Esophageal Cancer

Introduction : Esophageal cancer (or oesophageal cancer) is cancer arising from the esophagus—the food pipe that runs between the throat and the stomach Pathophysiology : The progression of Barrett metaplasia to adenocarcinoma is associated with several changes in gene structure, gene expression, and protein structure The oncosuppressor gene TP53 and various oncogenes, particularly erb -b2, have been studied as potential markers

Casson and colleagues identified mutations in the TP53 gene in patients with Barrett epithelium associated with adenocarcinoma. In addition, alterations in p16 genes and cell cycle abnormalities or aneuploidy appear to be some of the most important and well-characterized molecular changes. Treatment : Treatment of esophageal cancer varies by disease stage. Patients with stage I disease—particularly Tis and T1aN0 by endoscopic ultrasonography (EUS)—may be considered for endoscopic therapy, such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), performed at a center with experience in these techniques.

Patients with a pCR have a 3-year survival rate of approximately 50%, as opposed to 27% for those without a pCR. Preoperative chemotherapy followed by surgery is another option. However, the evidence for this approach is weak; the chance of increase in 2-year overall survival is less than 6%, compared with approximately 13% with trimodality therapy. Stage IV disease is treated with chemotherapy or symptomatic and supportive care, as indicated. For patients who, because of their clinical condition or owing to advanced disease, are not candidates for curative treatment, the goal of therapy is palliation of dysphagia, so that these patients can eat. No single method of palliation is best for every situation. Most patients require more than 1 kind of palliative treatment to sustain esophageal patency during the course of their disease.