Esophageal Cancer: Epidemiology, Diagnosis, and Treatment

Abstract

Esophageal cancer is a relatively uncommon and extremely lethal malignant neoplasm. In the West, this disease is much more common in black males over 50 years of age with low socioeconomic status. Epidemiological distribution suggests the influence of environmental and nutritional factors, with a poorly defined genetic predisposition. Malnutrition associated with alcoholism and smoking can contribute to esophageal carcinogenesis. The presence of painful swallowing, progressive dysphagia, heartburn, stomachache, nausea, and anorexia are suggestive of esophageal cancer. Diagnostic methods for esophageal carcinoma include esophagogram, endoscopy with biopsy, computerized axial tomography, and magnetic resonance imaging. Most patients with esophageal cancer already present to the surgeon with local tumor invasion or metastases. Consequently, many are not candidates for curative treatment. For these, repeated endoluminal dilation therapy and surgical placement of a gastrostomy or jejunostomy tube are used as palliation. Early detection allows possible surgical resection of the tumor and local lymph nodes and reconstruction of the esophagogastric tract. Current treatment protocols include surgery, chemotherapy, and radiation therapy. Although no data on efficacy have been published, efforts at early detection of squamous cell cancer have demonstrated the possibility of detection in early asymptomatic stages.