الفهرس 
Anatomy of the esophagusOnly 14 pages are availabe for public view
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Abstract
Esophageal cancer ranks among the ten most common malignancies in the world and is a frequent cause of cancer-related death. Its incidence is increasing, and improved survival will depend on prevention, earlier diagnosis, improved staging, and appropriate treatment.
Esophageal cancers are typically carcinomas which arise from the epithelium, or surface lining, of the esophagus. Most esophageal cancers fall into one of two classes: squamous cell carcinomas, which are similar to head and neck cancer in their appearance and association with tobacco and alcohol consumption, and adenocarcinomas, which are often associated with a history of gastroesophageal reflux disease and Barrett’s esophagus.
Dysphagia is the first symptom in most patients. Odynophagia may also be present. Substantial weight loss is characteristic as a result of poor nutrition and the active cancer. Pain, often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character. An early sign may hoarseness voice.
Most of the people diagnosed with esophageal cancer have late-stage disease. Diagnostic modalities are endoscopy and barium swallow. Staging modalities include endoscopic ultrasound, computed tomography (CT), Magnetic resonance imaging (MRI) and positron emission tomography (PET).
Treatment options include surgery, endoscopic treatment, chemotherapy, and radiation therapy. These therapies can be used individually or, in some instances, together to improve outcomes.
In the absence of widespread metastases, surgical resection of the esophagus for squamous cell and adenocarcinoma is preferred in most centers. Besides the benefit of restoring esophagogastric continuity, improvements in operative technique and perioperative management have resulted in a surgical mortality rate as low as 3 percent. However, surgery alone maintains a five-year survival rate between 15 and 20 percent.
Endoscopic Treatment of Esophageal Cancer includes endoscopic mucosal resection (EMR), mucosal ablative therapies and esophageal stenting.
Radiation therapy alone has been used for inoperable squamous cell carcinoma in the past; however, it had little effect on the relatively radioinsensitive adenocarcinomas. Short- and long-term morbidity (e.g., gastric irritation, strictures, or perforations) have been associated with radiation therapy as a single therapy, which has not been clearly shown to decrease overall mortality.
Chemotherapy has been shown to be an integral part of primary management of patients with locally defined disease, as well as palliation. Recent data suggest that multimodal therapy is superior to single chemotherapy.
Many modalities are being investigated and used in the palliative treatment of esophageal cancer. Each method has advantages and disadvantages, and it is important to remember that tumor characteristics, the institution’s capabilities, cost, and most importantly patient preferences will tailor definitive therapies. External beam and intraluminal radiotherapy (brachytherapy), chemoradiotherapy, esophageal dilatation, stent placement, laser fulguration, and surgical resection are just a few of the palliative options available.