Esophageal Cancer—An Update Review

With the decrease of cancer incidences in a few major cancers, such as breast cancer and lung cancer, the incidence of esophageal cancer has still been climbing up steadily for the past decades, especially adenocarcinoma. Our views on esophageal cancer have been evolving as well. Modifications of the American Joint Committee on Cancer (AJCC) staging has been implemented in its recent edition in 2010. Diagnostic and follow-up standards are changing with more and more physicians and hospitals considering endoscopic ultrasound-guided biopsy as a minimal requirement for definitive diagnosis and accurate staging. In some large centers and by some physicians, laproscopic/ thorascopic biopsy are attempted to diagnose esophageal cancer with more accurate definitive staging. The widespread use of imaging studies, such as computed tomography and/or positon emission tomography, has improved the diagnosis in guiding the therapeutic options. In early stage esophageal cancer management, the acceptable modalities are still radiofrequency ablation, endoscopic mucosal resection, and photodynamic therapy. The advantages and disadvantages are discussed in this article. Surgical resection of early esophageal cancer of T2 or greater staging or N1 is still considered standard with potential to ‘cure’ while minimal invasive laproscopic surgery showed acceptable improved effects and quality of life but are still limited to some tertiary centers. Multi-modality therapies of esophageal cancer in locally advanced stage, both resectable and unresectable, are discussed in this review. For operable diseases, neoadjuvant therapy, peri-surgery therapy, adjuvant therapy, chemotherapy, and/or radiation therapy are discussed. Unresectable esophageal cancer of both adenocarcinoma and squamous cell carcinoma as well as cancer with Her2/neu expression are also considered. The attached table listed the major landmark phase III clinical trials involving esophageal carcinoma. Metastatic cancer management, including the importance of quality of life management among the survivors is also examined.