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Esophageal Carcinoma
1
What are the presenting signs and symptoms of esophageal cancer?
Presenting symptoms most commonly include progressive dysphagia and weight loss. Notably, a tumor can obstruct over half of the esophageal lumen before dysphagia becomes symptomatic. Symptoms common to gastroesophageal reflux disease (GERD) such as chest or epigastric pain and regurgitation are also reported. Signs and symptoms of more advanced disease include melena and anemia from upper gastrointestinal bleeding, coughing or choking from a tracheoesophageal fistula, and hoarseness from recurrent laryngeal nerve involvement.
2
What is the epidemiology of esophageal cancer?
Esophageal cancer is the eighth most common cancer in the world and sixth most common cause of cancer death in the world. Its prevalence is highest in developing nations, particularly Asia and Eastern Africa. In the United States, it is estimated that in 2016 there will be 16,910 new diagnosis and 15,690 deaths from esophageal cancer. Esophageal cancer is roughly four times more prevalent in males, and is estimated to be the seventh most common cause of cancer death in males in 2016. The incidence of esophageal cancer is highest in the seventh decade of life.
3
What are the histological subtypes of esophageal cancer?
The two primary histological subtypes of esophageal cancer are adenocarcinoma and squamous cell carcinoma. Worldwide, squamous cell carcinoma is more common than adenocarcinoma, representing roughly 90% of cases. In North America and most Western European countries, adenocarcinoma is now more common than squamous cell carcinoma. The incidence of adenocarcinoma began dramatically rising in Western countries in the 1970s and may be attributed to increased rates of obesity and GERD. Conversely, the incidence of squamous cell carcinoma in Western countries has been on the decline. Squamous cell cancer is most commonly found in the upper third of the esophagus, while adenocarcinoma is most commonly found in the lower third of the esophagus. Histologic subtype is also important in treatment decisions as upper squamous cell are often treated nonsurgically with definitive chemoradiation therapy, while the treatment for adenocarcinoma involves surgical resection.
4
What are the risk factors for developing esophageal cancer?
Key risk factors for developing esophageal adenocarcinoma are GERD (five- to eightfold risk increase), obesity (twofold), cigarette smoking (twofold), male sex, and white ethnicity. Key risk factors for developing squamous cell carcinoma are alcohol consumption (three- to fourfold), cigarette smoking (three- to fivefold), and male sex. Alcohol consumption and cigarette smoking also appear to have a synergistic effect on this risk.
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