Esophageal Cancer
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Contents |
Etiology
- most cases can be attributed to smoking or excess alcohol or both
- other risk factors:
- Plummer Vinson syndrome
- tylosis
- achalasia
- lye stricture
- human papilloma virus
- high fat, low protein, & low calorie diets increase risk
- nitrosamines ( nitrates, nitrites) may be common etiology
- fungal toxins in pickled vegetables
- radiation-induced stricture
- zinc-deficiency may be risk
Epidemiology
- estimated 14,55 cases/year (2006)
- 2.7 times more common in men than women
- adenocarcinoma 50%
- more frequent in US than squamous cell carcinoma with greatest frequency in males age 40-50
- more common in whites
- male/female ratio 7:1, black/white ratio 1:4
- incidence increased with age & peaks in 7th decade
- more common in blacks
- most prominant histologic type world-wide
- male/female ratio 3:1, black/white ratio 6:1
- incidence 20-30 times higher in China than US
Pathology
-
- distal 1/3 of esophagus is most common site
- incidence of adenocarcinoma involving gastroesophageal (GE)- junction is increasing
- generally occurs on a background of Barrett's esophagus
- most often in proximal 2/3 of esophagus
- 10% may have malignant neoplasms of the oral cavity, pharynx, larynx or lung
- other types:
- mucoepidermoid carcinoma
- small cell carcinoma
- sarcoma
- adenoid cystic carcinoma
- primary lymphoma of the esophagus
- metastatic carcinoma
- metastatic spread
- regional lymph nodes
- lungs
- liver
- bone
- adrenal glands
- diaphragm
- adenocarcinoma may metastasize to brain
Genetics
Clinical-manifestations
- dysphagia is not noted until esophageal lumen is narrowed to 1/2 to 1/3 of its normal diameter because of its elasticity
- weight loss is common
- cough is suggestive of local extension into the trachea with tracheal esophageal fistula
- pain may radiate to back
- hoarseness may be a sign of recurrent laryngeal nerve involvement
- metastatic disease may result in:
- pleural effusion
- ascites
- bone involvement may result in pain &/or hypercalcemia
Laboratory
Diagnostic-procedures
- endoscopy
- endoscopic US for staging
- bronchoscopy to detect tracheal invasion except for adeno- carcinoma of the distal 1/3 of the esophagus
- endoscopic ultrasound ( EUS) to visualize tumor
Radiology
- CT of thorax, abdomen & pelvis to look for metastases
- PET scan for metastases (covered by Medicare)
- bone scan if patient has bone pain or elevated serum alkaline phosphatase
- barium swallow
Staging
Complications
Management
- Stage 0 (Tis N0 M0), carcinoma in situ
- radiation followed by surgery
- > 90% 5 yr survival
- Stage 1 (T1 NO MO)
- chemoradiation* followed by surgery
- > 50% 5 yr survival
- Stage 2a (T2-3 NO MO)
- chemoradiation* followed by surgery
- 15-30% 5 yr survival
- Stage 2b (T1-2 N1 MO)
- chemoradiation* followed by surgery
- 10-30% 5 yr survival
- chemoradiation, palliative resection of T3a tumors
- <10% 5 yr survival
- radiation therapy +/- intraluminal dilation & chemotherapy
- 5 yr survival is rare
- 30-40% of total surgically resectable
- * chemoradiation: two courses of 5-fluorouracil & cisplatin ( Platinol) plus 40 Gy of radiation in 15 sessions over 3 weeks
More General Terms
Additional Terms
- achalasia (cardiospasm)
- Barrett esophagus
- Plummer-Vinson; Patterson-Kelly syndrome; sideropenic dysphagia
- staging of esophageal cancer
- tylosis
Internet Database
OMIM: 133239
References
- Bonin et al, Cancer Management: A Multidisciplinary Approach, Chapter 5, 1999
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 281
- Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
- Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 568-69
- Esophageal Cancer: NIH Institute and Center Resources [1]
- National Guideline Clearinghouse Combined modality radiotherapy and chemotherapy in the non-surgical management of localized carcinoma of the esophagus. (Program in Evidence-based Care) ngc-guideline: [2]
- Neoadjuvant or adjuvant therapy for resectable esophageal cancer ngc-guideline: [3]
- The role of endoscopy in the assessment and treatment of esophageal cancer American Society for Gastrointestinal Endoscopy ngc-guideline: [4]
- The role of porfimer sodium (Photofrin™) in the palliative treatment of esophageal cancer. (Program in Evidence-based Care) ngc-guideline: [5]
- Management of oesophageal and gastric cancer. A national clinical guideline. Scottish Intercollegiate Guidelines Network ngc-guideline: [6]
- Preoperative or postoperative therapy for resectable esophageal cancer: guideline recommendations. Program in Evidence-based Care ngc-guideline: [7]
- PET imaging in esophageal cancer: recommendations. Program in Evidence-based Care ngc-guideline: [8] - Guidelines on the management of oesophageal and gastric cancer Scottish Intercollegiate Guidelines Network (SIGN) [9]
