Esophageal cancer

According to American Cancer Society statistics, 16,470 new cases and 14,530 deaths due to esophageal cancer were expected in 2009. Current estimates of 5-year overall survival in a SEER cohort were approximately 37 % for localized disease and only 17 % for all stages combined [1]. These statistics reflect a number of contributing factors. First, patients typically present with a history of progressive dysphagia and weight loss often spanning weeks to months, and with such symptoms of locally advanced disease, it is not surprising that most patients present with stage III or IV disease [historically at MD Anderson Cancer Center, fewer than 1 % of patients presented with in situ disease, and only one in five presented with local disease (Table 17.1)]. Second, the esophagus lacks a limiting serosal layer that would otherwise tend to restrict the local extension of tumor. Third, the esophagus possesses a rich network of lymphatics spanning its entire length, thereby facilitating longitudinal spread anywhere between the neck and the abdomen. As a result, regional lymph node involvement is found in more than 75 % of patients at the time of presentation. Finally, esophageal cancer is associated with a high incidence of both early invasion to adjacent structures (e.g., cardia of the stomach, pericardium, pleura, trachea, and aorta) and distant metastasis (most commonly to the lungs, liver, and bone).