Esophageal Cancer

Esophageal cancer is the 4th most common cause of cancer death in developing countries and is more common in men. Histologically there are two types; SCC and adenocarcinoma. Tobacco and alcohol abuse are major risk factors for SCC whereas obesity, gastroesophageal reflux disease (GERD) and Barrett’s esophagus are the major risk factors for adenocarcinoma.

Management: Surgery and radiotherapy

Surgery is a major component of treatment for resectable disease. Surgery and or radiotherapy may be curative in early diseases.

However, most patients present in late stages, hence the goal of treatment is to prolong survival and relieve symptoms.

Radiation (alone or in combination with chemotherapy) is given as a definitive, preoperative or postoperative therapy.

Note: All patients must be referred to a cancer specialized center for proper management.
Chemotherapy

There are several chemotherapy drug combinations given as neo-adjuvant, adjuvant or palliative, these include:

5–FU IV 1000 mg/m2day 1–day 5 plus cisplatin IV 75 mg/m2 day1 given every 3 weeks up to 6 cycles
OR
Paclitaxel IV 175 mg/m2 Day 1 plus cisplatin 75 mg/m2 Day 1 given every 3 weeks, 6 cycles
OR
Paclitaxel IV 175mg/m2 day 1plus IV carboplatin AUC 5 on day 1 every 3 weeks, 6 cycles
OR
Docetaxel IV 75mg/m2 day 1 plus IV cisplatin 75mg/m2 day 1 every 3 weeks, 6 cycles
OR
Capecitabine 1000mg/m2 (PO) 12 hourly on day 1–14, cycled every 3 weeks, 6 cycles or until disease progression or intolerable toxicity

Note: ● All patients should be referred to cancer specialized centers for proper management. ● Stenting, gastrostomy and parenteral nutrition are employed to provide feeding when there is total dysphagia.