Esophageal Cancer

The principal histologic types of esophageal cancer are squamous cell carcinoma and adenocarcinomasquamous cell carcinoma

Etiology cigarette smoking and chronic alcohol exposure as the most common etiologic factors for squamous cell carcinoma.

High body mass index, GERD, and resultant Barrett esophagus are often the associated factors for esophageal adenocarcinoma

Nutritional deficiencies have been recognized as contributing factors. In high-risk regions such as parts of China and Iran, deficiencies in vitamins (eg, riboflavin) or micronutrients may play a role in causation.

other factors may promote esophageal cancer Caustic injuries Certain foodstuffs Drinking hot liquids Environmental contributors (eg, nitrosamines in soil) Certain fungi, molds, or yeasts Acquired conditions (eg, achalasia)

Helicobacter pylori infection, which can cause stomach cancer, has not been associated with esophageal cancer

History Dysphagia, Weight loss Bleeding Pain may be felt in the epigastric or retrosternal area; Hoarseness Persistent cough Respiratory symptoms

Physical examination Physical examination findings in patients with esophageal cancer are typically normal, unless the cancer has metastasized to neck nodes or the liver.

Approach Considerations The goals of the workup are to establish the diagnosis and to stage the cancer. Esophagogastroduodenoscopy allows direct visualization and biopsies of the tumor

For early-stage esophageal cancer, CT of the chest and abdomen is an optional test for staging For early-stage esophageal cancer, PET is an optional test for staging. For locoregionalized esophageal cancer, PET is a recommended test for staging

Endoscopic ultrasonography (EUS) is the most sensitive test for determining the depth of tumor penetration (T staging) and the presence of enlarged periesophageal lymph nodes (N staging)

Contraindications to surgery include the following Metastasis to N2 nodes (ie, cervical or supraclavicular lymph nodes) or solid organs (eg, liver, lungs) Invasion of adjacent structures (eg, the recurrent laryngeal nerve, tracheobronchial tree, aorta, pericardium)

A forced expiratory volume in 1 second of less than 1.2 L and a left ventricular ejection fraction of less than 0.4 are relative contraindications to the operation.

Chemotherapy and radiotherapy for esophageal cancer are delivered preoperatively. No survival benefit is obtained when radiation and chemotherapy are administered postoperatively; however, postoperative continuance of chemotherapy started preoperatively may be beneficial

Prevention of Esophageal Cancer For squamous cell carcinoma, prevention consists of smoking cessation, efforts to reduce alcohol abuse, and consumption of a diet containing an adequate amount of fruits, vegetables, and vitamins For esophageal adenocarcinomas, prevention involves stopping the sequence of events leading from gastroesophageal reflux disease (GERD) to Barrett esophagus to adenocarcinoma.