Current Innovations in Management of Esophageal Carcinoma
Pp. 52-133 (82)
Julie H. Rowe, Fathima Kamil, Melissa Yan, Curtis J. Wray and Atilla Ertan
Esophageal cancer (EC) is the 8th most common cause of cancer worldwide
and is endemic in certain parts of the world, especially in developing countries. The
etiology of EC is multifactorial and includes tobacco and alcohol abuse, obesity,
chronic gastroesophageal reflux disease (GERD), and Barrett's esophagus. In addition,
there are hereditary cancer syndromes associated with an increased risk of ECs.
Histologically, EC is classified as either squamous cell carcinoma (ESCC) or
adenocarcinoma (EAC). The western hemisphere has seen a shift in decreasing
incidence of ESCC versus increasing incidence of EAC. Human epidermal growth
factor receptor 2 (Her2) gene and Her2 protein expression have been implicated in the
pathogenesis of esophageal cancer. A multidisciplinary approach to EC is essential for
workup, management, and treatment. Current therapeutic modalities include
endoscopic treatments, such as endoscopic mucosal resection (EMR), endoscopic
submucosal dissection (ESD), and ablation of early stage disease for both ESCC and
EAC. For locally advanced disease, neoadjuvant chemotherapy and radiation followed
by surgical resection are often used. However, the performance status of the patient as
being “medically fit” versus “unfit” also plays an instrumental role in determining
treatment. For metastatic EC, palliative chemotherapy remains the sole treatment. Most
recently, there has been interest in moving beyond standard cytotoxic chemotherapy
and to explore novel agents including immunotherapy, which could result in more
promising outcomes in this malignancy.
Endoscopy, Esophageal adenocarcinoma, Esophageal cancer,
Immunotherapy, Squamous cell carcinoma, Targeted therapy.
Department of Internal Medicine, Division of Oncology.