Multiple Management Modalities in Esophageal Cancer: Epidemiology, Presentation and Progression, Work-up, and Surgical Approaches

Abstract

Annually, approximately 13,200 people in the U.S. are diagnosed with esophageal cancer and 12,500 die of this malignancy. Of new cases, 9,900 occur in men and 3,300 occur in women. In part I of this two-part series, we explore the epidemiology, presentation and progression, work-up, and surgical approaches for esophageal cancer. In the 1960s, squamous cell cancers made up greater than 90% of all esophageal tumors. The incidence of esophageal adenocarcinomas has risen considerably over the past two decades, such that they are now more prevalent than squamous cell cancer in the western hemisphere. Despite advances in therapeutic modalities for this disease, half the patients are incurable at presentation, and overall survival after diagnosis is grim. Evolving knowledge regarding the etiology of esophageal carcinoma may lead to better preventive methods and treatment options for early stage superficial cancers of the esophagus. The use of endoscopic ultrasound and the developing role of positron emission tomography have led to better diagnostic accuracy in this disease. For years, the standard of care for esophageal cancer has been surgery; there are several variants of the surgical approach. We will discuss combined modality approaches in part II of this series. The Oncologist 2004;9:137-146 The Oncologist 2004;9:137-146 www.TheOncologist.com Correspondence: Richard H. Matthews, M.D., Ph.D., Beth Israel/Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts 02215, USA. Telephone: 617-232-9500, ext 4457 or ext 5628; Fax: 617-524-0643; e-mail: RHMatthews@comcast.net Received May 13, 2003; accepted for publication September 18, 2003. ©AlphaMed Press 1083-7159/2004 The Oncologist ® Gastrointestinal Cancer LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Describe the epidemiology, work-up, and staging of esophageal cancer.2. Identify the disease presentation, progression, and prognostic factors for esophageal cancer.3. Discuss the surgical approach and management of esophageal cancer.Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com CME CME by guest on April 30, 2019 http://theoncologist.alphamedpress.org/ Downloaded fromThis material is protected by U.S.

Predicting Response to Treatment in Gastroesophageal Junction Adenocarcinomas: Combining Clinical, Imaging, and Molecular Biomarkers

“…Gastroesophageal carcinomas have undergone distinct changes in their epidemiology over recent years [8]. The incidence of gastric adenocarcinoma is declining, but in western countries (but not Asian countries) there is an ongoing rise in adenocarcinomas of the distal esophagus and GEJ of more than sixfold in the past three decades [9].…”

Multiple Management Modalities in Esophageal Cancer: Combined Modality Management Approaches

“…For patients with locally advanced disease who are not surgical candidates, definitive chemoradiation with concurrent and adjuvant cisplatin/5-FU has been established as the present standard of care. One troublesome point relates to the extent of radiation fields; the Japanese surgical data suggest that cervical lymph nodes are involved more frequently than we may have appreciated [112]. This suggests extension of radiation fields to cover the neck, but this would be expected also to increase treatment toxicity.…”

pRB expression in esophageal mucosa of individuals at high risk for squamous cell carcinoma of the esophagus

“…The outcome of patients with advanced disease, the most common clinical presentation, is still very poor, and survival rates in five years rarely exceed 5%-10% [16] . ESCC is high prevalent in Southern Brazil, where alcohol consumption, tobacco use and hot "mate" drinking have been implicated as risk factors.…”