Esophageal cancer incidence is increasing across the developed world. Men are considerably more likely than women to develop the disease.
The two main histologic types are squamous cell carcinoma and adenocarcinoma. In the developed world, adenocarcinomas predominate.
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.
Targeted therapies can be used in patients with metastatic esophageal and esophageal junction cancer.
Treatment decisions for patients with recurrent or refractory disease are informed by prior treatment history.
Most esophageal cancers are neoplastic mucosal lesions that originate in the epithelial cells lining the esophagus.
Esophageal cancers are usually squamous cell carcinomas or adenocarcinomas.
Rarely, other cancers, such as melanoma, sarcoma, small cell carcinoma, or lymphoma, can occur in the esophagus.
History and exam
Key diagnostic factors
- weight loss
Other diagnostic factors
- postprandial/paroxysmal cough
- 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)
- vitamin and mineral deficiencies (squamous cell carcinoma)
- poor oral hygiene (squamous cell carcinoma)
1st investigations to order
- esophagogastroduodenoscopy (EGD) with biopsy
- CT thorax and abdomen
- (18F)-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scan
Investigations to consider
- comprehensive metabolic panel
- MRI thorax and abdomen
- endoscopic ultrasound (EUS) ± fine needle aspiration (FNA)
- bronchoscopy ± FNA
- thoracoscopy and laparoscopy
- molecular and pathologic tests
- liquid biopsy
- pulmonary function tests
- cardiac stress test
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
- Benign stricture
- Barrett esophagus
- NCCN clinical practice guidelines in oncology: esophageal and esophagogastric junction cancers
- NCCN clinical practice guidelines in oncology: management of immunotherapy-related toxicities
Quitting smokingMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer