Esophageal Ca Staging and Management According to Current Guidelines

Oesophageal cancer is the seventh most common cancer and is the growing public health problem with nearly 600,000 new cases yearly. Male gender, developing countries, Asia population, over 50 aged, alcohol and cigarette usage, hot beverages usage are the main factor that affect developing esophageal cancer. Obesity, gastroesophageal reflux disease, and Helicobacter pylori infection are the main related disease. To diagnose esophageal cancer, while symptoms, physical examination, and history are start-up points, upper gastrointestinal system endoscopy is gold standard technique. Histological classification is made by pathological examinations and sometimes immunohistochemical examinations performed for differentiation of esophageal SCC and AC. Computed tomography (CT) or positron emission tomography (PET) remains as gold standard diagnostic tools for staging. Endoscopic USG is the best way to evaluate the lymph node metastases. Surgical treatment is the most important stage for management of esophageal cancer. Endoscopic en bloc resection, using either endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), is the treatment of choice for lesions with intraepithelial high-grade dysplasia and most T1 tumors. For the patients suffering from cT2–T4 or cN1–3 M0; surgery remains as first-line therapeutic method and transthoracic oesophagectomy with en bloc two-field lymphadenectomy is preferred method. There is still an ongoing debate, definitive CRT with surveillance and salvage oesophagectomy is as good as surgery. Chemotherapy and chemoradiotherapy still remain as a treatment choice prior to surgery. Management of advanced and metastatic disease of esophageal cancer is difficult and consists of chemo-radio therapy and followed salvage surgery. The majority (90%) of relapses occur within the first 2 years after completion of local therapy. Three months interval follow-up should be recommended. Endoscopy with biopsy, CT scan can be used for early detection.