Esophageal cancer

Abstract

Esophageal cancer is a notoriously difficult cancer to treat. Locoregional therapies, such as surgery and radiotherapy, are hampered by the anatomic proximity of the esophagus to vital structures, its rich and multidirectional lymphatic plexus, and, typically, by the late stage of symptomatic disease. Currently available systemic therapies, such as chemotherapy, are effective but they leave much to be desired. Chemotherapy's effectiveness, perhaps surprisingly, relates in large measure to its synergism with radiotherapy at the locoregional level. All the major treatment modalities are hampered by the typical patient's inability to easily tolerate aggressive therapy, but this is especially so for surgical therapy. One only has to contrast the rigors of esophagectomy, especially after chemoradiation, with the tolerability of breast cancer surgery or right hemicolectomy, to see this point. Taking these factors together, esophageal cancer remains one of the most difficult cancers for an oncologist of any discipline to treat and one of the most difficult malignant illnesses that a patient can face. Sadly, it is also a cancer that is rapidly increasing in incidence, at least in the Western world. © 2006 Springer Science+Business Media, Inc.