Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- disfagia
- odinofagia
- perda de peso
Outros fatores diagnósticos
- soluços
- tosse pós-prandial/paroxística
Fatores de risco
- sexo masculino
- idade avançada
- tabagismo
- uso excessivo de álcool (carcinoma de células escamosas)
- Esôfago de Barrett (adenocarcinoma)
- DRGE (adenocarcinoma)
- hérnia de hiato (adenocarcinoma)
- história familiar de câncer esofágico ou outro tipo de câncer (carcinoma de células escamosas)
- condição socioeconômica baixa
- raça não branca (carcinoma de células escamosas)
- bebidas e alimentos em alta temperatura (carcinoma de células escamosas)
- consumo de chimarrão (carcinoma de células escamosas)
- baixa ingestão de frutas e verduras frescas
- síndromes de cânceres hereditários
- obesidade (adenocarcinoma)
- papilomavírus humano (carcinoma de células escamosas)
- acalasia
- deficiências de vitaminas e minerais (carcinoma de células escamosas)
- higiene bucal insatisfatória (carcinoma de células escamosas)
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- endoscopia digestiva alta (EDA) com biópsia
- ultrassonografia endoscópica (USE) ± aspiração com agulha fina (AAF)
- tomografia computadorizada (TC) de tórax e abdominal
- tomografia por emissão de pósitrons com 2-flúor-2-desoxi-D-glucose (FDG-PET)
- testes moleculares e patológicos
Investigações a serem consideradas
- perfil metabólico abrangente
- ressonância nuclear magnética (RNM) de tórax e abdome
- broncoscopia ± AAF
- toracoscopia e laparoscopia
- biópsia líquida
- testes de função pulmonar
- prova de esforço
- ecocardiograma
Algoritmo de tratamento
doença limitada (cT1, cN0, M0)
doença localizada (cT2, cN0, M0): elegível para cirurgia
doença localizada (cT2, cN0, M0): não elegível para cirurgia
doença localmente avançada (cT3-4, cN1-3, M0): elegível para cirurgia
doença localmente avançada (cT3-4, cN1-3, M0): não elegível para cirurgia
doença metastática (M1)
doença recorrente
Colaboradores
Autores
Ravi Rajaram, MD MSc FACS
Assistant Professor
Thoracic and Cardiovascular Surgery
University of Texas MD Anderson Cancer Center
Houston
TX
Declarações
RR is a research consultant for Johnson & Johnson and Cook Medical.
Agradecimentos
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.
Declarações
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) oesophagogastric sub-group. NS has acted as a clinical expert in oesophagogastric 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.
Revisores
Peter McCulloch, MBChB, MA, MD, FRCS (Ed), FRCS (Glas)
Clinical Reader in Surgery
Nuffield Department of Surgery
University of Oxford
Oxford
UK
Declarações
PM declares that he has no competing interests.
Nikhil I. Khushalani, MD
Assistant Professor of Oncology
Roswell Park Cancer Institute
Buffalo
NY
Declarações
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.
Referências
Principais artigos
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: esophageal and esophagogastric junction cancers [internet publication].Texto completo
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.Texto completo Resumo
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.Texto completo Resumo
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. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Estenose benigna
- Acalasia
- esôfago de Barrett
Mais Diagnósticos diferenciaisDiretrizes
- NCCN clinical practice guidelines in oncology: esophageal and esophagogastric junction cancers
- NCCN clinical practice guidelines in oncology: management of immunotherapy-related toxicities
Mais DiretrizesFolhetos informativos para os pacientes
Abandono do hábito de fumar
Câncer esofágico
Mais Folhetos informativos para os pacientes
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