Esophageal Cancer: A Review and Update
JOHN C. LAYKE, D.O., University of Illinois Metropolitan Group Hospitals, Chicago, Illinois
PETER P. LOPEZ, M.D., DeWitt Daughtry Family Department of Surgery,
Miller School of Medicine at the University of Miami, Miami, Florida
E
pithelial tumors of the esophagus
(i.e., squamous cell and adenocar-
cinoma) are responsible for more
than 95 percent of all esophageal
carcinomas, with an estimated 14,520 newly
diagnosed cases and 13,570 deaths in 2005.1
Nonepithelial cell carcinomas of the esopha-
gus (e.g., metastatic tumors, lymphomas,
sarcomas) are rare, and no evidence has sug-
gested an increasing trend.
A large portion of new patients with esoph-
ageal cancer will present with advanced
disease (i.e., stages III and IV). Of this
group, 90 percent will have had vague symp-
tomatology for approximately two to four
months.2 There is a need for early detection,
aggressive evaluation, and timely referral to
an appropriate subspecialist.
Epidemiology
Epidemiologic data have shown considerable
variability in determining trends in incidence
of gastrointestinal malignancies worldwide,
emphasizing that multifactorial etiologies are
responsible. A strong association consistently
has been demonstrated between Helicobacter
pylori infection and gastric cancer.3 The over-
all worldwide decrease in the incidence of
gastric cancer may be attributed to the aggres-
sive treatment of H. pylori, but the overall
incidence of esophageal cancer is on the rise.
The rising incidence of esophageal cancer
over the past two decades coincides with a
change in histologic type and primary tumor
location. Adenocarcinoma of the esophagus
has slowly replaced squamous cell carci-
noma as the most common type of esopha-
geal malignancy in the United States and
Western Europe.4 Within the United States,
the reported mean incidence of esophageal
cancer in patients younger than 80 years
is 3.2 per 100,000 persons, with an overall
male-to-female ratio of 3:1.5
Table 12,6,7 lists the m