小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 吞咽困难
- 吞咽痛
- 体重减轻
其他诊断因素
- 声嘶
- 呃逆
- 餐后/阵发性咳嗽
危险因素
- 男性
- 吸烟（鳞癌）
- 饮酒（鳞癌）
- GORD和巴雷特食管（腺癌）
- 食管裂孔疝（腺癌）
- 食管癌或其他癌症（鳞状细胞癌）家族史
- 低等社会经济状况
- 非白种人（鳞癌）
- 高温饮料和食物（鳞癌）
- 饮用马黛茶（鳞癌）
- 摄入新鲜水果和蔬菜量少
- 肥胖（腺癌）
- 人乳头瘤病毒（鳞癌）
- 贲门失弛缓（鳞癌）
- 三硝酸甘油酯、抗胆碱能类药物、β-肾上腺素类药物、氨茶碱、苯二氮卓类药物（腺癌）
- 维生素和矿物质缺乏（鳞癌）
- 口腔卫生不佳
诊断性检查
首要检查
- 食管胃十二指肠镜检查 (OGD) 及活组织检查
- 综合代谢分析
需考虑的检查
- 胸腹部CT
- 胸腹部MRI
- FDG-PET 扫描
- 超声内镜 (EUS) ± 细针穿刺活检 (FNA)
- 支气管镜检查 ± FNA
- 胸腔镜和腹腔镜
- 肺功能检查 (PFT)
- 心脏负荷试验
- 超声心动图
治疗流程
限制性疾病（cT1、cN0、M0）
局部疾病（cT2、cN0、M0）：适合手术
局限性疾病（cT2、cN0 和 M0）：不适合手术
局部晚期疾病（cT3-4、cN1-3、M0）：适合手术
局部晚期疾病（cT3-4、cN1-3、M0）：不适合手术
转移性（M1）疾病
复发性疾病
撰稿人
作者
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
利益声明
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) oesophago-gastric sub-group. NS has acted as a clinical expert in oesophago-gastric 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 Programme 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
利益声明
CF declares that she has no competing interests.
鸣谢
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.
利益声明
MJK is an author of several references cited in this topic. GA declares that he has no competing interests.
同行评议者
Peter McCulloch, MBChB, MA, MD, FRCS (Ed), FRCS (Glas)
Clinical Reader in Surgery
Nuffield Department of Surgery
University of Oxford
Oxford
UK
利益声明
PM declares that he has no competing interests.
Nikhil I. Khushalani, MD
Assistant Professor of Oncology
Roswell Park Cancer Institute
Buffalo
NY
利益声明
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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