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Esophageal Cancer

General Principles

Epidemiology and Etiology

Esophageal cancer is estimated to account for nearly 15,590 deaths in the United States in 2015. Esophageal cancer is three to four times more common in men than in women. Risk factors include tobacco, alcohol, obesity, gastroesophageal reflux disease, Barrett esophagus, achalasia, and caustic injury.

Pathology

Adenocarcinomas are most common in the lower third of the esophagus and at the gastroesophageal junction and have had a sharp increase in incidence over the last few decades in the United States. Squamous cell carcinomas are more common in the upper and middle esophagus.

Diagnosis

Clinical Presentation

Patients usually present with progressive dysphagia and weight loss. Other symptoms include odynophagia, cough, regurgitation, and hoarseness.

Diagnostic Testing

  • The diagnosis is usually established through upper endoscopy with biopsy.
  • Staging workup includes CT of the chest and abdomen (with or without PET) to determine the presence of distant metastases. For patients without distant metastases, endoscopic ultrasonography (EUS) is required for the definition of tumor depth and lymph node status.
  • Tumors located above the carina increase the risk of tracheoesophageal (TE) fistula formation and should be evaluated with bronchoscopy. Patients with TE fistulas often present with postprandial cough and aspiration pneumonias.

Treatment

  • Resectable disease: Patients with resectable disease are candidates for esophagectomy with or without preoperative chemotherapy and radiation (N Engl J Med 2012;366:2074  [PMID:22646630]), depending on the extent of disease.
  • Unresectable primary disease: Patients diagnosed with locally advanced disease are usually managed by concurrent chemoradiation.
  • Metastatic disease is treated with palliative chemotherapy, usually with regimens including 5FU, platinum, and a taxane or anthracycline agent. Ramucirumab, an antibody against vascular endothelial growth factor receptor-2 (VEGFR-2), is approved for use in the second-line setting in combination with paclitaxel or as a single agent (Lancet 2014;383:31  [PMID:24094768]).
  • Trastuzumab can be used in combination with chemotherapy in patients with HER2-amplified esophageal or gastroesophageal junction metastatic adenocarcinomas.

Outline


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Citation

Williams, Dominique, et al., editors. "Esophageal Cancer." Washington Manual of Medical Therapeutics, 35th ed., Wolters Kluwer Health, 2016. Washington Manual, www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602203/all/Esophageal_Cancer.
Esophageal Cancer. In: Williams D, Ramgopal R, Gdowski M, et al, eds. Washington Manual of Medical Therapeutics. 35th ed. Wolters Kluwer Health; 2016. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602203/all/Esophageal_Cancer. Accessed June 26, 2019.
Esophageal Cancer. (2016). In Williams, D., Ramgopal, R., Gdowski, M., Dretler, A., & Bhat, P. (Eds.), Washington Manual of Medical Therapeutics. Available from https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602203/all/Esophageal_Cancer
Esophageal Cancer [Internet]. In: Williams D, Ramgopal R, Gdowski M, Dretler A, Bhat P, editors. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. [cited 2019 June 26]. Available from: https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602203/all/Esophageal_Cancer.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Esophageal Cancer ID - 602203 ED - Williams,Dominique, ED - Ramgopal,Rajeev, ED - Gdowski,Mark, ED - Dretler,Alexandra, ED - Bhat,Pavat, BT - Washington Manual of Medical Therapeutics UR - https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602203/all/Esophageal_Cancer PB - Wolters Kluwer Health ET - 35 DB - Washington Manual DP - Unbound Medicine ER -