Esophageal cancer

In the US, esophageal and gastric cancer are often locally advanced or metastatic at presentation. Management of these patients requires palliation of problems with the ability of the patient to take in food and liquids.

Natural history of esophageal cancer

The esophagus begins at the cricopharyngeal muscle (15 cm from the teeth) and ends at the gastroesophageal junction (40 cm from the teeth). Cancer most frequently occurs in the middle third of the esophagus. The second most frequent location is in the lower third of the esophagus.

Esophageal cancer is uncommon in the US. The disease is most often seen in a region that extends from southwest China to Iran, often called the esophageal cancer belt, and in Africa and South America. In the US, an increase in the frequency in cases of adenocarcinoma of the esophagus has been observed over the last 5–10 years. While squamous carcinoma of the esophagus is most often associated with injury due to cigarettes, alcohol, and lye, adenocarcinoma is associated with Barrett's esophagus, a dysplastic condition of the distal esophagus, which may be initiated by reflux.

In the US the disease is frequently locally advanced at the time of diagnosis. Most patients with esophageal cancer present with difficulty in swallowing (dysphagia). The normal esophagus is elastic and distensible. For dysphagia to be present, approximately 75% of the wall circumference must be involved with tumor. Other symptoms that are commonly seen are weight loss, and pain with swallowing.