Esophageal Cancer

The epidemiology of esophageal cancer has marked variations in different areas of the world. The two major types are squamous cell carcinoma and adenocarcinoma; the latter entity has attracted much attention because of increasing prevalence in the Western nations. The major risk factors for adenocarcinoma include long-standing gastroesophageal reflux disease, Barrett’s metaplasia, and obesity. Risk factors for squamous cell carcinoma include alcoholism and smoking. Manifestations include dysphagia to solids and liquids, weight loss, and aspiration. Diagnosis requires upper endoscopy and target biopsies. Staging requires endoscopic ultrasound and CT imaging of chest and abdomen. Management includes surgery, chemotherapy, and radiation, based on location, stage, and type of cancer, in addition to consideration for age and comorbidities. New options for systemic therapy include targeted therapies and immunotherapy.