagus is confirmed, the pathology report is reviewed alongside imaging and endoscopy findings by a multidisciplinary team that typically includes gastroenterology, thoracic surgery, medical oncology, radiation oncology, radiology, pathology, and dietetics. The findings on the report guide which options the team considers.

For a very early tumor confined to the surface layers of the mucosa, with no lymphovascular invasion and a negative deep margin, endoscopic removal alone may be sufficient. Because squamous cell carcinoma spreads to lymph nodes earlier than adenocarcinoma does, the criteria for endoscopic treatment alone are stricter, and a tumor reaching the muscularis mucosae or the submucosa usually prompts a discussion of additional treatment.

For tumors that have grown deeper or reached lymph nodes but have not spread to distant organs, chemotherapy combined with radiation before surgery is the established approach and remains the standard for squamous cell carcinoma. Recent evidence favoring chemotherapy alone before and after surgery applies to adenocarcinoma and has not changed practice for squamous cell carcinoma. Because squamous cell carcinoma is more sensitive to radiation, definitive chemoradiation without surgery is also an accepted option, and it is often preferred for tumors in the uppermost part of the esophagus and the neck, where surgery would be particularly difficult. When chemoradiation is followed by surgery and cancer still remains in the specimen, adjuvant nivolumab may be considered if the tumor is PD-L1 positive.

For cancer that has spread to distant organs, treatment is guided by the PD-L1 result on the report. Options include chemotherapy combined with pembrolizumab or nivolumab, and nivolumab combined with ipilimumab without chemotherapy. A dMMR or MSI-high result, or a high tumor mutational burden, opens additional immunotherapy options.

Supportive care is an important part of managing this cancer whatever the treatment path. Swallowing difficulty and weight loss are common, and a dietitian is usually involved early. A stent or other endoscopic procedure may be used to keep the esophagus open. Support for stopping smoking and alcohol is offered, both because it improves treatment tolerance and because it lowers the risk of a second cancer. Follow-up includes regular clinical review, imaging, and endoscopy, often with examination of the mouth, throat, and voice box, and a palliative care team is frequently involved alongside active treatment to help with symptoms.

Questions to ask your doctor

What is the pathologic stage of my cancer (pT and pN), and what does that mean for me?
How deeply did the cancer grow into the wall of my esophagus?
Where along the esophagus was my tumor located?
Is my tumor a conventional squamous cell carcinoma, or does it belong to a specific subtype?
What was the histologic grade of my tumor?
How many lymph nodes were examined, and how many contained cancer?
Were all of the surgical margins negative, including the radial margin, and how close was the tumor to the nearest edge?
Was lymphovascular or perineural invasion present?
If I had chemotherapy and radiation before surgery, what was my treatment response score?
What was my PD-L1 result, and was it reported as TPS, CPS, or both?
Do my biomarker results make me eligible for immunotherapy or a clinical trial?
Is surgery recommended in my case, or would definitive chemotherapy and radiation be a reasonable alternative?
Should I be examined for a second cancer in my mouth, throat, or voice box?
What help is available to stop smoking and drinking, and how much difference would that make for me?
What follow-up tests and imaging will I need, and how often?