Endoscopic Therapy for Advanced Esophageal Cancer

Abstract

BACKGROUNDEsophageal cancer is currently the ninth leading cause of cancer death in the United States, and since the 1970s, the incidence of esophageal adenocarcinoma has been rising at an alarming rate (1). The National Cancer Institutes estimates 14,250 new cases of esophageal cancer and 13,300 deaths owing to esophageal cancer in 2004. The estimated 5-yr mortality rate remains at 5-10% (1).Unfortunately, the majority of patients present with advanced disease that is not curative by surgery (2). Palliative surgery is associated with a relatively high morbidity (20-60%) and mortality (10-33%), and approximately one-third of these patients will develop anastomotic strictures or local tumor recurrence necessitating further intervention (3). Because the median survival of such patients is less than 6 mo, palliative surgery has been replaced by nonsurgical techniques, primarily chemoradiation, brachytherapy, and/or endoscopic therapy (4). This chapter summarizes the goals, safety and efficacy, and techniques for endoscopic palliation of advanced esophageal cancer, focusing primarily on techniques for treatment of malignant dysphagia but also including treatment options for esophageal fistulas and bleeding tumors. TREATMENT OF DYSPHAGIA GOALS OF PALLIATIVE ENDOSCOPIC THERAPY FOR DYSPHAGIAMalignant dysphagia is defined as difficulty swallowing owing to malignancy and usually results from a partially or completely occluded esophageal lumen. It might present as intraluminal disease, extraluminal compression, tumor encroachment on esophageal innervation, or a combination of From: Endoscopic Oncology: Gastrointestinal Endoscopy and Cancer Management.