Esophageal cancer

Accurate pretherapy staging for esophageal cancer is important for stage-di rected therapy. Precise staging is also essential for quality control and e nsuring the validity of clinical trials. Endoscopic ultrasound is currently the best technique in local regional staging. Various investigators have a ttempted to overcome the problems of nontraversable lesions and restaging a fter neoadjuvant therapy. Positron emission tomography scan was shown to be especially useful in identifying distant metastases, Its more widespread u se is likely to impact on treatment strategies. Surgical resection remains the mainstay of treatment of esophageal cancer. Improvement in immediate po stoperative morbidity, mortality, and long-term survival was shown by vario us reports to relate to experience and volume. The concept of three-field d issection was further defined by illustrating the importance of lymphadenec tomy around the recurrent laryngeal nerves. Multimodality treatments contin ue to receive attention. Several studies have established the patterns of p ractice in the United States in treating esophageal cancer. Chemoradiation programs are gaining a more important role and are widely used, although th eir exact roles are uncertain. Closely related to this area of research is the search of molecular markers of favorable response to such therapies. Co ncerning palliative treatment for esophageal cancer, self-expanding metalli c stents have a definite role in patients with malignant dysphagia. Their r esults and complications are reviewed. Lastly, quality-of-life issues have assumed more importance in studies in oncology. Prospective quality-of-life data should be evaluated in future studies on different treatment methods for this deadly disease.