Esophageal cancer: Clinical Practice Guidelines in oncology™

Esophageal cancer is a major health hazard in many parts of the world. The incidence of adenocarcinoma is increasing in white men, particularly in the nonendemic areas such as North America and many Western European countries. Barrett's metaplasia, gastroesophageal reflux, hiatal hernia, and obesity are believed to be contributing factors. In addition, the most common location of esophageal carcinoma has shifted to the lower third of the esophagus. Unfortunately, esophageal carcinoma is often diagnosed late and, therefore, most therapeutic approaches are palliative. Advances have been made in staging procedures and therapeutic approaches. The guidelines emphasize that palpable advances have been made in the treatment of locoregional esophageal carcinoma. Similarly, endoscopic palliation of esophageal carcinoma has improved substantially because of improving technology. New chemotherapeutic agents are on the horizon, including antireceptor agents, vaccines, gene therapy, and anti-angiogenic agents. The panel expects numerous future advances in the treatment of esophageal carcinoma.