Carcinoma of the Esophagus - part 1 pps

Contemporary Issues in Cancer ImagingA Multidisciplinary Approach Series Editors Rodney H.. Husband Diagnostic Radiology, Royal Marsden Hospital, Surrey Current titles in the series Canc

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Carcinoma of the Esophagus

Contemporary Issues in Cancer Imaging

A Multidisciplinary Approach

Series Editors

Rodney H Reznek

Cancer Imaging, St Bartholomew’s Hospital, London

Janet E Husband

Diagnostic Radiology, Royal Marsden Hospital, Surrey

Current titles in the series

Cancer of the Ovary

Lung Cancer

Colorectal Cancer

Carcinoma of the Kidney

Forthcoming titles in the series

Carcinoma of the Bladder

Prostate Cancer

Squamous Cell Cancer of the Neck

Pancreatic Cancer

Interventional Radiological Treatment of Liver Tumours

Carcinoma of the Esophagus

Edited by

Sheila C Rankin

Series Editors

Rodney H Reznek

Janet E Husband

CAMBRIDGE UNIVERSITY PRESS

Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo

Cambridge University Press

The Edinburgh Building, Cambridge CB2 8RU, UK

First published in print format

ISBN-13 978-0-521-88285-9

© Cambridge University Press 2008

Every effort has been made in preparing this publication to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved Nevertheless, the authors, editors, and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation The authors, editors, and publishers therefore disclaimall liability for direct or consequential damages resulting fromthe use of material contained in this publication Readers are strongly advised to pay careful attention to information provided

by the manufacturer of any drugs or equipment that they plan to use

2007

Information on this title: www.cambridge.org/9780521882859

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Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate

Published in the United States of America by Cambridge University Press, New York

www.cambridge.org

eBook (EBL) hardback

1 Epidemiology and Clinical Presentation in Esophageal

Cancer

2 Pathology of Esophageal Cancer

3 Recent Advances in the Endoscopic Diagnosis of Esophageal

Cancer

4 Endoscopic Ultrasound in Esophageal Cancer

5 CT in Esophageal Cancer

6 FDG-PET and PET/CT in Esophageal Cancer

7 The Role of Surgery in the Management of Esophageal Cancer

and Palliation of Inoperable Disease

8 Chemotherapy and Radiotherapy in Esophageal Cancer

v

9 Role of Stents in the Management of Esophageal Cancer

10 Lasers in Esophageal Cancer

vi Contents

Satvinder S Mudan, B S C , M D , F R C S

Consultant in Surgical Oncology

Royal Marsden Hospital

London, UK

Ian D Penman, M D , F R C P E D I N

Consultant Gastroenterologist

Lothian University Hospitals Division

Western General Hospital, Edinburgh

Leslie Eisenbud Quint, M D

Professor of Radiology

Division of Cardiothoracic Imaging

University of Michigan Health System

Ann Arbor, Michigan, USA

Sheila C Rankin, F R C R

Consultant Radiologist Guy’s and St Thomas’ Foundation Trust London, UK

Tarun Sabharwal, F R C R , F R C S I

Consultant Interventional Radiologist and Honorary Senior Lecturer

Guy’s and St Thomas’ Foundation Trust Department of Radiology

St Thomas’ Hospital London, UK viii Contributors

The epidemiology of esophageal cancer in the Western world has changed drama-tically over the last two decades Up until the 1970s most esophageal cancers were of the squamous cell type, affecting mostly elderly men drawn from the poorer social classes and influenced by smoking and alcohol consumption Since then there has been a dramatic increase in the incidence of adenocarcinoma, which tends to affect more affluent white men, often in their most productive years of life [2]

Squamous cell carcinoma

SCC of the esophagus remains in the top ten of cancers globally and represents a major healthcare problem The marked geographical variation in incidence sug-gests that environmental factors are paramount in its causation High-incidence

Table 1.1 Squamous cell carcinoma and adenocarcinoma of the esophagus: epidemiology, etiology, and symptoms

Squamous cell carcinoma Adenocarcinoma Age 60–70 years, median 62.6 years 50–60 years, median 53.4 years Sex Male dominant, lower socioeconomic

group

Male dominant, middle or upper socioeconomic group, 52% are university graduates

Associations Head and neck cancer, smoking, alcohol

excess and liver dysfunction, radiation exposure, achalasia, poor nutritional status, human papillomavirus (HPV) infection, Helicobacter pylori infection, Plummer–Vinson syndrome, tylosis palmaris, lye ingestion

Barrett’s esophagus, gastroesophageal reflux disease, hiatus hernia, obesity, scleroderma, family history

Location Mostly midesophagus (75% at level

of tracheal bifurcation) and with a prominently linear growth pattern and wider nodal spread

Almost always distal one-third of esophagus (94% entirely subcarinal) and radial growth pattern with early local nodal dissemination Symptoms

and wider

nodal

spread

Progressive dysphagia, odynophagia, halitosis, unintentional weight loss, chest pain

Progressive dysphagia, odynophagia, halitosis, unintentional weight loss, chest pain

2 S S Mudan and J.-Y Kang

regions of the world such as Southern and Eastern Africa, and a central Asian belt passing from Turkey through countries such as Iraq, Iran, and Kazakhstan and on

to Northern China, are marked out by poverty and other poverty-related illnesses The incidence in high-risk provinces can reach up to 100/10 000 per year compared

to 5–10/10 000 per year in Western countries [2] In the USA, SCC is more common among black people than among white people, but incidence rates have fallen by half across both groups between 1970 and 2000, with incidence rates of approximately 2/100 000 for white males and 10/100 000 for black people in 2000 [1,2,5] These figures are probably related to increasing levels of wealth and education and reduction in exposure to causative agents

The male : female ratio is 3:1 except in high-incidence areas where the distribu-tion is more equal and reflects an equal exposure to risk factors [6] Regional, socioeconomic, and racial variation within a country is demonstrated by a higher incidence of SCC in low income and low socioeconomic groups [5,7,8]

Adenocarcinoma

The last 30 years have seen a dramatic fall in the incidence of noncardia gastric cancer and, as mentioned earlier, a decline or stabilization in the incidence of SCC

of the esophagus in Western countries [9,10,11,12,13] Over the same period the age-standardized incidence of adenocarcinoma of the lower esophagus, previously

a rare disease with incidence <1/100 000, has risen more rapidly than any other malignancy in the Western world Since the mid 1990s its incidence has exceeded that for SCC [14,15,16] The rise in incidence is most marked in the white male population, reaching about 5/100 000 for the white males in North America and 8–12/100 000 for white males in the highest incidence countries of Australia and the UK [7,13,17,18,19,20,21,22] This represents an increase of about 400–800% from the 1970s and is about four times greater than the incidence for black males

in the United States The trend is similar for other North European countries [10,23,24,25] Not only is the incidence higher in white males, but the annual increase in incidence,10% per year, is higher than for other racial groups and for white females, leading to an increasing sex and racial ratio [17,26,27] The demo-graphic distribution shows an age peak at 50–60 years and a male : female ratio between 2:1 and 12:1 [23] Although it is possible that improved anatomic classi-fication and histological vericlassi-fication might account for some of the time trends noted, the rapid changes point to a newly acquired etiological risk factor [10,13,14]

Epidemiology and Clinical Presentation in Esophageal Cancer 3