الفهرس 
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Abstract
Esophageal cancer is a malignancy with a poor prognosis. It is the sixth cause of cancer-related death worldwide. The incidence of esophageal cancer has increased dramatically during the past 3 decades.
Alcohol and tobacco use are predisposing conditions, also achalasia, caustic injuries, tylosis, Plummer-Vinson syndrome, Barrett’s metaplasia, gastroesophageal reflux, obesity, H.pylori infection contribute to the pathogenesis of esophageal carcinom. History of irradiation has been linked to an increased risk of esophagel carcinoma.
Dysphagia, usually for solids, is the most common presenting feature of esophageal carcinoma. It can progress to dysphagia for liquids and odynophagia. Weight loss inevitably follows and is an adverse prognostic factor. Regurgitation, retrosternal pain, and hoarseness might also occur. Direct invasion of the airway presenting as a tracheoesophageal fistula or invasion into the aorta with fulminant bleeding, although rare, can occur with local progression.
Oesophageal carcinoma is considered one of the most challenging gastrointestinal malignancies. The recent modalities of investigations improve diagnosis and staging but because the early presenting symptoms of oesophageal carcinoma are nonspecific early diagnosis remain restricted.
The surveillance endoscopy and patient who undergo upper GI endoscopy for reflux symptoms is the only tool for early diagnosis. Once diagnosis is confirmed by histopathological examination of specimen collected by endoscopic biopsies, recently evolved modalities of imaging (CT-PET, Endoscopic ultrasonography, and MRI) and improvement of imaging sensitivity provide revolution in preoperative staging and guide the treatment decision.
Management of esophageal carcinoma is based on tumor extent according to the TNM classification and is divided into curative and palliative treatment. The selection of curative versus palliative operation for oesophageal carcinoma is based on location of the tumor, the patient age and health, the extent of disease and intra operative staging.
Patient with early disease generally do well with surgical resection provide curative procedure with macroscopic and microscopic clear margins. In patient with local-regional advanced disease multimodality treatment can now provide better results including pre and post operative chemo and radio therapy.
For patients with regional disease, resection and en bloc lymphadenectomy provides the best chance of cure and should be the treatment of choice. The primary rationale for an en bloc resection and extended lymphadenectomy is to minimize the incidence of local and regional recurrence and maximize the chances of long-term survival and cure.
Endoscopic mucosal resection, photodynamic therapy, radiofrequency ablation, and combinations of these have been studied in the setting of high-grade dysplasia and early invasive carcinoma.
Minimal invasive esophagectomy is a recent option for esophageal resection in early stage cancer which includes transhiatal or transthoracic simple esophagectomy, also Robotic Esophagectomy technique which allows three-dimensional visualization, improved magnification, and a greater range of instrument motion during the surgery.
Gene therapy is a new treatment or prevention Strategy for esophageal cancer, P53 abnormalities are the most common gentic abnormalities in patients with esophageal cancer, p53 gene therapy depends on transfer of p53 gene into cancer cells which affect their angiogenesis, adenovirus-mediated transfer is a safe and feasibile method which allows injection of adenoviral p53 expression vectors into tumor lesions.