Esophageal cancer

Abstract

Esophageal cancer has an increasing incidence in countries with a Western life style. This phenomenon must be attributed to the increasing number of adenocarcinoma of the distal esophagus that is associated with gastroesophageal reflux and obesity. With regard to risk factors by location of the tumor and with regard to prognosis, squamous cell cancer and adenocarcinoma must be seen as two distinct tumor entities. Treatment for esophageal cancer is stage-dependent. When distant metastases have been excluded, patients should undergo a sophisticated staging, in order to fix the clinical stage as accurate as possible. In mucosa cancer, endoscopic mucosa resection is associated with a very favorable outcome and can now be regarded as a standard of care. Limited resection (Merendino procedure) and subtotal esophagectomy in selected cases are alternative treatment options. Radical transthoracic esophagectomy is the standard of care for treating the majority of patients presenting with locally advanced tumors. In tumors that penetrate the whole esophageal wall and in presumably nodal positive tumors, neoadjuvant treatment has become a standard of care. While in adenocarcinoma there are positive data for neoadjuvant chemotherapy alone, radiation should be added in squamous cell cancer and seems to be at least as effective as chemotherapy alone in adenocarcinoma. Radiation adds anti-tumor activity but also toxicity and leads to an increased postoperative morbidity. In patients presenting with metastatic disease, palliative treatment is indicated. This usually comprises systemic platinum-chemotherapy. Treatment for advanced adenocarcinoma of the esophagus follows the same rules as chemotherapy for advanced gastric adenocarcinoma. Additionally, endoscopic treatment for alleviating symptoms from local tumor growth is often required. © 2011 Springer-Verlag Berlin Heidelberg.