++
++
Pathology
Especially in white men, the incidence of adenocarcinoma of the gastroesophageal junction (GEJ) has risen significantly in the United States, whereas that of squamous cell carcinoma has slightly decreased. In the 1960s, squamous cell cancer accounted for 90% or more of esophageal cancer. Data from 1996 suggested that they occur with equal frequency, and by 2004 the trend had changed further. This is thought to be related to increase in body mass index and Barrett esophagus.
✫Abe K et al. Am J Surg Pathol 1996;20:453–461
Brown LM et al. J Natl Cancer Inst 2008;100:1184–1187
Daly JM et al. Cancer 1996;78:1820–1828
++
Work-up
H&P, esophagogastroduodenoscopy with biopsy, CBC, serum electrolytes, BUN, creatinine, LFTs and mineral panel, CT scan of chest and abdomen ± pelvis (if clinically indicated)
In patients with locoregional cancer with no evidence of M1 disease, a PET scan and endoscopic ultrasound (EUS) should be performed
For locoregional cancer at or above the carina, a bronchoscopy must be considered
In selected patients with local-regional GE junction cancer, a laparoscopic staging of the peritoneal cavity may be warranted
In addition, for patients with locoregional cancer (stages I–III), a multidisciplinary evaluation is required, including nutritional assessment. The need for supplementation depends on the severity of dysphagia and the overall nutritional status (>10% weight loss). Enteral nutritional support is preferred (PEG is avoided if surgery is a consideration)
If metastatic disease is documented or suspected, MSI or MMR deficiency should be tested. For metastatic adenocarcinoma, PD-L1 and HER2 expression should be tested
NCCN. Guidelines for Patients: Esophageal and Esophagogastric Junction Cancers. Version 4.2017
++