Oesophageal cancer is a significant health issue, with two main types: squamous cell carcinoma (SCC) and adenocarcinoma (ACA). SCC is more common in lower socioeconomic groups and is linked to smoking, alcohol, and poor nutrition, while ACA is associated with gastro-oesophageal reflux disease (GORD) and is more prevalent in developed countries, especially the UK. The UK has the highest incidence of ACA globally, with a rising trend. Treatment options include curative chemotherapy, chemoradiotherapy, and surgery, with the Ivor-Lewis oesophagectomy being the most common surgical approach. Minimally invasive techniques are increasingly used to reduce complications. Despite advances, long-term survival remains poor, with only 14.3% 5-year survival in England. Enhanced recovery pathways and molecular stratification of tumours offer potential improvements. Ongoing research explores monoclonal antibodies and immunotherapy for better outcomes. Epidemiologically, oesophageal cancer is more common in males than females, with SCC being more prevalent in Asia and ACA in Western nations. The UK has the highest incidence of ACA, with 7.2 per 100,000 in men and 2.5 in women. Risk factors for SCC include smoking, alcohol, and poor nutrition, while ACA is linked to GORD and Barrett's oesophagus. Barrett's oesophagus can progress to cancer, and early detection is crucial. The molecular biology of oesophageal cancer is complex, with various mutational signatures influencing treatment responses. Advances in genomic sequencing are aiding personalized treatment strategies. Diagnosis typically involves endoscopy and imaging, with staging based on the UICC/AJCC TNM classification. Treatment options depend on the stage and include curative chemotherapy, chemoradiotherapy, and surgery. Neoadjuvant therapy has shown benefits in improving survival, but only a subset of patients benefit. Surgery remains the mainstay of curative treatment, with the Ivor-Lewis oesophagectomy being the most common procedure. Minimally invasive and robotic approaches are gaining traction for their benefits in recovery and complications. Palliative treatment focuses on symptom management and quality of life, with chemotherapy and immunotherapy showing promise. Future developments include personalized medicine, immunotherapy, and improved surgical techniques. Despite progress, oesophageal cancer remains a challenging disease, but ongoing research and clinical trials are paving the way for more effective and tailored treatments.Oesophageal cancer is a significant health issue, with two main types: squamous cell carcinoma (SCC) and adenocarcinoma (ACA). SCC is more common in lower socioeconomic groups and is linked to smoking, alcohol, and poor nutrition, while ACA is associated with gastro-oesophageal reflux disease (GORD) and is more prevalent in developed countries, especially the UK. The UK has the highest incidence of ACA globally, with a rising trend. Treatment options include curative chemotherapy, chemoradiotherapy, and surgery, with the Ivor-Lewis oesophagectomy being the most common surgical approach. Minimally invasive techniques are increasingly used to reduce complications. Despite advances, long-term survival remains poor, with only 14.3% 5-year survival in England. Enhanced recovery pathways and molecular stratification of tumours offer potential improvements. Ongoing research explores monoclonal antibodies and immunotherapy for better outcomes. Epidemiologically, oesophageal cancer is more common in males than females, with SCC being more prevalent in Asia and ACA in Western nations. The UK has the highest incidence of ACA, with 7.2 per 100,000 in men and 2.5 in women. Risk factors for SCC include smoking, alcohol, and poor nutrition, while ACA is linked to GORD and Barrett's oesophagus. Barrett's oesophagus can progress to cancer, and early detection is crucial. The molecular biology of oesophageal cancer is complex, with various mutational signatures influencing treatment responses. Advances in genomic sequencing are aiding personalized treatment strategies. Diagnosis typically involves endoscopy and imaging, with staging based on the UICC/AJCC TNM classification. Treatment options depend on the stage and include curative chemotherapy, chemoradiotherapy, and surgery. Neoadjuvant therapy has shown benefits in improving survival, but only a subset of patients benefit. Surgery remains the mainstay of curative treatment, with the Ivor-Lewis oesophagectomy being the most common procedure. Minimally invasive and robotic approaches are gaining traction for their benefits in recovery and complications. Palliative treatment focuses on symptom management and quality of life, with chemotherapy and immunotherapy showing promise. Future developments include personalized medicine, immunotherapy, and improved surgical techniques. Despite progress, oesophageal cancer remains a challenging disease, but ongoing research and clinical trials are paving the way for more effective and tailored treatments.