Clinical Review

Esophageal Cancer: Current Diagnosis and Management

Journal of Clinical Outcomes Management. 2014 August;21(8)

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Esophageal cancer patients who are treated successfully need to be followed closely because a majority of esophageal cancers will recur within 3 years of treatment [61]. For the first 3 years post treatment, patients should be followed every 3 to 6 months [61]. For 3 to 5 years after treatment, patients should be followed every 6 months and annually thereafter [61]. During each visit, patients should have a thorough history and physical exam and assessment of quality of life [61]. Laboratory studies and EGD are performed as clinically indicated [61]. The importance of intensive post-treatment endoscopic surveillance should be emphasized given a defined rate of disease recurrence. Additionally, radiographic imaging such as CT of the chest and abdomen with contrast or PET/CT may be needed for restaging purposes [61].

Conclusion

Esophageal adenocarcinoma and esophageal SCC are aggressive cancers with poor prognosis. Overall, esophageal adenocarcinoma has increased in incidence, while the incidence of SCC has decreased in the Western world. GERD is the most common cause of esophageal adenocarcinoma, whereas increased alcohol consumption and tobacco commonly lead to esophageal SCC.

For patients with suspected esophageal cancer, a barium swallow is an inexpensive initial diagnostic study that is usually followed up with EGD with biopsies if suggestive of cancer. Once cancer is confirmed, a CT scan with intravenous contrast is obtained to look for adenopathy and metastasis. Those who do not have evidence of metastasis on CT scan typically undergo EUS for definitive locoregional staging.

In the past, patients with early stage esophageal cancer were referred for esophagectomy, but recently EMR has emerged as a viable alternative. Patients with locally advanced esophageal cancers are usually treated with neoadjuvant chemoradiation in combination with surgery. In addition, several studies have showed that esophageal stenting prior to neoadjuvant treatment significantly improves patients’ dysphagia. Unfortunately, many patients still initially present with metastatic or nonresectable disease. Improvement of quality of life is a major goal in patients with unresectable disease. Chemoradiotherapy, esophageal stenting, and brachytherapy are options for improvement of quality of life. Further studies are still needed to evaluate current and new therapeutic guidelines for resectable and nonresectable disease.

Corresponding author: Douglas G. Adler, MD, 30N 1900E 4R118, Salt Lake City, UT 84132, douglas.adler@hsc.utah.edu.

Financial disclosures: None.