Overview of Esophageal Cancer by a Gastroenterologist

Esophageal cancer ranks seventh in incidence and sixth in mortality rate among all cancers globally. Regarding the 2020 World data, 604,000 newly diagnosed cases and 544,000 deaths have been observed due to esophageal cancer. Esophageal cancers occur in various types as: squamous cell cancer (SCC), adenocarcinoma (AC), sarcoma, small cell carcinoma, rarely lymphoma, and melanoma. More than 90% of cases all over the world are in the form of SCC. However, in recent years, the incidence under 50 years of age and the frequency of AC have been increasing gradually, and this increase seems to suppress the incidence of SCC, especially in Europe and North America. The incidence of the esophagogastric junction (OGJ) AC appears to have increased moderately in recent years. Like esophageal AC, obesity, gastroesophageal reflux disease, and high fat intake are risk factors for OGJ cancer, and Helicobacter pylori infection is inversely related. Two of the most important risk factors in SCC in industrialized countries are smoking and alcohol consumption. Gastroesophageal reflux with acid and bile is the most important risk factor for AC. Despite differences in demographics and risk factors, the clinical presentation is similar between esophageal AC and squamous cell carcinoma. The endoscopic appearance is also similar, although approximately three quarters of all AC lesions are found in the distal esophagus. At the same time, squamous cell carcinoma is more common in the proximal and middle esophagus. Usually, most patients are asymptomatic in the early stages. With the progression of the disease, weight loss, early satiety, and difficulty in swallowing develop. When the esophageal lumen diameter is 13 mm or less, swallowing difficulty occurs against solid foods. The histological subtype, clinical tumourenodeemetastasi(TNM) stage, location of the tumor, and the patient’s performance status, comorbidities, and estimated treatment tolerance should be determined multidisciplinary based on.