Current Innovations in Management of Esophageal Carcinoma

Esophageal cancer (EC) is the 8th most common cause of cancer worldwide and is endemic in certain parts of the world, especially in developing countries. The etiology of EC is multifactorial and includes tobacco and alcohol abuse, obesity, chronic gastroesophageal reflux disease (GERD), and Barrett's esophagus. In addition, there are hereditary cancer syndromes associated with an increased risk of ECs. Histologically, EC is classified as either squamous cell carcinoma (ESCC) or adenocarcinoma (EAC). The western hemisphere has seen a shift in decreasing incidence of ESCC versus increasing incidence of EAC. Human epidermal growth factor receptor 2 (Her2) gene and Her2 protein expression have been implicated in the pathogenesis of esophageal cancer. A multidisciplinary approach to EC is essential for workup, management, and treatment. Current therapeutic modalities include endoscopic treatments, such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and ablation of early stage disease for both ESCC and EAC. For locally advanced disease, neoadjuvant chemotherapy and radiation followed by surgical resection are often used. However, the performance status of the patient as being “medically fit” versus “unfit” also plays an instrumental role in determining treatment. For metastatic EC, palliative chemotherapy remains the sole treatment. Most recently, there has been interest in moving beyond standard cytotoxic chemotherapy and to explore novel agents including immunotherapy, which could result in more promising outcomes in this malignancy.

Keywords: Endoscopy, Esophageal adenocarcinoma, Esophageal cancer, Immunotherapy, Squamous cell carcinoma, Targeted therapy.