American gastroenterological association technical review on the role of the gastroenterologist in the management of esophageal carcinoma

Esophageal cancer is increasing in incidence and is associated with a high mortality rate. The ability of gastroenterologists to increase survival in this disease will depend on earlier detection through screening and surveillance strategies. Early cancers can be staged with EUS and endoscopic mucosal resection. More advanced cancers will require the addition of CT and possible PET. Treatment of early cancers is increasingly shifting toward endoscopic treatment. More advanced but localized cancers can be treated by surgical resection. Cancers with regional lymphadenopathy may require neoadjuvant chemotherapy and radiation therapy. Patients with more advanced cancers may respond to primary therapy with radiation and chemotherapy. Palliation of esophageal cancers is based on stent therapy, but physicians should be attentive to the emotional needs of the dying patient. The future of therapy for esophageal cancer may rest with the development of chemoprevention methods, although there is not substantial evidence to support its use at this time.