Esophageal Cancer: Background and Clinical Evidence
Although esophageal cancer represents only 6 % of all gastrointestinal malignancies diagnosed in the United States, it remains a highly lethal disease and the seventh most common cause of cancer death in males. Rates of squamous cell carcinoma have been d
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Esophageal Cancer: Background and Clinical Evidence Matthew J. Boyer, Christopher G. Willett, Manisha Palta, and Brian G. Czito
3.1
Epidemiology
(a) In the United States, esophageal cancer constitutes 6 % of all GI malignancies. (b) Squamous cell carcinoma and adenocarci noma comprise approximately 95 % of all esophageal cancer types: (i) Worldwide, 90 % of patients with esophageal cancers have squamous cell carcinoma. (ii) In the United States, the rates of adenocarcinoma now exceed those of squamous cell carcinoma [1]. (c) The rate among white men in the United States is 7 nodes is staged as N1, N2, and N3, respectively. 3.3 Molecular Biology (c) M1 indicates the presence of distant metastatic disease. (a) Multiple genetic aberrations have been linked (d) The current AJCC staging system also to the development of esophageal cancer: accounts for the tumor’s histologic type (i) Patients with heritable tylosis, an auto(squamous cell carcinoma or adenocarcisomal dominant syndrome producing noma), histologic grade, and location in early papillomas of the esophagus, are at an stage, node-negative disease (Fig. 3.1): increased risk of esophageal cancer (i) For example, a T1 N0 grade 1 squa[17]. This has been linked to the long mous cell carcinoma is staged as IA, arm of chromosome 17 [18] and mutawhile grade 2–3 tumors are stage IB. tions in the protease RHBDF2 [19]. (ii) T2-3 N0 squamous cell carcinomas of (ii) Other investigators have reported mutathe lower esophagus are either stage IB tions in p53 as well as amplification of or IIA based on grade of 1 or 2–3, cyclin D1 and epidermal growth factor respectively. receptor (EGFR) underlying squamous (iii) T2-3 N0 squamous cell carcinomas of cell carcinoma development and overthe upper and middle esophagus are expression of p53, EGFR, and HER2 stage IIA and IIB based on the same associated with development of adenograde distinction. carcinoma [20]. (iv) For early stage node-negative adeno (iii) Whole exome sequencing has identicarcinomas, grades 1 and 2 are grouped fied mutations in p53 and the cyclin- such that a grade 3 T1 N0 tumor is dependent kinase inhibitor CDKN2, stage IB, while similar tumors with a as well as multiple other known lower grade are stage IA.
3 Esophageal Cancer: Background and Clinical Evidence
Fig. 3.1 American Joint Committee on Cancer 2010 esophageal cancer staging system
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(v) T2 N0 tumors are either staged as IB or significantly worse 5-year survival comIIA based on low- (grades 1–2) or high- pared to patients with tumors T2 lesions and/or those node-positive disease given an improvement in overall survival with this regimen. (c) Studies are underway in efforts to continue to optimize and refine neoadjuvant approaches in these patients, along with optimizing definitive regimens for nonoperative patients.
References 1. Blot WJ, McLaughlin JK. The changing epidemiology of esophageal cancer. Semin Oncol. 1999;26(5 Suppl 15):2–8. 2. Mahboubi E, Kmet J, Cook PJ, Day NE, Ghadirian P, Salmasizadeh S. Oesop
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