Recent Trends in Management of Esophageal Carcinoma
Ayman Magdy Boutros Ghali;
Abstract
Esophageal cancer is a malignancy with a poor prognosis. It is the sixth cause of cancer-related death worldwide. The incidence of esophageal cancer has increased dramatically during the past 3 decades.
Alcohol and tobacco use are predisposing conditions, also achalasia, caustic injuries, tylosis, Plummer-Vinson syndrome, Barrett’s metaplasia, gastroesophageal reflux, obesity, H.pylori infection contribute to the pathogenesis of esophageal carcinom. History of irradiation has been linked to an increased risk of esophagel carcinoma.
Dysphagia, usually for solids, is the most common presenting feature of esophageal carcinoma. It can progress to dysphagia for liquids and odynophagia. Weight loss inevitably follows and is an adverse prognostic factor. Regurgitation, retrosternal pain, and hoarseness might also occur. Direct invasion of the airway presenting as a tracheoesophageal fistula or invasion into the aorta with fulminant bleeding, although rare, can occur with local progression.
Oesophageal carcinoma is considered one of the most challenging gastrointestinal malignancies. The recent modalities of investigations improve diagnosis and staging but because the early presenting symptoms of oesophageal carcinoma are nonspecific early diagnosis remain restricted.
The surveillance endoscopy and patient who undergo upper GI endoscopy for reflux symptoms is the only tool for early diagnosis. Once diagnosis is confirmed by histopathological examination of specimen collected by endoscopic biopsies, recently evolved modalities of imaging (CT-PET, Endoscopic ultrasonography, and MRI) and improvement of imaging sensitivity provide revolution in preoperative staging and guide the treatment decision.
Management of esophageal carcinoma is based on tumor extent according to the TNM classification and is divided into curative and palliative treatment. The selection of curative versus palliative operation for oesophageal carcinoma is based on location of the tumor, the patient age and health, the extent of disease and intra operative staging.
Patient with early disease generally do well with surgical resection provide curative procedure with macroscopic and microscopic clear margins. In patient with local-regional advanced disease multimodality treatment can now provide better results including pre and post operative chemo and radio therapy.
For patients with regional disease, resection and en bloc lymphadenectomy provides the best chance of cure and should be the treatment of choice. The primary rationale for an en bloc resection and extended lymphadenectomy is to minimize the incidence of local and regional recurrence and maximize the chances of long-term survival and cure.
Alcohol and tobacco use are predisposing conditions, also achalasia, caustic injuries, tylosis, Plummer-Vinson syndrome, Barrett’s metaplasia, gastroesophageal reflux, obesity, H.pylori infection contribute to the pathogenesis of esophageal carcinom. History of irradiation has been linked to an increased risk of esophagel carcinoma.
Dysphagia, usually for solids, is the most common presenting feature of esophageal carcinoma. It can progress to dysphagia for liquids and odynophagia. Weight loss inevitably follows and is an adverse prognostic factor. Regurgitation, retrosternal pain, and hoarseness might also occur. Direct invasion of the airway presenting as a tracheoesophageal fistula or invasion into the aorta with fulminant bleeding, although rare, can occur with local progression.
Oesophageal carcinoma is considered one of the most challenging gastrointestinal malignancies. The recent modalities of investigations improve diagnosis and staging but because the early presenting symptoms of oesophageal carcinoma are nonspecific early diagnosis remain restricted.
The surveillance endoscopy and patient who undergo upper GI endoscopy for reflux symptoms is the only tool for early diagnosis. Once diagnosis is confirmed by histopathological examination of specimen collected by endoscopic biopsies, recently evolved modalities of imaging (CT-PET, Endoscopic ultrasonography, and MRI) and improvement of imaging sensitivity provide revolution in preoperative staging and guide the treatment decision.
Management of esophageal carcinoma is based on tumor extent according to the TNM classification and is divided into curative and palliative treatment. The selection of curative versus palliative operation for oesophageal carcinoma is based on location of the tumor, the patient age and health, the extent of disease and intra operative staging.
Patient with early disease generally do well with surgical resection provide curative procedure with macroscopic and microscopic clear margins. In patient with local-regional advanced disease multimodality treatment can now provide better results including pre and post operative chemo and radio therapy.
For patients with regional disease, resection and en bloc lymphadenectomy provides the best chance of cure and should be the treatment of choice. The primary rationale for an en bloc resection and extended lymphadenectomy is to minimize the incidence of local and regional recurrence and maximize the chances of long-term survival and cure.
Other data
| Title | Recent Trends in Management of Esophageal Carcinoma | Other Titles | الإتجاهات الحديثة فى علاج سرطان المرئ | Authors | Ayman Magdy Boutros Ghali | Issue Date | 2015 |
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