Summary
Definition
History and exam
Key diagnostic factors
- dysphagia
- odynophagia
- weight loss
Other diagnostic factors
- hiccups
- postprandial/paroxysmal cough
Risk factors
- male sex
- older age
- tobacco use
- excessive alcohol use (squamous cell carcinoma)
- Barrett esophagus (adenocarcinoma)
- GERD (adenocarcinoma)
- hiatal hernia (adenocarcinoma)
- family history of esophageal or other cancer (squamous cell carcinoma)
- low socioeconomic status
- nonwhite race (squamous cell carcinoma)
- high-temperature beverages and foods (squamous cell carcinoma)
- drinking maté (squamous cell carcinoma)
- low intake of fresh fruit and vegetables
- hereditary cancer syndromes
- obesity (adenocarcinoma)
- human papillomavirus (squamous cell carcinoma)
- achalasia
- vitamin and mineral deficiencies (squamous cell carcinoma)
- poor oral hygiene (squamous cell carcinoma)
Diagnostic tests
1st tests to order
- esophagogastroduodenoscopy (EGD) with biopsy
- endoscopic ultrasound (EUS) ± fine needle aspiration (FNA)
- CT thorax and abdomen
- (18F)-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scan
- molecular and pathologic tests
Tests to consider
- comprehensive metabolic panel
- MRI thorax and abdomen
- bronchoscopy ± fine needle aspiration (FNA)
- thoracoscopy and laparoscopy
- liquid biopsy
- pulmonary function tests
- cardiac stress test
- echocardiogram
Treatment algorithm
limited disease (cT1, cN0, M0)
localized disease (cT2, cN0, M0): suitable for surgery
localized disease (cT2, cN0, M0): unsuitable for surgery
locally advanced disease (cT3-4, cN1-3, M0): suitable for surgery
locally advanced disease (cT3-4, cN1-3, M0): unsuitable for surgery
metastatic (M1) disease
recurrent disease
Contributors
Authors
Ravi Rajaram, MD MSc FACS
Assistant Professor
Thoracic and Cardiovascular Surgery
University of Texas MD Anderson Cancer Center
Houston
TX
Disclosures
RR is a research consultant for Johnson & Johnson and Cook Medical.
Acknowledgements
Dr Ravi Rajaram would like to gratefully acknowledge Dr Naureen Starling, Dr Caroline Fong, Dr Mark J. Krasna, and Dr Ghulam Abbas, the previous contributors to this topic.
Disclosures
MJK is an author of several references cited in this topic. GA declares that he has no competing interests. NS has received research funding from AstraZeneca, BMS, and Pfizer; travel and accommodation funding from AstraZeneca, BMS, Eli Lilly, Merck, Roche, and MSD Oncology; honoraria from Eli Lilly, Merck Serono, MSD Oncology, Pierre Fabre, Servier, GSK, and Amgen. She has been on the advisory board for Pfizer, AstraZeneca, Servier, and MSD (Merck). NS is an Honorary Clinical Senior Lecturer within the Division of Clinical Studies at the Institute of Cancer Research and serves on the UK National Cancer Research Institute (NCRI) esophagogastric sub-group. NS has acted as a clinical expert in esophagogastric cancer for NICE (guideline committee and technology appraisal) and is an upper GI expert for International Cancer Benchmarking Partnership. She is a Trustee for Pancreatic Cancer UK and a member of the EORTC General Assembly representing The Royal Marsden, as well as a member of the European Society for Medical Oncology (ESMO) Gastrointestinal Faculty. Educational roles include the NIHR Training Lead for NIHR Biomedical Research Centre, member of the Cancer Research Centre of Excellence training committee, Deputy Training Program Director (one of three) for South London Medical Oncology Training, member of the pan-London specialist Medical oncology training committee, and member of the Medical Oncology National Recruitment steering committee. CF declares that she has received honoraria from Bristol Myers Squibb.
Peer reviewers
Peter McCulloch, MBChB, MA, MD, FRCS (Ed), FRCS (Glas)
Clinical Reader in Surgery
Nuffield Department of Surgery
University of Oxford
Oxford
UK
Disclosures
PM declares that he has no competing interests.
Nikhil I. Khushalani, MD
Assistant Professor of Oncology
Roswell Park Cancer Institute
Buffalo
NY
Disclosures
NIK has received funding for the conduction of clinical trials and associated translational studies from Merck, Pfizer, and Astra-Zeneca. NIK has a grant from the National Comprehensive Cancer Network (from research support by Roche).
References
Key articles
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: esophageal and esophagogastric junction cancers [internet publication].Full text
Obermannová R, Alsina M, Cervantes A, et al; ESMO Guidelines Committee. Oesophageal cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Oct;33(10):992-1004.Full text Abstract
van Hagen P, Hulshof MC, van Lanschot JJ, et al; CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012 May 31;366(22):2074-84.Full text Abstract
Shapiro J, van Lanschot JJ, Hulshof MC, et al; CROSS study group. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015 Sep;16(9):1090-8. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Benign stricture
- Achalasia
- Barrett esophagus
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: esophageal and esophagogastric junction cancers
- NCCN clinical practice guidelines in oncology: management of immunotherapy-related toxicities
More GuidelinesPatient information
Quitting smoking
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