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Oesophageal cancer—an overview

Nature Reviews Gastroenterology & Hepatology volume 10, pages 230–244 (2013)Cite this article

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Abstract

Oesophageal carcinoma is one of the most virulent malignant diseases and a major cause of cancer-related deaths worldwide. Diagnosis and accuracy of pretreatment staging have substantially improved throughout the past three decades. Therapy is challenging and the optimal approach is still debated. Oesophagectomy is considered to be the procedure of choice in patients with operable oesophageal cancer. Endoscopic measures and limited surgical procedures provide an alternative in patients with early carcinomas confined to the oesophageal mucosa. Chemotherapy and radiotherapy or concurrent chemoradiotherapy are also frequently applied, either as definitive treatment or as neoadjuvant therapy within multimodal approaches. The question of whether multimodal treatment offers improved results has been the focus of many studies since the 1990s. Although results are discordant and even some meta-analyses remain inconclusive, it is now widely accepted that multimodal therapy leads to a modest survival benefit. The role of minimally invasive oesophagectomy is not yet defined. Endoscopic stent insertion, radiotherapy and other palliative measures provide relief of tumour-related symptoms in advanced, unresectable tumour stages.

Key Points

  • Oesophageal carcinoma is the eighth most common cancer worldwide

  • Advanced endoscopic imaging technologies and endoscopic staining have considerably improved the diagnosis of early oesophageal carcinoma

  • 18F-fluorodeoxyglucose (FDG)-PET might have additional benefit for correct staging by detecting distant metastases and synchronous carcinomas

  • The usefulness of FDG-PET for response evaluation during neoadjuvant therapy is not yet established

  • Superficial oesophageal cancer can be removed by endoscopic means with long-term results comparable to surgery

  • Surgery is the mainstay of therapy in all cases of curable oesophageal cancer; neoadjuvant therapy (chemotherapy or chemoradiotherapy) provides a modest survival benefit

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Figure 1: Estimated age-standardized incidence rate of oesophageal cancer worldwide (both sexes, all ages).
Figure 2: Chromoendoscopy with Lugol dye.
Figure 3: NBI and AFI.
Figure 4: Squamous cell carcinoma within the upper third of the oesophagus in a 65-year-old man.
Figure 5: Bronchoscopy performed in the same patient as Figure 4.

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Acknowledgements

We wish to thank Prof. Dr A. Meining (Department of Gastroenterology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany) and Prof. Dr W. Kauer (Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany) for kindly providing the endoscopic images.

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  1. Department of General and Thoracic Surgery, Klinikum Nuremberg Nord, Prof-Ernst-Nathan-Strasse 1, Nuremberg, D-90419, Germany

    Michael Schweigert, Attila Dubecz & Hubert J. Stein

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M. Schweigert contributed to the research, discussion of content and writing of this manuscript. A. Dubecz contributed to the research and discussion of content. H. J. Stein contributed to the research, discussion of content and reviewing/editing of the manuscript.

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Schweigert, M., Dubecz, A. & Stein, H. Oesophageal cancer—an overview. Nat Rev Gastroenterol Hepatol 10, 230–244 (2013). https://doi.org/10.1038/nrgastro.2012.236

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