Esophageal Cancer and Management of Localized Disease: A Review

Matthew Chan, Rohit Paib, Frank Wong, John Hay, Eric Yoshida

ABSTRACT

Esophageal cancer is often diagnosed in its late stages, with a 5–year overall survival rate of approximately 28 % in British Columbia. It frequently presents as either squamous cell carcinoma or adenocarcinoma. The most common presenting complaint is dysphagia, typically characterized by a worsening tolerance to solid foods. Esophagogastroduodenoscopy with biopsy is the gold standard for diagnosis. Useful staging investigations include computed tomography scan of the chest and abdomen, 18–fluoro–deoxyglucose–positron emission tomography scan, and endoscopic ultrasound. Esophageal cancer is a heterogeneous disease with no single optimal treatment algorithm. Esophagectomy has traditionally been the gold standard treatment in early–stage (Tis-T1) disease, but endoscopic treatment is also an option. Neoadjuvant chemoradiotherapy prior to definitive surgery should always be considered in more invasive (T2) disease, and it is recommended in late–stage (≥T3 or N+) disease. There is controversial evidence against the survival benefit and potential added morbidity of neoadjuvant chemoradiotherapy in the treatment of early esophageal cancer. Unresectable and cervical tumors should be treated with definitive chemoradiotherapy. The optimal treatment of adenocarcinomas of the distal esophagus and gastro–esophageal junction is under investigation, but it likely includes peri–operative chemotherapy. Current research in esophageal cancer is investigating the use of early 18–fluoro–deoxyglucose–positron emission tomography scans to assess response to chemotherapy, which could have important implications in prognostication and treatment decisions.

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Chan M, Paib R, Wong F, Hay J, Yoshida E. Esophageal Cancer and Management of Localized Disease: A Review. UBCMJ. 2015; 6(2):37-40.