Esophageal cancer

Last reviewed: 24 Apr 2022
Last updated: 18 Jan 2022

Summary

Definition

History and exam

Key diagnostic factors

  • dysphagia
  • odynophagia
  • weight loss
More key diagnostic factors

Other diagnostic factors

  • hoarseness
  • hiccups
  • postprandial/paroxysmal cough
Other diagnostic factors

Risk factors

  • male sex
  • tobacco use (squamous cell carcinoma)
  • alcohol use (squamous cell carcinoma)
  • GERD and Barrett esophagus (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
  • obesity (adenocarcinoma)
  • human papillomavirus (squamous cell carcinoma)
  • achalasia (squamous cell carcinoma)
  • nitroglycerin, anticholinergics, beta-adrenergics, aminophyllines, benzodiazepines (adenocarcinoma)
  • vitamin and mineral deficiencies (squamous cell carcinoma)
  • poor oral hygiene
More risk factors

Diagnostic investigations

1st investigations to order

  • esophagogastroduodenoscopy (EGD) with biopsy
  • comprehensive metabolic panel
More 1st investigations to order

Investigations to consider

  • CT thorax and abdomen
  • MRI thorax and abdomen
  • FDG-PET scan
  • endoscopic ultrasound (EUS) ± fine needle aspiration (FNA)
  • bronchoscopy ± FNA
  • thoracoscopy and laparoscopy
  • pulmonary function tests
  • cardiac stress test
  • echocardiogram
More investigations to consider

Treatment algorithm

ACUTE

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

ONGOING

recurrent disease

Contributors

Authors

Naureen Starling, BSc(Hons), MBBS, MD(Res), FRCP

Consultant Medical Oncologist in GI Cancers

Associate Director of Clinical Research, GI and Lymphoma

The Royal Marsden Hospital NHS Trust

London

UK

Disclosures

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.

Caroline Fong, MBChB, MRes, MRCP

Clinical Research Fellow

GI and Lymphoma Unit

The Royal Marsden Hospital NHS Trust

London

UK

Disclosures

CF declares that she has no competing interests.

Acknowledgements

Dr Naureen Starling and Dr Caroline Fong would like to gratefully acknowledge Dr Mark J. Krasna and Dr Ghulam Abbas, 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.

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).

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