Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ INTRODUCTION ++ Epidemiology Table Graphic Jump LocationFavorite Table | Download (.pdf) | Print Epidemiology Incidence: 18,170 (male: 14,660; female: 3,510. Estimated new cases for 2014 in the United States) 7.7 per 100,000 male, 1.8 per 100,000 female Deaths: Estimated 15,450 in 2014 (male: 12,450; female: 3,000) Median age at diagnosis✫: Squamous cell esophageal carcinoma: 53.4 years Adenocarcinoma of the esophagus: 62.6 years Male to female ratio: 3:1 for squamous cell carcinoma and 7:1 for adenocarcinoma Stage at presentation: Locoregional disease: 50% Distant metastasis: 50% ✫Kelsen DP et al. Textbook of Gastrointestinal Oncology: Principles and Practice. Lippincott Williams & Williams, 2001 Siegel R et al. CA Cancer J Clin 2014;64:9–29 Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013) ++ Pathology Table Graphic Jump LocationFavorite Table | Download (.pdf) | Print Pathology Upper to midthoracic esophagus: Predominantly squamous cell carcinoma Distal esophagus and GE junction: Predominantly adenocarcinoma Other rare pathology: Basaloid-squamous carcinoma (1.9%)✫ or small cell carcinomas Especially in white men, the incidence of adenocarcinoma of the GE junction 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 in 2004 the trend has changed further so that adenocarcinoma now accounts for at least 75% of esophageal cancers. 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 †Daly JM et al. National Cancer Data Base Report on Esophageal Carcinoma. Cancer 1996;78:1820–1828 ++ Work-up H&P, esophagogastroduodenoscopy, CBC, serum electrolytes, BUN, creatinine, LFTs and mineral panel, PET scan ± CT scan, of chest and abdomen Endoscopic ultrasound is highly recommended if there is no evidence of distant metastases, with FNA if indicated 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 patients with locoregional cancer, PET/CT scan is strongly recommended. Suspicious metastatic cancer should be confirmed 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) ++ Staging Table Graphic Jump LocationFavorite Table | Download (.pdf) | Print Staging Primary Tumor (T) TX Primary tumor cannot be assessed T0 No evidence of primary tumor Tis High-grade dysplasia T1 Tumor invades lamina propria or submucosa T2 Tumor invades muscularis propria T3 Tumor invades adventitia T4a Resectable cancer invades adjacent structures such as pleura, pericardium, diaphragm T4b Unresectable cancer invades adjacent structures such as aorta, vertebral body, trachea Table Graphic Jump LocationFavorite Table | Download (.pdf)... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. What is MyAccess? Create a FREE MyAccess profile to: Use this site remotely Bookmark your favorite content Track your self-assessment progress and more!