Esophageal cancer and management of localized disease: a review.

Abstract

Esophageal cancer is often diagnosed in its late stages with a 5-year overall survival rate of approximately 28% in British Columbia. It frequently presents as either squamous cell carcinoma or adenocarcinoma. The most common presenting complaint is dysphagia, typically characterized by a worsening tolerance to solid foods.

Esophagogastroduodenoscopy with biopsy is the gold standard for diagnosis. CT scan of the chest and abdomen, FDG-PET scan, and endoscopic ultrasound are useful staging investigations.

Esophageal cancer is a heterogeneous disease with no single optimal treatment algorithm. Esophagectomy is the preferred treatment modality in Tis-T1 disease. Neoadjuvant chemoradiotherapy prior to definitive surgery should always be considered in T2 disease and is recommended in ≥T3 or N+ disease. There is controversial evidence against the survival benefit and potential added morbidity of neoadjuvant chemoradiotherapy in the treatment of early esophageal cancer. Unresectable and cervical tumors should be treated with definitive chemoradiotherapy. The optimal treatment of adenocarcinomas of the distal esophagus and gastro-esophageal junction is under investigation but likely includes peri-operative chemotherapy.

Current research in esophageal cancer includes the use of early FDG-PET scans to assess response to chemotherapy, which could have important implications in prognostication and treatment decisions.

Keywords: localized esophageal cancer, management, chemoradiotherapy, FDG-PET