Multiple management modalities in esophageal cancer: epidemiology, presentation and progression, work-up, and surgical approaches

Emory University School of Medicine, Department of Radiation Oncology, Atlanta, Georgia, USA.
The Oncologist (Impact Factor: 4.87). 02/2004; 9(2):137-46.
Source: PubMed


Annually, approximately 13,200 people in the U.S. are diagnosed with esophageal cancer and 12,500 die of this malignancy. Of new cases, 9,900 occur in men and 3,300 occur in women. In part I of this two-part series, we explore the epidemiology, presentation and progression, work-up, and surgical approaches for esophageal cancer. In the 1960s, squamous cell cancers made up greater than 90% of all esophageal tumors. The incidence of esophageal adenocarcinomas has risen considerably over the past two decades, such that they are now more prevalent than squamous cell cancer in the western hemisphere. Despite advances in therapeutic modalities for this disease, half the patients are incurable at presentation, and overall survival after diagnosis is grim. Evolving knowledge regarding the etiology of esophageal carcinoma may lead to better preventive methods and treatment options for early stage superficial cancers of the esophagus. The use of endoscopic ultrasound and the developing role of positron emission tomography have led to better diagnostic accuracy in this disease. For years, the standard of care for esophageal cancer has been surgery; there are several variants of the surgical approach. We will discuss combined modality approaches in part II of this series.

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Available from: Jerome C Landry, Jan 31, 2014
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    • "Although it is relevant to mention that very wide variations can occur even within a country, as it happens in China where the incidence ranges from 1.4 to 400 per 100,000 inhabitants per year, a fact probably related to variations of diet habits. On the other hand, it is in Western Europe and the USA where it is recorded the lowest incidence of 5 per 100,000 inhabitants per year [13] [14] [15] [16]. Within Europe, the highest incidence is reported in the United Kingdom, France and Ireland [4] [7]. "
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    ABSTRACT: Generalities. The esophageal cancer is the 8th most frequent malignant tumor worldwide, with about 400.000 new cases diagnosed each year, with a constantly increasing incidence. It is characterized by its rapid development and fatal prognosis in most cases, secondary to its early spreading and late diagnosis. There is an increased incidence in Caucasian males and a smaller incidence for black males and women. The overall 5 year survival rate it is estimated at 15% with very few series reporting 5 year survival rates higher than 20%. Incidence. Esophageal cancer incidence and mortality is strongly related to race and gender.
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    • "Although esophageal cancer is not as common as lung, breast or colon malignancies, it is associated with a high mortality rate, with an incidence rate that is close to its cancer-specific mortality (1). Due to presentation with severe comorbidity and an advanced stage of disease, over half of patients with esophageal cancer in the Western world are not able to undergo surgery (2). The 5-year survival rate for resectable disease ranges from 10–25% (3), while recurrent and metastatic esophageal cancer have even poorer prognoses. "
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    ABSTRACT: For the majority of inoperable esophageal cancer cases, chemoradiotherapy is the most suitable treatment option. Cetuximab may provide certain benefits, however, this can be an expensive therapy. Additionally, stereotactic body radiation therapy (SBRT) is typically contraindicated for esophageal cancer due to the potential for esophageal perforation and stenosis. The use of combined chemotherapy plus endostar with sequential SBRT for the treatment of esophageal squamous cancer has not been reported. In the current study, the case of a 71-year-old female with esophageal squamous cancer diagnosed 2 years prior is presented. Surgery and four cycles of cisplatin plus 5-fluorouracil chemotherapy had been administered. The patient showed recurrence at the paratracheal lymph node, exhibited severe dyspnea (grade III) and required a semi-liquid diet. Four cycles of the docetaxel, 5-fluorouracil and nedaplatin regimen plus endostar (3 mg; days 1-14; intravenously) with sequential SBRT (3300 cGy in 10 fractions) was administered. Following treatment, the symptoms of the patient completely disappeared, and objective efficacy evaluation indicated complete remission. At the time of writing, the patient is living without discomfort and the progression-free survival is >8 months. In conclusion, the present case indicates that combined treatment of chemotherapy and endostar with sequential stereotactic radiotherapy is a safe and effective option for the management of esophageal cancer.
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    • "It is also used to relieve painful symptoms and prior to surgery in hopes of reducing the size of a tumor. [29] Pancreatic cancer is the fourth leading cause of cancer-related deaths in the United States. Pancreatic cancer is the fifth leading cause of cancer-related mortality in the United States, with an estimated 33,370 deaths attributable to this disease in 2007. "
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