When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Câncer esofágico

Última revisão: 4 Oct 2024
Última atualização: 22 Feb 2024

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presença de fatores de risco
  • disfagia
  • odinofagia
  • perda de peso
Detalhes completos

Outros fatores diagnósticos

  • soluços
  • tosse pós-prandial/paroxística
Detalhes completos

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)
Detalhes completos

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
Detalhes completos

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
Detalhes completos

Algoritmo de tratamento

Aguda

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)

Contínua

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).

O uso deste conteúdo está sujeito ao nosso aviso legal