Oncology
Esophageal Cancer
식도암
Squamous cell carcinoma (alcohol/tobacco) or adenocarcinoma (Barrett esophagus)
- How common
- Common in Korean males
- Typical age
- Ages 50–70 (M:F 5:1)
What is it?
SCC arises from alcohol/tobacco irritation of squamous epithelium; adenocarcinoma evolves from chronic GERD via Barrett → dysplasia → cancer.
Commonly affected: SCC: mid/upper esophagus; AdenoCa: lower/GE junction
How it develops
- Chronic injurySCC: alcohol/tobacco/hot drinks; AdenoCa: acid reflux
- TP53 mutation + dysplasiaTP53 central to both SCC and adenocarcinoma
- In situ → invasive carcinomaCDKN2A/HER2 (adenoCa) drive progression
- Lymphatic/distant metsExtensive lymphatic network → liver, lung, bone mets
Symptoms
- Progressive dysphagiaSolids → liquids → saliva
- Weight lossFrom inability to swallow
- OdynophagiaPain on swallowing
- Aspiration pneumoniaTE fistula or obstruction
- HoarsenessRecurrent laryngeal nerve invasion
How it is examined
- Cervical LN examSupraclavicular adenopathy
- Nutritional assessmentWeight loss, albumin, sarcopenia
- PS assessmentECOG, comorbidities
Imaging
Barium swallow: apple-core or stricture pattern.
- Apple-core stricture
- Mucosal irregularity
EGD + biopsy for diagnosis; EUS for T/N, CT/PET-CT for distant mets.
- Esophageal wall thickening
- EUS 5-layer invasion
- Nodes and metastases
Non-surgical care
- TNM staging + histologyEUS, CT, PET-CT, diagnostic laparoscopy (GEJ)
- Neoadjuvant chemoRT (CROSS)Stage II/III: carbo/paclitaxel + 41.4Gy → surgery (CROSS)
- Definitive chemoRTInoperable SCC: cisplatin/5-FU + 50.4Gy
- Advanced 1st-lineSCC: pembrolizumab + cisplatin/5-FU; HER2+ adenoCa: trastuzumab
- Dysphagia palliationEsophageal stent, feeding tube, palliative RT
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Stage I-III, operable, good PS
Procedures that may be discussed
- Ivor Lewis (right thoracotomy + abdominal)
- McKeown 3-field (cervical anastomosis)
- Transhiatal esophagectomy
- Minimally invasive/robotic
- ESD (T1a)
Outlook
5-yr survival: localized 47%, regional 26%, distant 6%. CROSS improves surgical outcomes.