Carcinoma of the Esophagus

Carcinoma of the esophagus or the gastroesophageal junction is uncommon, accounting for approximately 1% of all malignancies in the United States [1]. An estimated 12,100 new cases and 10,900 deaths will occur in 1995 [1]. The diagnosis of esophageal cancer is often made late in the course of the disease in Western countries. Thus, according to the tumor-node-metastasis (TNM) system of staging, T3 or T4 and N-positive lesions are observed frequently. In fact, nearly 50% of patients have advanced incurable disease at the time of diagnosis. Therefore, the prognosis of patients with carcinoma of the esophagus remains poor, and the overall 5-year survival rates are still less than 10% [1]. The incidence of adenocarcinoma of the esophagus and proximal stomach in the Western world and especially in white males has increased in the past 15 years [2,3]. The proportion of adenocarcinomas has increased from the traditionally reported rate of 5% to 10% to 20% to 40% of all esophageal tumors [2]. It is our estimation that currently in the United States, adenocarcinoma occurs more frequently than does squamous-cell carcinoma. Squamous-cell carcinoma of the esophagus has the greatest variation in geographical distribution, a fact that provides insight into its pathogenesis. Geographic variations in the incidence often exist within the same country. Unlike squamous-cell carcinoma, for which alcohol and tobacco (among other factors) have been implicated as risk factors, the risk factors for adenocarcinoma remain elusive. Coexistence of Barrett's esophagus does not yet explain this phenomenal rise in the frequency of adenocarcinoma.