Esophageal and Esophagogastric Junction Cancers

1. Jaffer A. Ajani, MD, 2. James S. Barthel, MD, 3. David J. Bentrem, MD, 4. Thomas A. D'Amico, MD, 5. Prajnan Das, MD, MS, MPH, 6. Crystal S. Denlinger, MD, 7. Charles S. Fuchs, MD, MPH, 8. Hans Gerdes, MD, 9. Robert E. Glasgow, MD, 10. James A. Hayman, MD, MBA, 11. Wayne L. Hofstetter, MD, 12. David H. Ilson, MD, PhD, 13. Rajesh N. Keswani, MD, 14. Lawrence R. Kleinberg, MD, 15. W. Michael Korn, MD, 16. A. Craig Lockhart, MD, MHS, 17. Mary F. Mulcahy, MD, 18. Mark B. Orringer, MD, 19. Raymond U. Osarogiagbon, MD, 20. James A. Posey, MD, 21. Aaron R. Sasson, MD, 22. Walter J. Scott, MD, 23. Stephen Shibata, MD, 24. Vivian E. M. Strong, MD, 25. Thomas K. Varghese Jr., MD, 26. Graham Warren, MD, PhD, 27. Mary Kay Washington, MD, PhD, 28. Christopher Willett, MD and 29. Cameron D. Wright, MD

NCCN Clinical Practice Guidelines NCCN Guidelines esophageal carcinoma chemotherapy chemoradiation combined modality therapy surgery resection multidisciplinary care biologic therapy organ preservation

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Overview
Upper gastrointestinal tract cancers originating in the esophagus, esophagogastric junction (EGJ), and stomach constitute a major health problem around the world. An estimated 37,640 new cases of and 25,070 deaths from upper gastrointestinal cancers occurred in the United States in 2010.1 A dramatic shift in the location of upper gastrointestinal tumors has occurred in the United States.2,3 Changes in histology and location of upper gastrointestinal tumors have also been observed in some parts of Europe.4 In Western Hemisphere countries, the most common site of esophageal cancer is in the lower third of the esophagus, where it often involves the EGJ. Previous SectionNext Section

Epidemiology
Esophageal cancer is the eighth most common cancer worldwide.5 An estimated 16,640 new cases of and 14,500 deaths from esophageal cancer occurred in United States in 2010.1 It is endemic in many parts of the world, particularly in developing nations. The incidence of esophageal cancer represents one of the widest variations, with a 60-fold difference between high- and low-incidence regions.6 High prevalence areas include Asia, southern and eastern Africa, and Northern France.7 Esophageal cancers are histologically classified as squamous cell carcinoma (SCC) or adenocarcinoma.8 Esophageal adenocarcinoma may be associated with a better long-term prognosis after resection than SCC.9 However, more concrete data are desirable for such an assertion. SCC is most common in the endemic regions of the world and adenocarcinoma is most common in nonendemic areas, such as North America and many Western European countries. Both SCC and adenocarcinoma are more common in men. SCCs have become increasingly less common, accounting for fewer than 30% of all esophageal malignancies in the United States and Western Europe. Adenocarcinoma is diagnosed predominantly in white men in whom the incidence has risen more steeply. However, adenocarcinoma is gradually increasing in men of all ethnic backgrounds and also in women.2