Cancer of the esophagus

Evidence continues to mount that the incidence of adenocarcinoma of the esophagus in Western countries is increasing at an alarming rate. In an animal model of esophageal cancer, exposure of the rat esophagus to gastric acid was found to protect against the development of adenocarcinomas induced by the administration of a carcinogen (methyl-N-amyl nitrosamine). Although it may not be appropriate to extrapolate the results of this study to humans, the findings raise the possibility that the increasing use of antisecretory drugs might be a factor contributing to the rising frequency of esophageal adenocarcinoma. Human papillomavirus infection has been associated with squamous cell carcinoma of the esophagus. A recent study suggests that there is substantial geographic variability in the prevalence of human papillomavirus infection in patients with esophageal tumors, with the highest prevalence rates found in areas of the world that have the highest frequencies of esophageal cancer. Endosonography appears to be the most accurate nonsurgical technique available for staging esophageal cancer. Some recent reports show that the accuracy of the procedure varies substantially among different tumor stages and that the accuracy is influenced heavily by the experience of the endosonographer. Finally, recent studies suggest that multimodal therapy for esophageal cancer provides a significant survival advantage over single-modality therapy for patients who have locally advanced tumors.