小结
定义
病史和体格检查
关键诊断因素
- dysphagia
- odynophagia
- weight loss
其他诊断因素
- hiccups
- postprandial/paroxysmal cough
危险因素
- 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)
诊断性检查
首要检查
- 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
需考虑的检查
- comprehensive metabolic panel
- MRI thorax and abdomen
- bronchoscopy ± fine needle aspiration (FNA)
- thoracoscopy and laparoscopy
- liquid biopsy
- pulmonary function tests
- cardiac stress test
- echocardiogram
治疗流程
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
撰稿人
作者
Ravi Rajaram, MD MSc FACS
Assistant Professor
Thoracic and Cardiovascular Surgery
University of Texas MD Anderson Cancer Center
Houston
TX
利益声明
RR is a research consultant for Johnson & Johnson and Cook Medical.
鸣谢
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.
利益声明
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.
同行评议者
Peter McCulloch, MBChB, MA, MD, FRCS (Ed), FRCS (Glas)
Clinical Reader in Surgery
Nuffield Department of Surgery
University of Oxford
Oxford
UK
利益声明
PM declares that he has no competing interests.
Nikhil I. Khushalani, MD
Assistant Professor of Oncology
Roswell Park Cancer Institute
Buffalo
NY
利益声明
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).
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: esophageal and esophagogastric junction cancers [internet publication].全文
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.全文 摘要
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.全文 摘要
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. 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Benign stricture
- Achalasia
- Barrett esophagus
更多 鉴别诊断指南
- NCCN clinical practice guidelines in oncology: esophageal and esophagogastric junction cancers
- NCCN clinical practice guidelines in oncology: management of immunotherapy-related toxicities
更多 指南患者教育信息
Quitting smoking
Esophageal cancer
更多 患者教育信息
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