Evolving Trends in Esophageal Cancer Epidemiology: Paradigm Shift in a Multi-Ethnic Country

Background Esophageal cancer is the eight commonest cancer and the sixth leading cause of cancer-related death worldwide. Although its incidence in Malaysia is relatively low, with an age-standardised rate of 2.5 per 100,000 population, it remains a significant health concern due to late presentation and the complexity of management. Methods Retrospective review of prospectively collected data of all patients with histologically confirmed esophageal cancer from January 2020 to December 2024 at an Esophagogastric Cancer Referral Centre in Northern Malaysia. Results A-total-of-167-esophageal-cancer cases were diagnosed during the study-period. The mean-age at diagnosis was 65.7 with 70.5% male. Esophageal-cancer was prevalent among Chinese (41.9%), followed by Malays (38.9%) and Indians (20.4%).Dysphagia was the most common presenting symptom. Tumors-majority were located at the cardioesophageal-junction (44.3%), followed by lower-third of esophagus (25.7%), mid-esophagus (19.2%), upper-third (7.2%) and cervical esophagus (4.2%). Over-90% of patients presented with advanced disease, with 29.3% at stage-3 and 66.5% at stage-4. Adenocarcinoma (63.5%) the predominant histology subtype, particularly among Malays. Whereas squamous cell carcinoma had a higher prevalence among the Chinese ethnicity. 28.7% of patients received curative-intent treatment. Conclusion The epidemiology of esophageal cancer in Northern Malaysia is undergoing a paradigm shift, with increasing prevalence of adenocarcinoma across all ethnicity and a distal shift in tumour location to cardioesophageal junction. Late-stage diagnoses remain a major challenge, underscoring the need for heightened awareness, targeted screenings, and further research into ethnic-specific risk factors and interventions.