Esophageal cancer overview: Difference between revisions
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==Secondary Prevention== | ==Secondary Prevention== | ||
Secondary prevention may be effective in reducing the incidence of esophageal cancer, if treated early at the dysplasia stage with monoclonal antibody therapy. At present, there is no particular program in place to reduce the incidence of esophageal cancer. | Secondary prevention may be effective in reducing the incidence of esophageal cancer, if treated early at the dysplasia stage with monoclonal antibody therapy. At present, there is no particular program in place to reduce the incidence of esophageal cancer. | ||
[[Category:Disease]] | [[Category:Disease]] | ||
Revision as of 13:57, 20 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Esophageal cancer is malignancy of the esophagus. There are two subtypes, squamous cell carcinoma and adenocarcinoma. Esophageal tumors usually lead to dysphagia, odynophagia, weight loss, and hematemesis and are diagnosed by carrying out a biopsy. Esophageal cancer must be differentiated from gastroesophageal reflux disease (GERD), Barrett's esophagus, esophageal achalasia, gastritis, gastric ulcer, and stomach cancer. Common risk factors in the development of esophageal cancer are smoking, alcohol, gastroesophageal reflux disease, and Barrett's esophagus. Small and localized tumors are treated with surgery, and advanced tumors are treated with chemotherapy, radiotherapy or a combination of both. Prognosis depends on the extent of the disease and other medical problems, but is fairly poor.
Classification
Esophageal cancer may be classified into squamous cell carcinoma or adenocarcinoma based on histology.
Pathophysiology
The pathophysiology of esophageal cancer depends on the histological subtype whether squamous cell carcinoma or adenocarcinoma.
Differential diagnosis
Esophageal cancer must be differentiated from gastroesophageal reflux disease (GERD), Barrett's esophagus, esophageal achalasia, gastritis, gastric ulcer, and stomach cancer.
Epidemiology and Demographics
Esophageal cancer is the 6th leading cause of death from cancer and the 8th most common cancer in the world. In the United States, about 17000 new cases are diagnosed every year and 4.45 per 100,000 Americans has esophageal cancer. Esophageal cancer is mostly present in the "Asian belt" region which includes, Chin, Japan, India and Iran.
Risk Factors
Common risk factors in the development of esophageal cancer are tobacco smoking, alcohol, gastroesophageal reflux disease, and Barrett's esophagus.
Screening
Screening may be effective in reducing the incidence of esophageal cancer, especially in Barrett's esophagus-associated adenocarcinoma, however, not very cost effective.
Natural History, Screening and Prognosis
The incidence of esophageal dysplasia turning malignant is very low, especially outside the United States. Complications of esophageal cancer include dysphagia, anemia, and tracheoesophageal fistula. This finding has caused some uncertainty as to the usefulness of screening. Esophageal cancer is associated with a 5 year survival rate of 20%.
Diagnostic Study of Choice
Esophageal cancer is best diagnosed using an endoscope to visualize the esophageal lesion, followed by a biopsy to confirm the diagnosis. These are performed in the same sitting.
Staging
According to the American Joint Committee on Cancer, there are 4 stages of esophageal cancer based on the different degrees of tumor spread.
History and Symptoms
Patient history in esophageal cancer includes pain in the throat or chest, regurgitation of food and hoarseness of voice. Symptoms of esophageal cancer include dysphagia, odynophagia, weight loss, and hematemesis. It should be noted that superficial esophageal cancer may have an insidious onset, so screening for Barrett's esophagus is important in this case to diagnose cancer earlier.
Physical examination
Physical examination of patients with esophageal cancer is usually unremarkable.
Laboratory Findings
There are no diagnostic lab findings since diagnosis is based mainly on biopsy and esophageal endoscopy. However, routine tests are done to rule out anemia and metastases to the liver.
CT
CT scan may be used for staging of esophageal cancer. Findings on CT scan suggestive of esophageal cancer include eccentric or circumferential wall thickening, or peri-esophageal soft tissue and fat stranding.
MRI
MRI can be useful when used with positive emission tomography (PET) for staging esophageal cancer since it has greater soft tissue contrast than CT.
Other Imaging Findings
Other imaging studies for esophageal cancer include positive emission tomography scanning with 18-fluorodeoxyglucose (FDG-PET).
Other Diagnostic Studies
Laparoscopy, thoracoscopy and bronchoscopy can be used in addition to EUS and CT in locally advanced esophageal cancer.
Medical Therapy
The predominant therapy for esophageal cancer is surgical. Chemotherapy is used to treat advanced esophageal cancer. Chemotherapy can be used alone as monotherapy or in combination with radiotherapy or surgery. Chemotherapy may be used as adjuvant therapy to shrink a tumor before being surgically resected or as neoadjuvant therapy after surgery to kill any cancerous cells that may have been left, and finally, in advanced tumors to shrink them or to relieve symptoms.
Surgery
The predominant therapy for esophageal cancer is surgical resection by esophagectomy. Adjunctive chemotherapy and radiation may be required in more advanced cases of esophageal cancer.
Primary Prevention
Effective measures for the primary prevention of esophageal cancer include the treatment of gastroesophageal reflux disease and Barrett's esophagus, weight loss, avoidance of tobacco and alcohol, and a diet rich in fruits and vegetables.
Secondary Prevention
Secondary prevention may be effective in reducing the incidence of esophageal cancer, if treated early at the dysplasia stage with monoclonal antibody therapy. At present, there is no particular program in place to reduce the incidence of esophageal cancer.