Current possibilities of multidisciplinary treatment of esophageal cancer

Esophageal carcinoma is the 8th most common malignancy in the world with an estimated 456.000 new cases per year and nearly 17.000 cases in the USA alone, accounting for 3.2% of all malignancies. A dramatic increase in incidence is detected mainly in male patients over the age of 50. Esophageal squamous cell carcinoma (SCC) is the predominant histological type worldwide (87%), while adenocarcinoma (AC) is the dominant type in developed countries (11%). Esophageal carcinoma is often diagnosed as local advanced stage, the main reason being the lack of early clinical symptoms. Progressive dysphagia is a manifestation of already locally advanced disease, in which neoadjuvant chemoradiotherapy is fully indicated. Esophageal carcinoma is the most common indication for subtotal or total esophagectomy. The surgical procedures on the esophagus are very specific. The esophagus is one of the most difficult organs to access of the gastrointestinal tract, the surgical procedure itself is difficult and burdensome for the patient, as it often requires a two- or three-cavity approach. Reconstruction after esophagectomy with the creation of an anastomosis using a suitable transponate (stomach, small or large intestine) and its mobilization are classified as technically demanding procedures. The newly constructed anastomosis is risky to ischemia in case of insufficient vascular supply. Postoperative complications in terms of anastomotic dehiscence have fatal consequences for patients. Adequate preoperative preparation in terms of the application of enteral and parenteral nutrition preparations is essential to ensure metabolic balance. Esophageal cancer is the 6th most common cause of death from malignancy. The total mortality is 5.3%. This review study mainly deals with the etiology, diagnosis and treatment of esophageal cancer and emphasizes the need to develop early detection and prediction methods in order to improve prognosis and reduce mortality. (author)