Incidence is increasing across the Western world.
Men are twice as likely as women to develop the disease.
The 2 main histological types are squamous cell carcinoma and adenocarcinoma. In the US, adenocarcinomas now account for 80% of cases overall.
Low socioeconomic status, smoking, excessive alcohol use, GORD, Barrett's oesophagus, and obesity are some of the main risk factors.
Tumours are often locally advanced at the time of diagnosis. Accurate staging is important for prognosis and treatment planning.
Superficial intramucosal oesophageal cancer is best managed by endoscopic resection and surveillance.
Early stage cancers in surgical candidates are best treated by oesophagectomy.
For locally advanced disease, combined modality therapy is considered the current standard. This involves chemotherapy or chemoradiotherapy followed by surgery.
High-risk patients should be treated with a combination of chemotherapy and radiotherapy for best results, but local recurrence rates remain high.
Most oesophageal cancers are mucosal lesions that originate in the epithelial cells lining the oesophagus.
History and exam
- male sex
- tobacco use (squamous cell carcinoma)
- alcohol use (squamous cell carcinoma)
- GORD and Barrett's oesophagus (adenocarcinoma)
- hiatus hernia (adenocarcinoma)
- FHx of oesophageal, stomach, oral, or pharyngeal cancer (squamous cell carcinoma)
- low socioeconomic status
- non-white race (squamous cell carcinoma)
- high-temperature beverages and foods (squamous cell carcinoma)
- drinking maté (squamous cell carcinoma)
- low intake of fresh fruit and vegetables
- obesity (adenocarcinoma)
- human papillomavirus (squamous cell carcinoma)
- achalasia (squamous cell carcinoma)
- glyceryl trinitrate, anticholinergics, beta-adrenergics, aminophyllines, benzodiazepines (adenocarcinoma)
- vitamin and mineral deficiencies (squamous cell carcinoma)
- poor oral hygiene
Cancer Institute of New Jersey System Partnership Leader
Oncology Service Line
MJK is an author of several references cited in this monograph.
Minimally invasive Thoracic Surgery Meridian Health
Meridian Health System
GA declares that he has no competing interests.
Clinical Reader in Surgery
Nuffield Department of Surgery
University of Oxford
PM declares that he has no competing interests.
Assistant Professor of Oncology
Roswell Park Cancer Institute
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).
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