Esophageal cancer incidence is increasing across the Western world.
Men are twice as likely as women to develop the disease.
The 2 main histologic 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, GERD, Barrett esophagus, and obesity are some of the main risk factors.
Tumors are often locally advanced at the time of diagnosis. Accurate staging is important for prognosis and treatment planning.
Superficial intramucosal esophageal cancer is best managed by endoscopic resection and surveillance.
Early stage cancers in surgical candidates are best treated by esophagectomy.
For locally advanced disease, combined modality therapy is considered the current standard. This involves chemotherapy or chemoradiation followed by surgery.
High-risk patients should be treated with combination chemoradiation for best results, but local recurrence rates remain high.
Most esophageal cancers are mucosal lesions that originate in the epithelial cells lining the esophagus.
History and exam
- male gender
- tobacco use (squamous cell carcinoma)
- alcohol use (squamous cell carcinoma)
- GERD and Barrett esophagus (adenocarcinoma)
- hiatal hernia (adenocarcinoma)
- FHx of esophageal, stomach, oral, or pharyngeal 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
Mark J. Krasna, MD
Cancer Institute of New Jersey System Partnership Leader
Oncology Service Line
MJK is an author of several references cited in this monograph.
Ghulam Abbas, MD, MHCM, FACS
Minimally invasive Thoracic Surgery Meridian Health
Meridian Health System
GA declares that he has no competing interests.
Peter McCulloch, MBChB, MA, MD, FRCS (Ed), FRCS (Glas)
Clinical Reader in Surgery
Nuffield Department of Surgery
University of Oxford
PM declares that he has no competing interests.
Nikhil I. Khushalani, MD
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).
Use of this content is subject to our disclaimer