Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 20 peer-reviewed journal articles Updated
Oncology · Esophageal Cancer

Location & Subtypes: Adenocarcinoma vs. Squamous Cell Carcinoma

At a Glance

Esophageal cancer has two main subtypes—adenocarcinoma and squamous cell carcinoma—which grow in different parts of the esophagus. The exact cell type and tumor location, measured by the Siewert classification at the stomach junction, determine your specific surgical and treatment plan.

While all esophageal cancers are serious, they are not all the same. The “identity” of your cancer—defined by its cell type and its exact location—is the blueprint your doctors use to build your treatment plan [1][2].

The Two Main Subtypes

Esophageal cancer is divided into two primary histological subtypes based on the type of cells that became cancerous.

1. Adenocarcinoma (EAC)

  • Where it grows: Usually in the lower third of the esophagus, near the stomach [3].
  • Primary Drivers: Strongly linked to chronic acid reflux (GERD), obesity, and a precancerous condition called Barrett’s esophagus [4][5].
  • Who gets it: It is now the most common type of esophageal cancer in Western countries like the United States and parts of Europe [6][7].

2. Squamous Cell Carcinoma (ESCC)

  • Where it grows: Typically in the upper or middle sections of the esophagus [2].
  • Primary Drivers: Often associated with long-term smoking, heavy alcohol use, and the regular consumption of very hot beverages [8][9].
  • Who gets it: While its incidence is decreasing in the West, it remains the most common type globally, particularly in “the esophageal cancer belt” stretching through parts of Asia and Africa [10][7].

The Siewert Classification: Mapping the “Junction”

When a tumor occurs right where the esophagus meets the stomach—the Gastroesophageal Junction (GEJ)—doctors use the Siewert Classification system. This system is critical because it tells the surgeon how much of the esophagus versus the stomach needs to be removed [11][12].

Note: The Siewert classification is only used for tumors located at this exact junction (GEJ). If your tumor is higher up in the esophagus, it will not have a Siewert score, and that is perfectly normal.

The classification is based on where the center (epicenter) of the tumor is located:

Classification Location of Tumor Center Typical Surgical Approach
Siewert Type I 1 to 5 cm above the junction Esophagectomy: Removal of the esophagus and part of the upper stomach [11].
Siewert Type II 1 cm above to 2 cm below the junction Individualized: Can be treated with either an esophagectomy or an extended gastrectomy, depending on how far it has spread [13][14].
Siewert Type III 2 to 5 cm below the junction Gastrectomy: Removal of the stomach and potentially the very end of the esophagus [15][16].

Why Subtype and Location Matter

Your subtype and Siewert classification are not just labels; they dictate your entire medical journey.

  • Surgical Planning: For “junctional” tumors (Type II), surgeons must decide whether to approach the tumor through the chest (transthoracic) or through the abdomen (transhiatal) [13][17]. Modern imaging, like MPR CT scans, helps them see the exact boundaries to avoid removing more tissue than necessary [11][18].
  • Therapy Choice: Adenocarcinoma and Squamous Cell Carcinoma often respond differently to radiation and chemotherapy. Current guidelines are increasingly tailoring neoadjuvant therapy (treatment before surgery) to match the specific subtype to improve the chances of a “complete response” (no cancer left in the tissue samples) [19][20][2].
  • The Goal of “R0”: Regardless of the type or location, the primary goal of surgery is an R0 resection—meaning the surgeon removes the entire tumor with a “clear margin” of healthy tissue around it to prevent the cancer from returning [13][12].

Common questions in this guide

What is the difference between esophageal adenocarcinoma and squamous cell carcinoma?
Adenocarcinoma usually grows in the lower esophagus and is heavily linked to acid reflux and Barrett's esophagus. Squamous cell carcinoma typically forms in the upper or middle esophagus and is associated with long-term smoking and alcohol use.
What is the Siewert Classification system?
A Siewert classification is used for tumors located exactly where the esophagus meets the stomach, known as the gastroesophageal junction (GEJ). This system helps surgeons understand how far the tumor extends into the stomach or esophagus to plan the correct surgery.
Will I need an esophagectomy or a gastrectomy for my esophageal cancer?
The surgical approach depends on exactly where the center of your tumor is located. Tumors slightly above the junction (Type I) usually require removing the esophagus, while tumors slightly below (Type III) typically require removing the stomach.
Does my tumor subtype change the type of chemotherapy or radiation I receive?
Your tumor subtype influences how your cancer responds to therapies. Because adenocarcinoma and squamous cell carcinoma behave differently, your medical team will tailor your chemotherapy and radiation treatments specifically to your tumor type before surgery.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my imaging, am I classified as Siewert Type I, II, or III?
  2. 2.Will my surgery be an esophagectomy (removing the esophagus) or a gastrectomy (removing the stomach), and why is that approach best for my tumor location?
  3. 3.Does the length of the tumor's 'esophageal invasion' change your surgical plan?
  4. 4.How does my histological subtype (Adenocarcinoma vs. Squamous Cell Carcinoma) change the type of chemotherapy or radiation I receive?
  5. 5.If my tumor is Siewert Type II, what are the trade-offs between a transthoracic and a transhiatal surgical approach for me?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (20)
  1. 1

    Esophageal cancer: Treatment advances and need for screening.

    Eisner DC

    JAAPA : official journal of the American Academy of Physician Assistants 2024; (37(4)):19-24 doi:10.1097/01.JAA.0001007328.84376.da.

    PMID: 38484297
  2. 2

    Integrated bioinformatics analysis of differences between EAC and ESCC.

    Lyu Q, Chai Y, Chen W, et al.

    BMC cancer 2025; (25(1)):1668 doi:10.1186/s12885-025-15090-z.

    PMID: 41162922
  3. 3

    Molecular phenotyping reveals the identity of Barrett's esophagus and its malignant transition.

    Nowicki-Osuch K, Zhuang L, Jammula S, et al.

    Science (New York, N.Y.) 2021; (373(6556)):760-767 doi:10.1126/science.abd1449.

    PMID: 34385390
  4. 4

    Obesity and increased risk of esophageal adenocarcinoma.

    Elliott JA, Donohoe CL, Reynolds JV

    Expert review of endocrinology & metabolism 2015; (10(5)):511-523 doi:10.1586/17446651.2015.1077696.

    PMID: 30298765
  5. 5

    Epidemiology of Barrett's Esophagus and Esophageal Adenocarcinoma: Implications for Screening and Surveillance.

    Cook MB, Thrift AP

    Gastrointestinal endoscopy clinics of North America 2021; (31(1)):1-26 doi:10.1016/j.giec.2020.08.001.

    PMID: 33213789
  6. 6

    Global Burden, Risk Factors, and Trends of Esophageal Cancer: An Analysis of Cancer Registries from 48 Countries.

    Huang J, Koulaouzidis A, Marlicz W, et al.

    Cancers 2021; (13(1)) doi:10.3390/cancers13010141.

    PMID: 33466239
  7. 7

    Secular Trends in Incidence of Esophageal Cancer in Taiwan from 1985 to 2019: An Age-Period-Cohort Analysis.

    Tsai MC, Chou YC, Lee YK, et al.

    Cancers 2022; (14(23)) doi:10.3390/cancers14235844.

    PMID: 36497327
  8. 8

    Hot Tea Consumption and Esophageal Cancer Risk: A Meta-Analysis of Observational Studies.

    Luo H, Ge H

    Frontiers in nutrition 2022; (9()):831567 doi:10.3389/fnut.2022.831567.

    PMID: 35479756
  9. 9

    The role of dietary carotenoids in preventing the development of esophageal squamous cell carcinoma.

    Lu Y, Zhao W, Xie P, et al.

    International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition 2024; (94(1)):10-18 doi:10.1024/0300-9831/a000770.

    PMID: 36200170
  10. 10

    Population-based investigation of common and deviating patterns of gastric cancer and oesophageal cancer incidence across populations and time.

    Li M, Park JY, Sheikh M, et al.

    Gut 2023; (72(5)):846-854 doi:10.1136/gutjnl-2022-328233.

    PMID: 36241389
  11. 11

    Four-step formula for the Siewert classification of adenocarcinomas of the esophagogastric junction: a computed tomography-based quantitative model.

    Liu YT, Li YA, Li JZ, et al.

    Expert review of medical devices 2025; (22(7)):747-755 doi:10.1080/17434440.2025.2510534.

    PMID: 40439686
  12. 12

    Optimal management of gastroesophageal junction cancer.

    Greally M, Agarwal R, Ilson DH

    Cancer 2019; (125(12)):1990-2001 doi:10.1002/cncr.32066.

    PMID: 30973648
  13. 13

    Esophagogastric junction adenocarcinomas: individualization of resection with special considerations for Siewert type II, and Nishi types EG, E=G and GE cancers.

    Hölscher AH, Law S

    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2020; (23(1)):3-9 doi:10.1007/s10120-019-01022-x.

    PMID: 31691875
  14. 14

    [Surgical treatment strategies for Siewert type II adenocarcinoma of the esophagogastric junction].

    Yan Q, Lyu ZJ, Zheng JB, Li Y

    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 2020; (23(10)):1008-1012 doi:10.3760/cma.j.cn.441530-20191031-00467.

    PMID: 33054000
  15. 15

    [Comparative study with propensity score matching of gastrectomy versus total gastrectomy for the safety and prognosis of Siewert types Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction].

    Wang B, Yang R, Qiao Y, et al.

    Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery 2025; (28(2)):169-177 doi:10.3760/cma.j.cn441530-20240228-00077.

    PMID: 39971568
  16. 16

    Comparison of proximal gastrectomy with tubular esophagogastric anastomosis and total gastrectomy with Roux-en-Y reconstruction in the treatment of adenocarcinoma of the esophagogastric junction of Siewert type II/III at stage II.

    Zhang Z, Zhao T, Wang Y, et al.

    BMC surgery 2024; (24(1)):382 doi:10.1186/s12893-024-02685-9.

    PMID: 39614266
  17. 17

    Surgical approach to advanced Siewert II cancer: beyond the borders? The West Side.

    Hölscher AH, Bollschweiler E, Fetzner UK, Babic B

    Updates in surgery 2023; (75(2)):329-333 doi:10.1007/s13304-022-01363-w.

    PMID: 36001282
  18. 18

    Preoperative ultrasound-guided dual localization with titanium clips and carbon nanoparticles for predicting the surgical approach and guiding the resection of Siewert type II esophagogastric junction adenocarcinoma.

    Wu W, Luo Z, Fang Y, et al.

    Journal of cancer research and clinical oncology 2024; (150(3)):145 doi:10.1007/s00432-024-05689-3.

    PMID: 38507110
  19. 19

    Racial Disparities in Esophageal Cancer.

    Pickens A

    Thoracic surgery clinics 2022; (32(1)):57-65 doi:10.1016/j.thorsurg.2021.09.004.

    PMID: 34801196
  20. 20

    Nomograms to predict survival rates for esophageal cancer patients with malignant behaviors based on ICD-0-3.

    Sun Y, Wang J, Li Y, et al.

    Future oncology (London, England) 2019; (15(2)):121-132 doi:10.2217/fon-2018-0493.

    PMID: 30232909

This page provides educational information about esophageal cancer subtypes and surgical classifications. Always consult your oncology team or thoracic surgeon to understand your specific tumor type and surgical plan.

Get notified when new evidence is published on Carcinoma of esophagus.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.