625 lines
No EOL
257 KiB
HTML
625 lines
No EOL
257 KiB
HTML
<?xml version="1.0" encoding="utf-8"?>
|
|
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
|
|
|
|
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
|
|
<!-- AppResources meta begin -->
|
|
<meta name="paf-app-resources" content="" />
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- AppResources meta end -->
|
|
|
|
<!-- TemplateResources meta begin -->
|
|
<meta name="paf_template" content="" />
|
|
|
|
<!-- TemplateResources meta end -->
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books" /><meta name="ncbi_pdid" content="book-part" /><meta name="ncbi_acc" content="NBK65900" /><meta name="ncbi_domain" content="pdqcis" /><meta name="ncbi_report" content="record" /><meta name="ncbi_type" content="fulltext" /><meta name="ncbi_objectid" content="" /><meta name="ncbi_pcid" content="/NBK65900.19/" /><meta name="ncbi_pagename" content="Esophageal Cancer Treatment (Adult) (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf" /><meta name="ncbi_bookparttype" content="chapter" /><meta name="ncbi_app" content="bookshelf" />
|
|
<!-- Logger end -->
|
|
|
|
<title>Esophageal Cancer Treatment (Adult) (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf</title>
|
|
|
|
<!-- AppResources external_resources begin -->
|
|
<link rel="stylesheet" href="/core/jig/1.15.2/css/jig.min.css" /><script type="text/javascript" src="/core/jig/1.15.2/js/jig.min.js"></script>
|
|
|
|
<!-- AppResources external_resources end -->
|
|
|
|
<!-- Page meta begin -->
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="PDQ Cancer Information Summaries [Internet]" /><meta name="citation_title" content="Esophageal Cancer Treatment (Adult) (PDQ®)" /><meta name="citation_publisher" content="National Cancer Institute (US)" /><meta name="citation_date" content="2021/06/17" /><meta name="citation_author" content="PDQ Adult Treatment Editorial Board" /><meta name="citation_pmid" content="26389338" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK65900/" /><meta name="citation_keywords" content="esophageal cancer" /><meta name="citation_keywords" content="esophageal cancer" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Esophageal Cancer Treatment (Adult) (PDQ®)" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Cancer Institute (US)" /><meta name="DC.Contributor" content="PDQ Adult Treatment Editorial Board" /><meta name="DC.Date" content="2021/06/17" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK65900/" /><meta name="description" content="Esophageal cancer treatment options include surgery alone for very early disease and add chemotherapy and radiation therapy for more advanced cases. Get detailed information about the treatment of newly diagnosed and recurrent esophageal cancer in this summary for clinicians." /><meta name="og:title" content="Esophageal Cancer Treatment (Adult) (PDQ®)" /><meta name="og:type" content="book" /><meta name="og:description" content="Esophageal cancer treatment options include surgery alone for very early disease and add chemotherapy and radiation therapy for more advanced cases. Get detailed information about the treatment of newly diagnosed and recurrent esophageal cancer in this summary for clinicians." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK65900/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/pdqcis/CDR0000062741/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK65900/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
|
|
|
|
<!-- Page meta end -->
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico" /><meta name="ncbi_phid" content="CE8BCAEA7C95087100000000007D0064.m_13" />
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3985586/3808861/4121862/3974050/3917732/251717/4216701/14534/45193/4113719/3849091/3984811/3751656/4033350/3840896/3577051/3852958/4008682/4207974/4206132/4062871/12930/3964959/3854974/36029/4128070/9685/3549676/3609192/3609193/3609213/3395586.css" /><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3411343/3882866.css" media="print" /></head>
|
|
<body class="book-part">
|
|
<div class="grid">
|
|
<div class="col twelve_col nomargin shadow">
|
|
<!-- System messages like service outage or JS required; this is handled by the TemplateResources portlet -->
|
|
<div class="sysmessages">
|
|
<noscript>
|
|
<p class="nojs">
|
|
<strong>Warning:</strong>
|
|
The NCBI web site requires JavaScript to function.
|
|
<a href="/guide/browsers/#enablejs" title="Learn how to enable JavaScript" target="_blank">more...</a>
|
|
</p>
|
|
</noscript>
|
|
</div>
|
|
<!--/.sysmessage-->
|
|
<div class="wrap">
|
|
<div class="page">
|
|
<div class="top">
|
|
<div id="universal_header">
|
|
<section class="usa-banner">
|
|
<div class="usa-accordion">
|
|
<header class="usa-banner-header">
|
|
<div class="usa-grid usa-banner-inner">
|
|
<img src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/favicons/favicon-57.png" alt="U.S. flag" />
|
|
<p>An official website of the United States government</p>
|
|
<button class="non-usa-accordion-button usa-banner-button" aria-expanded="false" aria-controls="gov-banner-top" type="button">
|
|
<span class="usa-banner-button-text">Here's how you know</span>
|
|
</button>
|
|
</div>
|
|
</header>
|
|
<div class="usa-banner-content usa-grid usa-accordion-content" id="gov-banner-top" aria-hidden="true">
|
|
<div class="usa-banner-guidance-gov usa-width-one-half">
|
|
<img class="usa-banner-icon usa-media_block-img" src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-dot-gov.svg" alt="Dot gov" />
|
|
<div class="usa-media_block-body">
|
|
<p>
|
|
<strong>The .gov means it's official.</strong>
|
|
<br />
|
|
Federal government websites often end in .gov or .mil. Before
|
|
sharing sensitive information, make sure you're on a federal
|
|
government site.
|
|
</p>
|
|
</div>
|
|
</div>
|
|
<div class="usa-banner-guidance-ssl usa-width-one-half">
|
|
<img class="usa-banner-icon usa-media_block-img" src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-https.svg" alt="Https" />
|
|
<div class="usa-media_block-body">
|
|
<p>
|
|
<strong>The site is secure.</strong>
|
|
<br />
|
|
The <strong>https://</strong> ensures that you are connecting to the
|
|
official website and that any information you provide is encrypted
|
|
and transmitted securely.
|
|
</p>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
<div class="usa-overlay"></div>
|
|
<header class="ncbi-header" role="banner" data-section="Header">
|
|
|
|
<div class="usa-grid">
|
|
<div class="usa-width-one-whole">
|
|
|
|
<div class="ncbi-header__logo">
|
|
<a href="/" class="logo" aria-label="NCBI Logo" data-ga-action="click_image" data-ga-label="NIH NLM Logo">
|
|
<img src="https://www.ncbi.nlm.nih.gov/coreutils/nwds/img/logos/AgencyLogo.svg" alt="NIH NLM Logo" />
|
|
</a>
|
|
</div>
|
|
|
|
<div class="ncbi-header__account">
|
|
<a id="account_login" href="https://account.ncbi.nlm.nih.gov" class="usa-button header-button" style="display:none" data-ga-action="open_menu" data-ga-label="account_menu">Log in</a>
|
|
<button id="account_info" class="header-button" style="display:none" aria-controls="account_popup" type="button">
|
|
<span class="fa fa-user" aria-hidden="true">
|
|
<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" width="20px" height="20px">
|
|
<g style="fill: #fff">
|
|
<ellipse cx="12" cy="8" rx="5" ry="6"></ellipse>
|
|
<path d="M21.8,19.1c-0.9-1.8-2.6-3.3-4.8-4.2c-0.6-0.2-1.3-0.2-1.8,0.1c-1,0.6-2,0.9-3.2,0.9s-2.2-0.3-3.2-0.9 C8.3,14.8,7.6,14.7,7,15c-2.2,0.9-3.9,2.4-4.8,4.2C1.5,20.5,2.6,22,4.1,22h15.8C21.4,22,22.5,20.5,21.8,19.1z"></path>
|
|
</g>
|
|
</svg>
|
|
</span>
|
|
<span class="username desktop-only" aria-hidden="true" id="uname_short"></span>
|
|
<span class="sr-only">Show account info</span>
|
|
</button>
|
|
</div>
|
|
|
|
<div class="ncbi-popup-anchor">
|
|
<div class="ncbi-popup account-popup" id="account_popup" aria-hidden="true">
|
|
<div class="ncbi-popup-head">
|
|
<button class="ncbi-close-button" data-ga-action="close_menu" data-ga-label="account_menu" type="button">
|
|
<span class="fa fa-times">
|
|
<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 48 48" width="24px" height="24px">
|
|
<path d="M38 12.83l-2.83-2.83-11.17 11.17-11.17-11.17-2.83 2.83 11.17 11.17-11.17 11.17 2.83 2.83 11.17-11.17 11.17 11.17 2.83-2.83-11.17-11.17z"></path>
|
|
</svg>
|
|
</span>
|
|
<span class="usa-sr-only">Close</span></button>
|
|
<h4>Account</h4>
|
|
</div>
|
|
<div class="account-user-info">
|
|
Logged in as:<br />
|
|
<b><span class="username" id="uname_long">username</span></b>
|
|
</div>
|
|
<div class="account-links">
|
|
<ul class="usa-unstyled-list">
|
|
<li><a id="account_myncbi" href="/myncbi/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_myncbi">Dashboard</a></li>
|
|
<li><a id="account_pubs" href="/myncbi/collections/bibliography/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_pubs">Publications</a></li>
|
|
<li><a id="account_settings" href="/account/settings/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_settings">Account settings</a></li>
|
|
<li><a id="account_logout" href="/account/signout/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_logout">Log out</a></li>
|
|
</ul>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
</div>
|
|
</div>
|
|
</header>
|
|
<div role="navigation" aria-label="access keys">
|
|
<a id="nws_header_accesskey_0" href="https://www.ncbi.nlm.nih.gov/guide/browsers/#ncbi_accesskeys" class="usa-sr-only" accesskey="0" tabindex="-1">Access keys</a>
|
|
<a id="nws_header_accesskey_1" href="https://www.ncbi.nlm.nih.gov" class="usa-sr-only" accesskey="1" tabindex="-1">NCBI Homepage</a>
|
|
<a id="nws_header_accesskey_2" href="/myncbi/" class="set-base-url usa-sr-only" accesskey="2" tabindex="-1">MyNCBI Homepage</a>
|
|
<a id="nws_header_accesskey_3" href="#maincontent" class="usa-sr-only" accesskey="3" tabindex="-1">Main Content</a>
|
|
<a id="nws_header_accesskey_4" href="#" class="usa-sr-only" accesskey="4" tabindex="-1">Main Navigation</a>
|
|
</div>
|
|
<section data-section="Alerts">
|
|
<div class="ncbi-alerts-placeholder"></div>
|
|
</section>
|
|
</div>
|
|
<div class="header">
|
|
<div class="res_logo"><h1 class="res_name"><a href="/books/" title="Bookshelf home">Bookshelf</a></h1><h2 class="res_tagline"></h2></div>
|
|
<div class="search"><form method="get" action="/books/"><div class="search_form"><label for="database" class="offscreen_noflow">Search database</label><select id="database"><optgroup label="Recent"><option value="books" selected="selected" data-ac_dict="bookshelf-search">Books</option><option value="pcsubstance">PubChem Substance</option><option value="pubmed">PubMed</option><option value="clinvar" class="last">ClinVar</option></optgroup><optgroup label="All"><option value="gquery">All Databases</option><option value="assembly">Assembly</option><option value="biocollections">Biocollections</option><option value="bioproject">BioProject</option><option value="biosample">BioSample</option><option value="books" data-ac_dict="bookshelf-search">Books</option><option value="clinvar">ClinVar</option><option value="cdd">Conserved Domains</option><option value="gap">dbGaP</option><option value="dbvar">dbVar</option><option value="gene">Gene</option><option value="genome">Genome</option><option value="gds">GEO DataSets</option><option value="geoprofiles">GEO Profiles</option><option value="gtr">GTR</option><option value="ipg">Identical Protein Groups</option><option value="medgen">MedGen</option><option value="mesh">MeSH</option><option value="nlmcatalog">NLM Catalog</option><option value="nuccore">Nucleotide</option><option value="omim">OMIM</option><option value="pmc">PMC</option><option value="protein">Protein</option><option value="proteinclusters">Protein Clusters</option><option value="protfam">Protein Family Models</option><option value="pcassay">PubChem BioAssay</option><option value="pccompound">PubChem Compound</option><option value="pcsubstance">PubChem Substance</option><option value="pubmed">PubMed</option><option value="snp">SNP</option><option value="sra">SRA</option><option value="structure">Structure</option><option value="taxonomy">Taxonomy</option><option value="toolkit">ToolKit</option><option value="toolkitall">ToolKitAll</option><option value="toolkitbookgh">ToolKitBookgh</option></optgroup></select><div class="nowrap"><label for="term" class="offscreen_noflow" accesskey="/">Search term</label><div class="nowrap"><input type="text" name="term" id="term" title="Search Books. Use up and down arrows to choose an item from the autocomplete." value="" class="jig-ncbiclearbutton jig-ncbiautocomplete" data-jigconfig="dictionary:'bookshelf-search',disableUrl:'NcbiSearchBarAutoComplCtrl'" autocomplete="off" data-sbconfig="ds:'no',pjs:'no',afs:'no'" /></div><button id="search" type="submit" class="button_search nowrap" cmd="go">Search</button></div></div></form><ul class="searchlinks inline_list"><li>
|
|
<a href="/books/browse/">Browse Titles</a>
|
|
</li><li>
|
|
<a href="/books/advanced/">Advanced</a>
|
|
</li><li class="help">
|
|
<a href="/books/NBK3833/">Help</a>
|
|
</li><li class="disclaimer">
|
|
<a target="_blank" data-ga-category="literature_resources" data-ga-action="link_click" data-ga-label="disclaimer_link" href="https://www.ncbi.nlm.nih.gov/books/about/disclaimer/">Disclaimer</a>
|
|
</li></ul></div>
|
|
</div>
|
|
|
|
|
|
|
|
<!--<component id="Page" label="headcontent"/>-->
|
|
|
|
</div>
|
|
<div class="content">
|
|
<!-- site messages -->
|
|
<!-- Custom content 1 -->
|
|
<div class="col1">
|
|
|
|
</div>
|
|
|
|
<div class="container">
|
|
<div id="maincontent" class="content eight_col col">
|
|
<!-- Custom content in the left column above book nav -->
|
|
<div class="col2">
|
|
|
|
</div>
|
|
|
|
<!-- Book content -->
|
|
|
|
|
|
<!-- Custom content between navigation and content -->
|
|
<div class="col3">
|
|
|
|
</div>
|
|
|
|
<div class="document">
|
|
<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65900_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65900_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
|
|
<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65900_"><span class="title" itemprop="name">Esophageal Cancer Treatment (Adult) (PDQ®)</span></h1><div class="subtitle whole_rhythm">Health Professional Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: June 17, 2021.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062741__426">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of adult esophageal cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p><p id="CDR0000062741__427">This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p></div><div id="CDR0000062741__1"><h2 id="_CDR0000062741__1_">General Information About Esophageal Cancer</h2><p id="CDR0000062741__398">Two histologic types account for the majority of malignant esophageal neoplasms: adenocarcinoma and squamous cell carcinoma. Adenocarcinomas typically start in the lower esophagus and squamous cell carcinoma can develop throughout the esophagus. The epidemiology of these types varies markedly.</p><div id="CDR0000062741__184"><h3>Incidence and Mortality</h3><p id="CDR0000062741__116">Estimated new cases and deaths from esophageal cancer in the United States in 2021:[<a class="bk_pop" href="#CDR0000062741_rl_1_1">1</a>]</p><ul id="CDR0000062741__117"><li class="half_rhythm"><div>New cases: 19,260.</div></li><li class="half_rhythm"><div>Deaths: 15,530.</div></li></ul><p id="CDR0000062741__247">The incidence of esophageal cancer has risen in recent decades, coinciding with
|
|
a shift in histologic type and primary tumor location. In the United States, squamous cell carcinoma has historically been more prevalent although the incidence of adenocarcinoma has risen dramatically in the last few decades in the United States and western Europe.[<a class="bk_pop" href="#CDR0000062741_rl_1_2">2</a>,<a class="bk_pop" href="#CDR0000062741_rl_1_3">3</a>] Worldwide, squamous cell carcinoma remains the predominant histology, however, adenocarcinoma of
|
|
the esophagus is now more prevalent than squamous cell carcinoma in the United
|
|
States and western Europe.[<a class="bk_pop" href="#CDR0000062741_rl_1_4">4</a>] The incidence of adenocarcinoma has increased most notably among White men.[<a class="bk_pop" href="#CDR0000062741_rl_1_5">5</a>] In the United States, the median age of patients who present with esophageal cancer is 68 years.[<a class="bk_pop" href="#CDR0000062741_rl_1_6">6</a>] Most adenocarcinomas are located in the distal esophagus.
|
|
The cause for the rising incidence and demographic alterations is unknown.
|
|
</p></div><div id="CDR0000062741__249"><h3>Anatomy</h3><a id="CDR0000062741__250"></a><div id="CDR0000062741__392" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=The%20esophagus%20and%20stomach%20are%20part%20of%20the%20upper%20gastrointestinal%20(digestive)%20system&p=BOOKS&id=571275_CDR0000428446.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000428446.jpg" alt="Gastrointestinal (digestive) system anatomy; drawing shows the esophagus, liver, stomach, small intestine, and large intestine." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>The esophagus and stomach are part of the upper gastrointestinal (digestive) system.</p></div></div><p id="CDR0000062741__402">The esophagus serves as a conduit to the gastrointestinal tract for food. The esophagus extends from the larynx to the stomach and lies in the posterior mediastinum within the thorax near the lung pleura, peritoneum, pericardium, and diaphragm. As it travels into the abdominal cavity, the esophagus makes an abrupt turn and enters the stomach. The esophagus is the most muscular segment of the gastrointestinal system and is composed of inner circular and outer longitudinal muscle layers. The upper and lower esophagus are controlled by the sphincter function of the cricopharyngeus muscle and gastroesophageal sphincter, respectively. The esophagus has a rich network of lymphatic channels concentrated in the lamina propria and submucosa, which drains longitudinally along the submucosa. </p><p id="CDR0000062741__403">Tumors of the esophagus are conventionally described in terms of distance of the upper border of the tumor to the incisors. When measured from the incisors via endoscopy, the esophagus extends approximately 30 to 40 cm. The esophagus is divided into four main segments: </p><ol id="CDR0000062741__404"><li class="half_rhythm"><div>Cervical esophagus (~15–20 cm from the incisors).</div></li><li class="half_rhythm"><div>Upper thoracic esophagus (~20–25 cm from the incisors).</div></li><li class="half_rhythm"><div>Middle thoracic esophagus (~25–30 cm from the incisors).</div></li><li class="half_rhythm"><div>Lower thoracic esophagus and gastroesophageal junction (~30–40 cm from the incisors).</div></li></ol></div><div id="CDR0000062741__243"><h3>Risk Factors </h3><p id="CDR0000062741__5"> Risk factors for squamous cell carcinoma of the esophagus include:
|
|
</p><ul id="CDR0000062741__399"><li class="half_rhythm"><div>Tobacco.</div></li><li class="half_rhythm"><div>Alcohol.</div></li></ul><p id="CDR0000062741__368">Risk factors associated with esophageal adenocarcinoma are less clear.[<a class="bk_pop" href="#CDR0000062741_rl_1_3">3</a>] Barrett esophagus is an exception and its presence is associated with an increased risk of developing adenocarcinoma of the esophagus. Chronic reflux is considered the predominant cause of Barrett metaplasia. The results of a population-based, case-controlled study
|
|
from Sweden strongly suggest that symptomatic gastroesophageal reflux is a risk
|
|
factor for esophageal adenocarcinoma. The frequency, severity, and duration of
|
|
reflux symptoms were positively correlated with increased risk of esophageal
|
|
adenocarcinoma.[<a class="bk_pop" href="#CDR0000062741_rl_1_7">7</a>]</p><p id="CDR0000062741__401">(Refer to the PDQ summary on <a href="/books/n/pdqcis/CDR0000062880/">Esophageal Cancer Prevention</a> for more information.)</p></div><div id="CDR0000062741__251"><h3>Prognostic Factors</h3><p id="CDR0000062741__369">Favorable prognostic factors include the following:</p><ul id="CDR0000062741__370"><li class="half_rhythm"><div>Early-stage disease.</div></li><li class="half_rhythm"><div>Complete resection.</div></li></ul><p id="CDR0000062741__371">Patients with severe dysplasia in distal esophageal Barrett mucosa often have
|
|
<i>in situ</i> or invasive cancer within the dysplastic area. After
|
|
resection, these patients usually have excellent prognoses.[<a class="bk_pop" href="#CDR0000062741_rl_1_8">8</a>]
|
|
</p><p id="CDR0000062741__252">In most cases, esophageal cancer is a treatable disease, but it is rarely curable. The 5-year relative survival rate is 19.9%.
|
|
Patients with early-stage disease have a better chance of survival; 17.5% of patients are diagnosed at the local stage and have a 5-year relative survival rate of 46.4%.[<a class="bk_pop" href="#CDR0000062741_rl_1_6">6</a>]
|
|
</p></div><div id="CDR0000062741__197"><h3>Related Summaries</h3><p id="CDR0000062741__198">Other PDQ summaries containing information related to esophageal cancer include the following:</p><ul id="CDR0000062741__199"><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062880/">Esophageal Cancer Prevention</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062877/">Esophageal Cancer Screening</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000799417/">Childhood Esophageal Cancer Treatment</a></div></li></ul><p id="CDR0000062741__395">For information about gastrointestinal stromal tumors, which can occur in the esophagus and are usually benign, refer to the following summary:</p><ul id="CDR0000062741__396"><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000639481/">Gastrointestinal Stromal Tumors Treatment (Adult)</a></div></li></ul><p id="CDR0000062741__253">For information about supportive care for patients with esophageal cancer, refer to the following summaries:</p><ul id="CDR0000062741__372"><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000276584/">Nutrition in Cancer Care</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062870/#CDR0000062870__656">Dysphagia</a> section in the <a href="/books/n/pdqcis/CDR0000062870/">Oral Complications of Chemotherapy and Head/Neck Radiation</a> summary</div></li></ul></div><div id="CDR0000062741_rl_1"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062741_rl_1_1">American Cancer Society: Cancer Facts and Figures 2021. American Cancer Society, 2021. <a href="https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2021/cancer-facts-and-figures-2021.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed June 02, 2021.</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_2">Brown LM, Devesa SS, Chow WH: Incidence of adenocarcinoma of the esophagus among white Americans by sex, stage, and age. J Natl Cancer Inst 100 (16): 1184-7, 2008. [<a href="/pmc/articles/PMC2518165/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2518165</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18695138" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18695138</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_3">Blot WJ, McLaughlin JK: The changing epidemiology of esophageal cancer. Semin Oncol 26 (5 Suppl 15): 2-8, 1999. [<a href="https://pubmed.ncbi.nlm.nih.gov/10566604" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10566604</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_4">Schmassmann A, Oldendorf MG, Gebbers JO: Changing incidence of gastric and oesophageal cancer subtypes in central Switzerland between 1982 and 2007. Eur J Epidemiol 24 (10): 603-9, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19669623" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19669623</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_5">Kubo A, Corley DA: Marked multi-ethnic variation of esophageal and gastric cardia carcinomas within the United States. Am J Gastroenterol 99 (4): 582-8, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15089886" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15089886</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_6">National Cancer Institute: SEER Cancer Stat Facts: Esophageal Cancer. Bethesda, Md: National Cancer Institute. <a href="https://seer.cancer.gov/statfacts/html/esoph.html" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed April 5, 2021.</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_7">Lagergren J, Bergström R, Lindgren A, et al.: Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340 (11): 825-31, 1999. [<a href="https://pubmed.ncbi.nlm.nih.gov/10080844" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10080844</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_1_8">Reed MF, Tolis G, Edil BH, et al.: Surgical treatment of esophageal high-grade dysplasia. Ann Thorac Surg 79 (4): 1110-5; discussion 1110-5, 2005. [<a href="https://pubmed.ncbi.nlm.nih.gov/15797034" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15797034</span></a>]</div></li></ol></div></div><div id="CDR0000062741__9"><h2 id="_CDR0000062741__9_">Cellular Classification of Esophageal Cancer</h2><p id="CDR0000062741__10">Adenocarcinomas, typically arising in Barrett esophagus, account for at least
|
|
50% of malignant lesions, and the incidence of this histology appears to be
|
|
rising. Barrett esophagus contains glandular epithelium cephalad to the
|
|
esophagogastric junction. </p><p id="CDR0000062741__400">Three different types of glandular epithelium can be
|
|
seen:</p><ul id="CDR0000062741__96"><li class="half_rhythm"><div>Metaplastic columnar epithelium.</div></li><li class="half_rhythm"><div>Metaplastic parietal cell glandular
|
|
epithelium within the esophageal wall.</div></li><li class="half_rhythm"><div>Metaplastic intestinal epithelium
|
|
with typical goblet cells. Dysplasia is particularly likely to develop in the
|
|
intestinal type mucosa.
|
|
</div></li></ul><p id="CDR0000062741__373">Fewer than 50% of esophageal cancers in the United States are squamous cell carcinomas.[<a class="bk_pop" href="#CDR0000062741_rl_9_1">1</a>]</p><p id="CDR0000062741__11">Gastrointestinal stromal tumors can occur in the esophagus and are usually
|
|
benign. (Refer to the PDQ summary on <a href="/books/n/pdqcis/CDR0000639481/">Gastrointestinal Stromal Tumors Treatment [Adult]</a> for
|
|
more information.)
|
|
</p><div id="CDR0000062741_rl_9"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062741_rl_9_1">Howlader N, Noone AM, Krapcho M, et al.: SEER Cancer Statistics Review (CSR) 1975-2017. Bethesda, Md: National Cancer Institute, 2020. <a href="https://seer.cancer.gov/csr/1975_2017/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed March 17, 2021.</div></li></ol></div></div><div id="CDR0000062741__12"><h2 id="_CDR0000062741__12_">Stage Information for Esophageal Cancer</h2><p id="CDR0000062741__13">One of the major difficulties in allocating and comparing treatment modalities
|
|
for patients with esophageal cancer is the lack of precise preoperative
|
|
staging. The stage determines whether the intent of the therapeutic approach will be
|
|
curative or palliative.
|
|
</p><div id="CDR0000062741__255"><h3>Staging Evaluation</h3><p id="CDR0000062741__256">Standard noninvasive staging modalities include the following:</p><ul id="CDR0000062741__374"><li class="half_rhythm"><div>Endoscopic ultrasound.</div></li><li class="half_rhythm"><div>Computed tomography
|
|
(CT) scan of the chest and abdomen.</div></li><li class="half_rhythm"><div>Positron emission tomography (PET)-CT scan.</div></li></ul><p id="CDR0000062741__257">The overall
|
|
tumor depth staging accuracy of endoscopic ultrasound is 85% to 90%, compared with 50% to 80%
|
|
for CT; the accuracy of regional nodal staging is 70% to 80% for endoscopic ultrasound and 50% to
|
|
70% for CT.[<a class="bk_pop" href="#CDR0000062741_rl_12_1">1</a>,<a class="bk_pop" href="#CDR0000062741_rl_12_2">2</a>]</p><p id="CDR0000062741__258">One retrospective series reported 93% sensitivity and 100% specificity of regional nodal staging with endoscopic ultrasound-guided fine-needle aspiration (FNA). Endoscopic ultrasound-guided FNA for lymph node
|
|
staging is under prospective evaluation.[<a class="bk_pop" href="#CDR0000062741_rl_12_3">3</a>]</p><p id="CDR0000062741__259">Thoracoscopy and
|
|
laparoscopy have been used in esophageal cancer staging at some surgical
|
|
centers.[<a class="bk_pop" href="#CDR0000062741_rl_12_4">4</a>-<a class="bk_pop" href="#CDR0000062741_rl_12_6">6</a>] An intergroup trial reported an increase in positive lymph node detection to 56% of 107 evaluable patients with the use of thoracoscopy/laparoscopy, from 41% (with the use of noninvasive staging tests, e.g., CT, magnetic resonance imaging, and endoscopic ultrasound), with no major complications or deaths.[<a class="bk_pop" href="#CDR0000062741_rl_12_7">7</a>] </p><p id="CDR0000062741__375">Noninvasive PET scan using the
|
|
radiolabeled glucose analog fluorine F 18-fludeoxyglucose (18F-FDG) for preoperative
|
|
staging of esophageal cancer is more sensitive than a CT scan or endoscopic ultrasound in detection of distant metastases. A recent study of 262 patients with potentially resectable esophageal cancer demonstrated the utility of 18F-FDG PET in identifying confirmed distant metastatic disease in at least 4.8% of patients after standard evaluation.[<a class="bk_pop" href="#CDR0000062741_rl_12_8">8</a>-<a class="bk_pop" href="#CDR0000062741_rl_12_12">12</a>]</p></div><div id="CDR0000062741__186"><h3>AJCC Staging System</h3><p id="CDR0000062741__200">The AJCC has
|
|
designated staging by TNM (tumor, node, metastasis) classification to define cancer of the esophagus and esophagogastric junction.[<a class="bk_pop" href="#CDR0000062741_rl_12_13">13</a>] Tumors located in the gastric cardia within 5 cm of the gastroesophageal junction with extension into the esophagus or the gastroesophageal junction are classified as esophageal cancer. Tumors with the epicenter of the tumor located in the gastric cardia beyond 5 cm of the gastroesophageal junction or without extension into the esophagus are classified as gastric cancer.[<a class="bk_pop" href="#CDR0000062741_rl_12_13">13</a>] (Refer to the <a href="/books/n/pdqcis/CDR0000062911/#CDR0000062911__17">Stage Information for Gastric Cancer </a> section in the PDQ summary on <a href="/books/n/pdqcis/CDR0000062911/">Gastric Cancer Treatment</a> for more information.)</p><p id="CDR0000062741__262">The classification of involved abdominal lymph nodes as M1 disease
|
|
is controversial. The presence of positive abdominal lymph nodes does not
|
|
appear to have a prognosis as grave as that for metastases to distant organs.[<a class="bk_pop" href="#CDR0000062741_rl_12_14">14</a>]
|
|
Patients with regional and/or celiac axis lymphadenopathy should not
|
|
necessarily be considered to have unresectable disease caused by metastases.
|
|
Complete resection of the primary tumor and appropriate lymphadenectomy is attempted when possible.</p><div id="CDR0000062741__454" class="table"><h3><span class="title">Table 1. Definitions of Primary Tumor, Regional Lymph Node, Distant Metastasis, Histologic Grade for Squamous Cell Carcinoma and Adenocarcinoma, and Location for Squamous Cell Carcinoma of the Esophagus<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__454_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">T Category/Criteria</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">N Category/Criteria</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">M Category/Criteria</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">G Definition</th><th colspan="2" rowspan="1" style="text-align:center;vertical-align:top;">L Category/Criteria<sup>b</sup></th></tr></thead><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">TX = Tumor cannot be assessed.</td><td colspan="1" rowspan="1" style="vertical-align:top;">NX = Regional lymph nodes cannot be assessed.</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td><td colspan="1" rowspan="1" style="vertical-align:top;">GX = Grade cannot be assessed.</td><td colspan="2" rowspan="1" style="vertical-align:top;">X = Location unknown.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T0 = No evidence of primary tumor.</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td><td colspan="1" rowspan="1" style="vertical-align:top;">M1 = Distant metastasis.</td><td colspan="1" rowspan="1" style="vertical-align:top;">G1 = Well differentiated.</td><td colspan="2" rowspan="1" style="vertical-align:top;">Upper = Cervical esophagus to lower border of azygos vein.</td></tr><tr><td colspan="1" rowspan="2" style="vertical-align:top;">Tis = High-grade dysplasia, defined as malignant cells confined to the epithelium by the basement membrane.</td><td colspan="1" rowspan="2" style="vertical-align:top;">N1 = Metastasis in one or two regional lymph nodes.</td><td colspan="1" rowspan="11" style="vertical-align:top;"></td><td colspan="1" rowspan="1" style="vertical-align:top;">G2 = Moderately differentiated.</td><td colspan="2" rowspan="1" style="vertical-align:top;">Middle = Lower border of azygos vein to lower border of inferior pulmonary vein.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G3 = Poorly differentiated, undifferentiated.</td><td colspan="2" rowspan="1" style="vertical-align:top;">Lower = Lower border of inferior pulmonary vein to stomach, including gastroesophageal junction.</td></tr><tr><td colspan="1" rowspan="2" style="vertical-align:top;">T1 = Tumor invades the lamina propria, muscularis mucosae, or submucosa.</td><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = Metastasis in three to six regional lymph nodes.</td><td colspan="1" rowspan="9" style="vertical-align:top;"></td><td colspan="2" rowspan="9" style="vertical-align:top;"></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N3 = Metastasis in seven or more regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T1a = Tumor invades the lamina propria or muscularis mucosae.</td><td colspan="1" rowspan="7" style="vertical-align:top;"></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T1b = Tumor invades the submucosa.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades the muscularis propria.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor invades adventitia.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4 = Tumor invades adjacent structures.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4a = Tumor invades the pleura, pericardium, azygos vein, diaphragm, or peritoneum.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4b = Tumor invades other adjacent structures, such as the aorta, vertebral body, or airway.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = definition of primary tumor; N = definition of regional lymph nodes; M = definition of distant metastasis; G = definition of histologic grade; L = definition of location. </p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp. 185–202.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>Location is defined by the position of the epicenter of the tumor in the esophagus.</p></div></dd></dl></div></div></div><div id="CDR0000062741__434"><h4>Staging for squamous cell carcinoma of the esophagus</h4><div id="CDR0000062741__484" class="table"><h3><span class="title">Table 2. Definitions of pTNM Stage 0 for Squamous Cell Carcinoma of the Esophagus<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.19/table/CDR0000062741__484/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__484_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Grade</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Tumor Location</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Illustration</th></tr></thead><tbody><tr><td colspan="1" rowspan="5" style="vertical-align:top;">0</td><td colspan="1" rowspan="5" style="vertical-align:top;">Tis, N0, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">N/A</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tis = High grade dysplasia, defined as malignant cells confined to the epithelium by the basement membrane.</td><td colspan="1" rowspan="5" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000792771&p=BOOKS&id=571275_CDR0000792771.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000792771.jpg" alt="Stage 0 squamous cell carcinoma of the esophagus; drawing shows the esophagus and stomach. An inset shows cancer cells in the inner lining of the esophagus wall. Also shown are the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer of the esophagus wall. The lymph nodes are also shown." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G1 = N/A.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>. </td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph nodes; M = distant metastasis; G = grade; L = tumor location; N/A = not applicable; p = pathological. </p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp. 185–202</p></div></dd></dl></div></div></div><div id="CDR0000062741__436" class="table"><h3><span class="title">Table 3. Definitions of pTNM Stages IA and IB for Squamous Cell Carcinoma of the Esophagus<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.19/table/CDR0000062741__436/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__436_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Grade</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Tumor Location</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Illustration</th></tr></thead><tbody><tr><td colspan="1" rowspan="10" style="vertical-align:top;">IA</td><td colspan="1" rowspan="5" style="vertical-align:top;">Tia, N0, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">G1</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor invades the lamina propria or muscularis mucosae.</td><td colspan="1" rowspan="10" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000752730&p=BOOKS&id=571275_CDR0000752730.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000752730.jpg" alt="Stage IA squamous cell carcinoma of the esophagus; drawing shows the esophagus and stomach. An inset shows grade 1 cancer cells or cancer cells of an unknown grade in the mucosa layer and thin muscle layer of the esophagus wall. Also shown are the submucosa layer, thick muscle layer, and connective tissue layer of the esophagus wall. The lymph nodes are also shown." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G1 = Well differentiated.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">T1a, N0, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">GX</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor invades the lamina propria or muscularis mucosae.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis. </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">GX = Grade cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="23" style="vertical-align:top;">IB</td><td colspan="1" rowspan="6" style="vertical-align:top;">T1a, N0, M0</td><td colspan="1" rowspan="6" style="vertical-align:top;">G2–G3</td><td colspan="1" rowspan="6" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor invades the lamina propria or muscularis mucosae.</td><td colspan="1" rowspan="23" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000752731&p=BOOKS&id=571275_CDR0000752731.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000752731.jpg" alt="Stage IB squamous cell carcinoma of the esophagus; drawing shows the esophagus and stomach. A two-panel inset shows the layers of the esophagus wall: the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer. The lymph nodes are also shown. The left panel shows cancer cells that are any grade or of an unknown grade in the mucosa layer, thin muscle layer, and submucosa layer. The right panel shows grade 1 cancer cells in the mucosa layer, thin muscle layer, submucosa layer, and thick muscle layer." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis. </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G2 = Moderately differentiated.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G3 = Poorly differentiated, undifferentiated.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="7" style="vertical-align:top;">T1b, N0, M0</td><td colspan="1" rowspan="7" style="vertical-align:top;">G1–G3</td><td colspan="1" rowspan="7" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T1b = Tumor invades the submucosa.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis. </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G1 = Well differentiated.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G2 = Moderately differentiated.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G3 = Poorly differentiated, undifferentiated.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>. </td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">T1b, N0, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">GX</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T1b = Tumor invades the submucosa.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis. </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">GX = Grade cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>. </td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">T2, N0, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">G1</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades the muscularis propria.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis. </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G1 = Well differentiated.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph nodes; M = distant metastasis; G = grade; L = tumor location; p = pathological.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp. 185–202.</p></div></dd></dl></div></div></div><div id="CDR0000062741__488" class="table"><h3><span class="title">Table 4. Definitions of pTNM Stages IIA and IIB for Squamous Cell Carcinoma of the Esophagus<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.19/table/CDR0000062741__488/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__488_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Grade</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Tumor Location<sup>b</sup></th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Illustration</th></tr></thead><tbody><tr><td colspan="1" rowspan="22" style="vertical-align:top;">IIA</td><td colspan="1" rowspan="5" style="vertical-align:top;">T2, N0, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">GX</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades the muscularis propria.</td><td colspan="1" rowspan="22" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000752732&p=BOOKS&id=571275_CDR0000752732.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000752732.jpg" alt="Stage IIA squamous cell carcinoma of the esophagus (1); drawing shows the esophagus and stomach. An inset shows grade 2 or 3 cancer cells or cancer cells of an unknown grade in the mucosa layer, thin muscle layer, submucosa layer, and thick muscle layer of the esophagus wall. Also shown are the connective tissue layer of the esophagus wall and the lymph nodes." class="tileshop" title="Click on image to zoom" /></a></div><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000757897&p=BOOKS&id=571275_CDR0000757897.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000757897.jpg" alt="Stage IIA squamous cell carcinoma of the esophagus (2); drawing shows the esophagus, including the lower part of the esophagus, and the stomach. An inset shows cancer cells of any grade in the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer of the lower esophagus wall. The lymph nodes are also shown." class="tileshop" title="Click on image to zoom" /></a></div><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000796479&p=BOOKS&id=571275_CDR0000796479.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000796479.jpg" alt="Stage IIA squamous cell carcinoma of the esophagus (3); drawing shows the upper and middle parts of the esophagus and the stomach. An inset shows grade 1 cancer cells in the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer of the upper and middle esophagus wall. The lymph nodes are also shown." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">GX = Grade cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="6" style="vertical-align:top;">T2, N0, M0</td><td colspan="1" rowspan="6" style="vertical-align:top;">G2–G3</td><td colspan="1" rowspan="6" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades the muscularis propria. </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G2 = Moderately differentiated.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G3 = Poorly differentiated, undifferentiated.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">T3, N0, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="5" style="vertical-align:top;">Lower</td><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor invades adventitia.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Lower = Lower border of inferior pulmonary vein to stomach, including gastroesophageal junction.</td></tr><tr><td colspan="1" rowspan="6" style="vertical-align:top;">T3, N0, M0</td><td colspan="1" rowspan="6" style="vertical-align:top;">G1</td><td colspan="1" rowspan="6" style="vertical-align:top;">Upper/middle</td><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor invades adventitia.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G1 = Well differentiated.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Upper = Cervical esophagus to lower border of azygos vein.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Middle = Lower border of azygos vein to lower border of inferior pulmonary vein.</td></tr><tr><td colspan="1" rowspan="22" style="vertical-align:top;">IIB</td><td colspan="1" rowspan="7" style="vertical-align:top;">T3, N0, M0</td><td colspan="1" rowspan="7" style="vertical-align:top;">G2–G3</td><td colspan="1" rowspan="7" style="vertical-align:top;">Upper/middle</td><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor invades adventitia.</td><td colspan="1" rowspan="22" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000752733&p=BOOKS&id=571275_CDR0000752733.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000752733.jpg" alt="Stage IIB squamous cell carcinoma of the esophagus (1); drawing shows the upper and middle parts of the esophagus and the stomach. An inset shows grade 2 or 3 cancer cells in the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer of the upper and middle esophagus wall." class="tileshop" title="Click on image to zoom" /></a></div><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000796796&p=BOOKS&id=571275_CDR0000796796.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000796796.jpg" alt="Stage IIB squamous cell carcinoma of the esophagus (2); drawing shows the esophagus and stomach. An inset shows (a) cancer cells of an unknown grade in the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer of the esophagus wall. Also shown is (b) the location of the tumor in the esophagus is unknown." class="tileshop" title="Click on image to zoom" /></a></div><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000796797&p=BOOKS&id=571275_CDR0000796797.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000796797.jpg" alt="Stage IIB squamous cell carcinoma of the esophagus (3); drawing shows the esophagus and stomach. An inset shows cancer cells of any grade in the mucosa layer, thin muscle layer, and submucosa layer of the esophagus wall. Also shown are the thick muscle layer and connective tissue layer of the esophagus wall and cancer in 1 lymph node near the tumor." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G2 = Moderately differentiated.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G3 = Poorly differentiated, undifferentiated.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Upper = Cervical esophagus to lower border of azygos vein.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Middle = Lower border of azygos vein to lower border of inferior pulmonary vein.</td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">T3, N0, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">GX</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor invades adventitia.
|
|
</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.
|
|
</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">GX = Grade cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">T3, N0, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="5" style="vertical-align:top;">Location X</td><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor invades adventitia.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Location X = Location unknown.</td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">T1, N1, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1 = Tumor invades the lamina propria, muscularis mucosae, or submucosa.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastasis in one or two regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph nodes; M = distant metastasis; G = grade; L = tumor location; p = pathological.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp. 185–202.
|
|
</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>Location is defined by the position of the epicenter of the tumor in the esophagus.</p></div></dd></dl></div></div></div><div id="CDR0000062741__445" class="table"><h3><span class="title">Table 5. Definitions of pTNM Stages IIIA and IIIB for Squamous Cell Carcinoma of the Esophagus<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.19/table/CDR0000062741__445/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__445_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage </th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM </th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Grade</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Tumor Location<sup>b</sup></th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Illustration</th></tr></thead><tbody><tr><td colspan="1" rowspan="12" style="vertical-align:top;">IIIA</td><td colspan="1" rowspan="7" style="vertical-align:top;">T1, N2, M0</td><td colspan="1" rowspan="7" style="vertical-align:top;">Any</td><td colspan="1" rowspan="7" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1 = Tumor invades the lamina propria, muscularis mucosae, or submucosa.</td><td colspan="1" rowspan="12" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000759456&p=BOOKS&id=571275_CDR0000759456.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000759456.jpg" alt="Stage IIIA squamous cell carcinoma of the esophagus; drawing shows the esophagus and stomach. A two-panel inset shows the layers of the esophagus wall: the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer. The left panel shows cancer in the mucosa layer, thin muscle layer, and submucosa layer and in 3 lymph nodes near the tumor. The right panel shows cancer in the mucosa layer, thin muscle layer, submucosa layer, and thick muscle layer and in 1 lymph node near the tumor." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor invades the lamina propria or muscularis mucosae.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1b = Tumor invades the submucosa.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = Metastasis in three to six regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">T2, N1, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades the muscularis propria. </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastasis in one or two regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="17" style="vertical-align:top;">IIIB</td><td colspan="1" rowspan="5" style="vertical-align:top;">T2, N2, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades the muscularis propria.</td><td colspan="1" rowspan="11" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000759737&p=BOOKS&id=571275_CDR0000759737.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000759737.jpg" alt="Stage IIIB squamous cell carcinoma of the esophagus (1); drawing shows the esophagus and stomach. An inset shows cancer cells in the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer of the esophagus wall and in 4 lymph nodes near the tumor." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = Metastasis in three to six regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="6" style="vertical-align:top;">T3, N1–N2, M0</td><td colspan="1" rowspan="6" style="vertical-align:top;">Any</td><td colspan="1" rowspan="6" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor invades adventitia.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastasis in one or two regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = Metastasis in three to six regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="6" style="vertical-align:top;">T4a, N0–1, M0</td><td colspan="1" rowspan="6" style="vertical-align:top;">Any</td><td colspan="1" rowspan="6" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T4a = Tumor invades the pleura, pericardium, azygos vein, diaphragm, or peritoneum.</td><td colspan="1" rowspan="6" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000796024&p=BOOKS&id=571275_CDR0000796024.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000796024.jpg" alt="Stage IIIB squamous cell carcinoma of the esophagus (2); drawing shows cancer in the esophagus and in the (a) diaphragm, (b) azygos vein, (c) pleura, and (d) membrane (sac) around the heart. Also shown are the airway, lung, aorta, chest wall, heart, and rib." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastasis in one or two regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph nodes; M = distant metastasis; G = grade; L = tumor location; p = pathological.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp. 185–202.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>Location is defined by the position of the epicenter of the tumor in the esophagus.</p></div></dd></dl></div></div></div><div id="CDR0000062741__450" class="table"><h3><span class="title">Table 6. Definitions of pTNM Stages IVA and IVB for Squamous Cell Carcinoma of the Esophagus<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.19/table/CDR0000062741__450/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__450_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage </th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM </th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Grade</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Tumor Location<sup>b</sup></th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Illustration</th></tr></thead><tbody><tr><td colspan="1" rowspan="17" style="vertical-align:top;">IVA</td><td colspan="1" rowspan="5" style="vertical-align:top;">T4a, N2, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T4a = Tumor invades the pleura, pericardium, azygos vein, diaphragm, or peritoneum.</td><td colspan="1" rowspan="5" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000796025&p=BOOKS&id=571275_CDR0000796025.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000796025.jpg" alt="Stage IVA squamous cell carcinoma of the esophagus (1); drawing shows cancer in the esophagus and in the (a) diaphragm, (b) azygos vein, (c) pleura, and (d) membrane (sac) around the heart. Also shown is cancer in 3 lymph nodes near the tumor. The airway, lung, aorta, chest wall, heart, and rib are also shown." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = Metastasis in three to six regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="7" style="vertical-align:top;">T4b, N0–2, M0</td><td colspan="1" rowspan="7" style="vertical-align:top;">Any</td><td colspan="1" rowspan="7" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T4b = Tumor invades other adjacent structures, such as the aorta, vertebral body, or airway.</td><td colspan="1" rowspan="7" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000796026&p=BOOKS&id=571275_CDR0000796026.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000796026.jpg" alt="Stage IVA squamous cell carcinoma of the esophagus (2); drawing shows cancer in the esophagus, airway, aorta, and spine." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastasis in one or two regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = Metastasis in three to six regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">Any T, N3, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any T = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td><td colspan="1" rowspan="5" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000796027&p=BOOKS&id=571275_CDR0000796027.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000796027.jpg" alt="Stage IVA squamous cell carcinoma of the esophagus (3); drawing shows cancer in the esophagus and in 9 lymph nodes near the tumor." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N3 = Metastasis in seven or more regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">IVB</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any T, Any N, M1</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any T = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td><td colspan="1" rowspan="5" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000759710&p=BOOKS&id=571275_CDR0000759710.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000759710.jpg" alt="Stage IVB squamous cell carcinoma of the esophagus; drawing shows other parts of the body where esophagus cancer may spread, including the lung and liver. An inset shows cancer cells spreading from the esophagus, through the blood and lymph system, to another part of the body where metastatic cancer has formed." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any N = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M1 = Distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any L = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph nodes; M = distant metastasis; G = grade; L = tumor location; p = pathological.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp. 185–202.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>Location is defined by the position of the epicenter of the tumor in the esophagus.</p></div></dd></dl></div></div></div><div id="CDR0000062741__TrialSearch_434_sid_12"><h5>Current Clinical Trials</h5><p id="CDR0000062741__TrialSearch_434_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div></div><div id="CDR0000062741__393"><h4>Staging for adenocarcinoma of the esophagus</h4><div id="CDR0000062741__455" class="table"><h3><span class="title">Table 7. Definitions of pTNM Stage 0 for Adenocarcinoma of the Esophagus<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.19/table/CDR0000062741__455/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__455_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Grade </th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Illustration</th></tr></thead><tbody><tr><td colspan="1" rowspan="3" style="vertical-align:top;">0</td><td colspan="1" rowspan="3" style="vertical-align:top;">Tis, N0, M0</td><td colspan="1" rowspan="3" style="vertical-align:top;">N/A</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tis = High-grade dysplasia, defined as malignant cells confined to the epithelium by the basement membrane.</td><td colspan="1" rowspan="3" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000792769&p=BOOKS&id=571275_CDR0000792769.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000792769.jpg" alt="Stage 0 adenocarcinoma of the esophagus; drawing shows the esophagus and stomach. An inset shows cancer cells in the inner lining of the esophagus wall. Also shown are the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer of the esophagus wall. The lymph nodes are also shown." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph nodes; M = distant metastasis; G = grade; N/A = not applicable; p = pathological.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp. 185–202.</p></div></dd></dl></div></div></div><div id="CDR0000062741__456" class="table"><h3><span class="title">Table 8. Definitions of pTNM Stages IA, IB, and IC for Adenocarcinoma of the Esophagus<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.19/table/CDR0000062741__456/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__456_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM </th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Grade</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Illustration</th></tr></thead><tbody><tr><td colspan="1" rowspan="8" style="vertical-align:top;">IA</td><td colspan="1" rowspan="4" style="vertical-align:top;">T1a, N0, M0</td><td colspan="1" rowspan="4" style="vertical-align:top;">G1</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor invades the lamina propria or muscularis mucosae.</td><td colspan="1" rowspan="8" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000762340&p=BOOKS&id=571275_CDR0000762340.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000762340.jpg" alt="Stage IA adenocarcinoma of the esophagus; drawing shows the esophagus and stomach. An inset shows cancer cells in the mucosa layer and thin muscle layer of the esophagus wall. The cancer cells are grade 1 or the grade is not known. Also shown are the submucosa layer, thick muscle layer, and connective tissue layer of the esophagus wall. The lymph nodes are also shown." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G1 = Well differentiated.</td></tr><tr><td colspan="1" rowspan="4" style="vertical-align:top;">T1a, N0, M0</td><td colspan="1" rowspan="4" style="vertical-align:top;">GX</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor invades the lamina propria or muscularis mucosae.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">GX = Grade cannot be assessed.</td></tr><tr><td colspan="1" rowspan="13" style="vertical-align:top;">IB</td><td colspan="1" rowspan="4" style="vertical-align:top;">T1a, N0, M0</td><td colspan="1" rowspan="4" style="vertical-align:top;">G2</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor invades the lamina propria or muscularis mucosae.</td><td colspan="1" rowspan="13" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000762344&p=BOOKS&id=571275_CDR0000762344.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000762344.jpg" alt="Stage IB adenocarcinoma of the esophagus; drawing shows the esophagus and stomach. A two-panel inset shows the layers of the esophagus wall: the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer. The lymph nodes are also shown. The left panel shows grade 2 cancer cells in the mucosa layer and thin muscle layer. The right panel shows cancer cells in the mucosa layer, thin muscle layer, and submucosa layer. The cancer cells are grade 1 or 2 or the grade is not known." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G2 = Moderately differentiated.</td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">T1b, N0, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">G1–2</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T1b = Tumor invades the submucosa.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G1 = Well differentiated.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G2 = Moderately differentiated.</td></tr><tr><td colspan="1" rowspan="4" style="vertical-align:top;">T1b, N0, M0</td><td colspan="1" rowspan="4" style="vertical-align:top;">GX</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T1b = Tumor invades the submucosa.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">GX = Grade cannot be assessed.</td></tr><tr><td colspan="1" rowspan="11" style="vertical-align:top;">IC</td><td colspan="1" rowspan="6" style="vertical-align:top;">T1, N0, M0</td><td colspan="1" rowspan="6" style="vertical-align:top;">G3</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1 = Tumor invades the lamina propria, muscularis mucosae, or submucosa.</td><td colspan="1" rowspan="11" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000794331&p=BOOKS&id=571275_CDR0000794331.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000794331.jpg" alt="Stage IC adenocarcinoma of the esophagus; drawing shows the esophagus and stomach. A two-panel inset shows the layers of the esophagus wall: the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer. The lymph nodes are also shown. The left panel shows grade 3 cancer cells in the mucosa layer, thin muscle layer, and submucosa layer. The right panel shows grade 1 or 2 cancer cells in the mucosa layer, thin muscle layer, submucosa layer, and thick muscle layer." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor invades the lamina propria or muscularis mucosae.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1b = Tumor invades the submucosa.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G3 = Poorly differentiated, undifferentiated.</td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">T2, N0, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">G1–2</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades the muscularis propria.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G1 = Well differentiated.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G2 = Moderately differentiated.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph nodes; M = distant metastasis; G = grade; p = pathological.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp. 185–202.</p></div></dd></dl></div></div></div><div id="CDR0000062741__461" class="table"><h3><span class="title">Table 9. Definitions of pTNM Stages IIA and IIB for Adenocarcinoma of the Esophagus<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.19/table/CDR0000062741__461/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__461_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Grade </th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Illustration</th></tr></thead><tbody><tr><td colspan="1" rowspan="8" style="vertical-align:top;">IIA</td><td colspan="1" rowspan="4" style="vertical-align:top;">T2, N0, M0</td><td colspan="1" rowspan="4" style="vertical-align:top;">G3</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades the muscularis propria.</td><td colspan="1" rowspan="8" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000762342&p=BOOKS&id=571275_CDR0000762342.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000762342.jpg" alt="Stage IIA adenocarcinoma of the esophagus; drawing shows the esophagus and stomach. An inset shows cancer cells in the mucosa layer, thin muscle layer, submucosa layer, and thick muscle layer of the esophagus wall. The cancer cells are grade 3 or the grade is not known. Also shown is the connective tissue layer of the esophagus wall and the lymph nodes." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">G3 = Poorly differentiated, undifferentiated. </td></tr><tr><td colspan="1" rowspan="4" style="vertical-align:top;">T2, N0, M0</td><td colspan="1" rowspan="4" style="vertical-align:top;">GX</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades the muscularis propria.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"> GX = Grade cannot be assessed.</td></tr><tr><td colspan="1" rowspan="10" style="vertical-align:top;">IIB</td><td colspan="1" rowspan="6" style="vertical-align:top;">T1, N1, M0</td><td colspan="1" rowspan="6" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1 = Tumor invades the lamina propria, muscularis mucosae, or submucosa.</td><td colspan="1" rowspan="10" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000762355&p=BOOKS&id=571275_CDR0000762355.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000762355.jpg" alt="Stage IIB adenocarcinoma of the esophagus; drawing shows the esophagus and stomach. A two-panel inset shows the layers of the esophagus wall: the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer. The left panel shows cancer in the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer. The right panel shows cancer in the mucosa layer, thin muscle layer, and submucosa layer and in 1 lymph node near the tumor." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor invades the lamina propria or muscularis mucosae.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1b = Tumor invades the submucosa.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastasis in one or two regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="4" style="vertical-align:top;">T3, N0, M0</td><td colspan="1" rowspan="4" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor invades adventitia.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph nodes; M = distant metastasis; G = grade; p = pathological.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp. 185–202.</p></div></dd></dl></div></div></div><div id="CDR0000062741__465" class="table"><h3><span class="title">Table 10. Definitions of pTNM Stages IIIA and IIIB for Adenocarcinoma of the Esophagus<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.19/table/CDR0000062741__465/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__465_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Grade</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Illustration</th></tr></thead><tbody><tr><td colspan="1" rowspan="10" style="vertical-align:top;">IIIA</td><td colspan="1" rowspan="6" style="vertical-align:top;">T1, N2, M0</td><td colspan="1" rowspan="6" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1 = Tumor invades the lamina propria, muscularis mucosae, or submucosa.</td><td colspan="1" rowspan="10" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000762220&p=BOOKS&id=571275_CDR0000762220.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000762220.jpg" alt="Stage IIIA adenocarcinoma of the esophagus; drawing shows the esophagus and stomach. A two-panel inset shows the layers of the esophagus wall: the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer. The left panel shows cancer in the mucosa layer, thin muscle layer, and submucosa layer and in 3 lymph nodes near the tumor. The right panel shows cancer in the mucosa layer, thin muscle layer, submucosa layer, and thick muscle layer and in 1 lymph node near the tumor." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor invades the lamina propria or muscularis mucosae.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1b = Tumor invades the submucosa.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = Metastasis in three to six regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="4" style="vertical-align:top;">T2, N1, M0</td><td colspan="1" rowspan="4" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades the muscularis propria.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastasis in one or two regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="14" style="vertical-align:top;">IIIB</td><td colspan="1" rowspan="4" style="vertical-align:top;">T2, N2, M0</td><td colspan="1" rowspan="4" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades the muscularis propria.</td><td colspan="1" rowspan="9" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000762234&p=BOOKS&id=571275_CDR0000762234.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000762234.jpg" alt="Stage IIIB adenocarcinoma of the esophagus (1); drawing shows the esophagus and stomach. An inset shows the layers of the esophagus wall: the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer. The left panel shows cancer in the mucosa layer, thin muscle layer, submucosa layer, and thick muscle layer and in 3 lymph nodes near the tumor. The right panel shows cancer in the mucosa layer, thin muscle layer, submucosa layer, thick muscle layer, and connective tissue layer and in 4 lymph nodes near the tumor." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = Metastasis in three to six regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">T3, N1–2, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor invades adventitia.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastasis in one or two regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = Metastasis in three to six regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="5" style="vertical-align:top;">T4a, N0–1, M0</td><td colspan="1" rowspan="5" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T4a = Tumor invades the pleura, pericardium, azygos vein, diaphragm, or peritoneum.</td><td colspan="1" rowspan="5" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000794333&p=BOOKS&id=571275_CDR0000794333.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000794333.jpg" alt="Stage IIIB adenocarcinoma of the esophagus (2); drawing shows cancer in the esophagus and in the (a) diaphragm, (b) azygos vein, (c) pleura, and (d) membrane (sac) around the heart. Also shown are the airway, lung, aorta, chest wall, heart, and rib." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastasis in one or two regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph nodes; M = distant metastasis; G = grade; p = pathological.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp. 185–202.</p></div></dd></dl></div></div></div><div id="CDR0000062741__470" class="table"><h3><span class="title">Table 11. Definitions of pTNM Stages IVA and IVB for Adenocarcinoma of the Esophagus<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.19/table/CDR0000062741__470/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__470_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Grade</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Illustration</th></tr></thead><tbody><tr><td colspan="1" rowspan="14" style="vertical-align:top;">IVA</td><td colspan="1" rowspan="4" style="vertical-align:top;">T4a, N2, M0</td><td colspan="1" rowspan="4" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T4a = Tumor invades the pleura, pericardium, azygos vein, diaphragm, or peritoneum.</td><td colspan="1" rowspan="4" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000762235&p=BOOKS&id=571275_CDR0000762235.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000762235.jpg" alt="Stage IVA adenocarcinoma of the esophagus (1); drawing shows cancer in the esophagus and in the (a) diaphragm, (b) azygos vein, (c) pleura, and (d) membrane (sac) around the heart. Also shown is cancer in 3 lymph nodes near the tumor. The airway, lung, aorta, chest wall, heart, and rib are also shown." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = Metastasis in three to six regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="6" style="vertical-align:top;">T4b, N0–2, M0</td><td colspan="1" rowspan="6" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">–T4b = Tumor invades other adjacent structures, such as the aorta, vertebral body, or airway.</td><td colspan="1" rowspan="6" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000794334&p=BOOKS&id=571275_CDR0000794334.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000794334.jpg" alt="Stage IVA adenocarcinoma of the esophagus (2); drawing shows cancer in the esophagus, airway, aorta, and spine." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastasis in one or two regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = Metastasis in three to six regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="4" style="vertical-align:top;">Any T, N3, M0</td><td colspan="1" rowspan="4" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any T = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td><td colspan="1" rowspan="4" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000794335&p=BOOKS&id=571275_CDR0000794335.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000794335.jpg" alt="Stage IVA adenocarcinoma of the esophagus (3); drawing shows cancer in the esophagus and in 9 lymph nodes near the tumor." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N3 = Metastasis in seven or more regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="4" style="vertical-align:top;">IVB</td><td colspan="1" rowspan="4" style="vertical-align:top;">Any T, Any N, M1</td><td colspan="1" rowspan="4" style="vertical-align:top;">Any</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any T = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td><td colspan="1" rowspan="4" style="vertical-align:top;"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20CDR0000794336&p=BOOKS&id=571275_CDR0000794336.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65900.19/bin/CDR0000794336.jpg" alt="Stage IVB adenocarcinoma of the esophagus; drawing showing other parts of the body where esophagus cancer may spread, including the lung and liver. An inset shows cancer cells spreading from the esophagus, through the blood and lymph system, to another part of the body where metastatic cancer has formed." class="tileshop" title="Click on image to zoom" /></a></div></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any N = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M1 = Distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any G = See <a class="figpopup" href="/books/NBK65900.19/table/CDR0000062741__454/?report=objectonly" target="object" rid-figpopup="figCDR0000062741454" rid-ob="figobCDR0000062741454">Table 1</a>.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph nodes; M = distant metastasis; G = grade; p = pathological.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp. 185–202.</p></div></dd></dl></div></div></div></div></div><div id="CDR0000062741_rl_12"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062741_rl_12_1">Ziegler K, Sanft C, Zeitz M, et al.: Evaluation of endosonography in TN staging of oesophageal cancer. Gut 32 (1): 16-20, 1991. [<a href="/pmc/articles/PMC1379206/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1379206</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/1991632" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1991632</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_2">Tio TL, Coene PP, den Hartog Jager FC, et al.: Preoperative TNM classification of esophageal carcinoma by endosonography. Hepatogastroenterology 37 (4): 376-81, 1990. [<a href="https://pubmed.ncbi.nlm.nih.gov/2210603" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2210603</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_3">Vazquez-Sequeiros E, Norton ID, Clain JE, et al.: Impact of EUS-guided fine-needle aspiration on lymph node staging in patients with esophageal carcinoma. Gastrointest Endosc 53 (7): 751-7, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11375583" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11375583</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_4">Bonavina L, Incarbone R, Lattuada E, et al.: Preoperative laparoscopy in management of patients with carcinoma of the esophagus and of the esophagogastric junction. J Surg Oncol 65 (3): 171-4, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9236925" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9236925</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_5">Sugarbaker DJ, Jaklitsch MT, Liptay MJ: Thoracoscopic staging and surgical therapy for esophageal cancer. Chest 107 (6 Suppl): 218S-223S, 1995. [<a href="https://pubmed.ncbi.nlm.nih.gov/7781397" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7781397</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_6">Luketich JD, Schauer P, Landreneau R, et al.: Minimally invasive surgical staging is superior to endoscopic ultrasound in detecting lymph node metastases in esophageal cancer. J Thorac Cardiovasc Surg 114 (5): 817-21; discussion 821-3, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9375612" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9375612</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_7">Krasna MJ, Reed CE, Nedzwiecki D, et al.: CALGB 9380: a prospective trial of the feasibility of thoracoscopy/laparoscopy in staging esophageal cancer. Ann Thorac Surg 71 (4): 1073-9, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11308139" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11308139</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_8">Flamen P, Lerut A, Van Cutsem E, et al.: Utility of positron emission tomography for the staging of patients with potentially operable esophageal carcinoma. J Clin Oncol 18 (18): 3202-10, 2000. [<a href="https://pubmed.ncbi.nlm.nih.gov/10986052" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10986052</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_9">Flamen P, Van Cutsem E, Lerut A, et al.: Positron emission tomography for assessment of the response to induction radiochemotherapy in locally advanced oesophageal cancer. Ann Oncol 13 (3): 361-8, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/11996465" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11996465</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_10">Weber WA, Ott K, Becker K, et al.: Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol 19 (12): 3058-65, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11408502" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11408502</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_11">van Westreenen HL, Westerterp M, Bossuyt PM, et al.: Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol 22 (18): 3805-12, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15365078" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15365078</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_12">Meyers BF, Downey RJ, Decker PA, et al.: The utility of positron emission tomography in staging of potentially operable carcinoma of the thoracic esophagus: results of the American College of Surgeons Oncology Group Z0060 trial. J Thorac Cardiovasc Surg 133 (3): 738-45, 2007. [<a href="https://pubmed.ncbi.nlm.nih.gov/17320575" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17320575</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_13">Rice TW, Kelsen D, Blackstone EH, et al.: Esophagus and Esophagogastric Junction. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer; 2017, pp 185-202.</div></li><li><div class="bk_ref" id="CDR0000062741_rl_12_14">Korst RJ, Rusch VW, Venkatraman E, et al.: Proposed revision of the staging classification for esophageal cancer. J Thorac Cardiovasc Surg 115 (3): 660-69; discussion 669-70, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9535455" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9535455</span></a>]</div></li></ol></div></div><div id="CDR0000062741__44"><h2 id="_CDR0000062741__44_">Treatment Option Overview for Esophageal Cancer</h2><p id="CDR0000062741__406">For patients with minimally invasive resectable esophageal cancer, surgical resection alone offers the potential for cure. In contrast, therapeutic management for patients with locally advanced resectable esophageal cancer has evolved significantly over the last few decades. Because of the risk of distant metastases and local relapse, multimodality therapy with integration of chemotherapy, radiation therapy, and surgical resection has become the standard of care.</p><p id="CDR0000062741__263">Combined modality therapies are under clinical evaluation and include the following:
|
|
</p><ul id="CDR0000062741__376"><li class="half_rhythm"><div>Surgery alone.</div></li><li class="half_rhythm"><div> Chemotherapy.</div></li><li class="half_rhythm"><div>
|
|
Radiation therapy.</div></li></ul><p id="CDR0000062741__377">Effective palliation may be obtained in individual cases with various
|
|
combinations of the following:</p><ul id="CDR0000062741__378"><li class="half_rhythm"><div>Surgery.</div></li><li class="half_rhythm"><div> Chemotherapy. </div></li><li class="half_rhythm"><div>Radiation therapy.</div></li><li class="half_rhythm"><div>Stents.[<a class="bk_pop" href="#CDR0000062741_rl_44_1">1</a>]
|
|
</div></li><li class="half_rhythm"><div>Photodynamic therapy.[<a class="bk_pop" href="#CDR0000062741_rl_44_2">2</a>-<a class="bk_pop" href="#CDR0000062741_rl_44_4">4</a>]</div></li><li class="half_rhythm"><div> Endoscopic therapy with Nd:YAG laser.[<a class="bk_pop" href="#CDR0000062741_rl_44_5">5</a>]</div></li></ul><div id="CDR0000062741__347" class="table"><h3><span class="title">Table 12. Standard Treatment Options for Esophageal Cancer</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65900.19/table/CDR0000062741__347/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062741__347_lrgtbl__"><table class="no_top_margin"><thead><tr><th colspan="1" rowspan="1" style="vertical-align:top;">Stage (<a href="#CDR0000062741__12">TNM Staging Criteria</a>)</th><th colspan="1" rowspan="1" style="vertical-align:top;">Treatment Options </th></tr></thead><tbody><tr><td colspan="1" rowspan="2" style="vertical-align:top;"><a href="#CDR0000062741__297">Stage 0 Esophageal Cancer</a>
|
|
</td><td colspan="1" rowspan="1" style="vertical-align:top;">Surgery</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Endoscopic resection</td></tr><tr><td colspan="1" rowspan="2" style="vertical-align:top;"><a href="#CDR0000062741__55">Stage I Esophageal Cancer</a>
|
|
</td><td colspan="1" rowspan="1" style="vertical-align:top;">Chemoradiation therapy followed by surgery</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Surgery alone</td></tr><tr><td colspan="1" rowspan="4" style="vertical-align:top;"><a href="#CDR0000062741__60">Stage II Esophageal Cancer</a>
|
|
</td><td colspan="1" rowspan="1" style="vertical-align:top;">Chemoradiation followed by surgery</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Surgery alone</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Chemotherapy followed by surgery
|
|
</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Definitive chemoradiation</td></tr><tr><td colspan="1" rowspan="3" style="vertical-align:top;"><a href="#CDR0000062741__65">Stage III Esophageal Cancer </a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Chemoradiation followed by surgery</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Preoperative chemotherapy followed by surgery</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Definitive chemoradiation</td></tr><tr><td colspan="1" rowspan="6" style="vertical-align:top;"><a href="#CDR0000062741__70">Stage IV Esophageal Cancer </a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Chemoradiation followed by surgery (for patients with stage IVA disease)</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Chemotherapy, which has provided partial responses for patients with metastatic distal esophageal adenocarcinomas </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Nd:YAG endoluminal tumor destruction or electrocoagulation</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Endoscopic-placed stents to provide palliation of dysphagia</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Radiation therapy with or without intraluminal intubation and dilation</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Intraluminal brachytherapy to provide palliation of dysphagia</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="#CDR0000062741__81">Recurrent Esophageal Cancer </a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Palliative use of any of the standard therapies, including supportive care</td></tr></tbody></table></div></div><div id="CDR0000062741__264"><h3>Surgery</h3><div id="CDR0000062741__265"><h4>Surgery (Barrett esophagus)</h4><p id="CDR0000062741__266">The prevalence of Barrett metaplasia in adenocarcinoma of the esophagus
|
|
suggests that Barrett esophagus is a premalignant condition. Endoscopic surveillance of
|
|
patients with Barrett metaplasia may detect adenocarcinoma at an earlier
|
|
stage that is more amenable to curative resection. Strong
|
|
consideration should be given to resection in patients with high-grade
|
|
dysplasia in the setting of Barrett metaplasia.[<a class="bk_pop" href="#CDR0000062741_rl_44_6">6</a>] </p></div><div id="CDR0000062741__267"><h4>Surgery (esophageal cancer)</h4><p id="CDR0000062741__268">The survival rate of patients
|
|
with esophageal cancer is poor. Surgical treatment of resectable esophageal cancers results in 5-year survival
|
|
rates of 5% to 30%, with higher survival rates in patients with early-stage
|
|
cancers.[<a class="bk_pop" href="#CDR0000062741_rl_44_7">7</a>] Asymptomatic small tumors confined to the
|
|
esophageal mucosa or submucosa are detected only by chance. Surgery is the
|
|
treatment of choice for these small tumors. Once symptoms are present
|
|
(e.g., dysphagia, in most cases), esophageal cancers have usually invaded
|
|
the muscularis propria or beyond and may have metastasized to lymph nodes or
|
|
other organs.
|
|
</p><p id="CDR0000062741__271"> In some patients
|
|
with partial esophageal obstruction, dysphagia may be relieved by
|
|
placement of an expandable metallic stent [<a class="bk_pop" href="#CDR0000062741_rl_44_8">8</a>] or by radiation therapy if the
|
|
patient has disseminated disease or is not a candidate for surgery.
|
|
Alternative methods of relieving dysphagia have been reported, including laser
|
|
therapy and electrocoagulation to destroy intraluminal tumor.[<a class="bk_pop" href="#CDR0000062741_rl_44_9">9</a>-<a class="bk_pop" href="#CDR0000062741_rl_44_11">11</a>]</p><p id="CDR0000062741__269">In the presence of complete esophageal obstruction without clinical evidence
|
|
of systemic metastasis, surgical excision of the tumor with mobilization of the
|
|
stomach to replace the esophagus has been the traditional means of relieving
|
|
the dysphagia. </p><p id="CDR0000062741__270">The optimal surgical approach for radical resection of esophageal cancer is not known. One approach
|
|
advocates transhiatal esophagectomy with anastomosis of the stomach to the
|
|
cervical esophagus. A second approach advocates abdominal mobilization of the
|
|
stomach and transthoracic excision of the esophagus with anastomosis of the
|
|
stomach to the upper thoracic esophagus or the cervical esophagus. One study concluded that transhiatal esophagectomy was associated with lower morbidity than was transthoracic esophagectomy with extended en bloc lymphadenectomy; however, median overall disease-free and quality-adjusted survival did not differ significantly.[<a class="bk_pop" href="#CDR0000062741_rl_44_12">12</a>] Similarly, no differences in long-term quality of life (QOL) using validated QOL instruments have been reported.[<a class="bk_pop" href="#CDR0000062741_rl_44_13">13</a>] More recently, minimally invasive approaches that offer potential advantages of smaller incisions, decreased intraoperative blood loss, fewer postoperative complications, and shorter hospital stays have emerged. However, the ability to obtain negative surgical margins, the adequacy of lymph node dissection, and long-term outcomes have not been fully established with this approach.[<a class="bk_pop" href="#CDR0000062741_rl_44_14">14</a>]</p><p id="CDR0000062741__379">In the United States, the median age of patients who present
|
|
with esophageal cancer is 68 years.[<a class="bk_pop" href="#CDR0000062741_rl_44_15">15</a>] The results of a retrospective
|
|
review of 505 consecutive patients who were operated on by a single surgical
|
|
team over 17 years found no difference in the perioperative mortality, median
|
|
survival, or palliative benefit of esophagectomy on dysphagia when the patients older than 70 years were compared with their younger peers.[<a class="bk_pop" href="#CDR0000062741_rl_44_16">16</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335144/" class="def">Levels of
|
|
evidence: 3iiA</a> and <a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335145/" class="def"> 3iiB</a>] All of the patients in this series were selected for
|
|
surgery on the basis of potential operative risk. Age alone does not determine
|
|
therapy for patients with potentially resectable disease.</p><p id="CDR0000062741__272">Surgical treatment of esophageal cancer is associated with an operative mortality rate of less than 10%.[<a class="bk_pop" href="#CDR0000062741_rl_44_7">7</a>] In an attempt to avoid perioperative mortality and to relieve dysphagia,
|
|
definitive radiation therapy in combination with chemotherapy has been studied.
|
|
</p></div></div><div id="CDR0000062741__212"><h3>Preoperative Chemoradiation Therapy</h3><p id="CDR0000062741__213">On the basis of several randomized trial results, chemoradiation followed by surgery is a standard treatment option for patients with stages IB, II, III, and IVA esophageal cancer.</p><p id="CDR0000062741__277">Phase III trials have compared preoperative concurrent chemoradiation therapy with surgery alone for patients with esophageal cancer.[<a class="bk_pop" href="#CDR0000062741_rl_44_17">17</a>-<a class="bk_pop" href="#CDR0000062741_rl_44_21">21</a>,<a class="bk_pop" href="#CDR0000062741_rl_44_21">21</a>-<a class="bk_pop" href="#CDR0000062741_rl_44_23">23</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] The benefit of neoadjuvant chemoradiation has been controversial because of contradictory results of early randomized studies.[<a class="bk_pop" href="#CDR0000062741_rl_44_17">17</a>-<a class="bk_pop" href="#CDR0000062741_rl_44_20">20</a>] However, the Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) has definitively demonstrated a survival benefit for preoperative chemoradiation compared with surgery alone in locally advanced esophageal cancer.[<a class="bk_pop" href="#CDR0000062741_rl_44_21">21</a>] </p><p id="CDR0000062741__411">For early-stage tumors, the role of preoperative chemoradiation remains controversial. Although the CROSS study included early-stage patients, the Francophone de
|
|
Cancérologie Digestive (FFCD) 9901 study (<a href="https://www.cancer.gov/clinicaltrials/NCT00047112" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCT00047112</a>)[<a class="bk_pop" href="#CDR0000062741_rl_44_23">23</a>], which included only early-stage (stage I or II) patients, failed to demonstrate a survival advantage in this group of patients. </p><p id="CDR0000062741__278">Evidence (preoperative chemoradiation therapy):</p><ol id="CDR0000062741__279"><li class="half_rhythm"><div>The CROSS study randomly assigned 366 patients with resectable esophageal or junctional cancers to receive either surgery alone or weekly administration of carboplatin (dose titrated to achieve an AUC [area under the curve] of 2 mg/mL/minute) and paclitaxel (50 mg/m<sup>2</sup> of BSA [body surface area]) and concurrent radiation therapy (41.4 Gy in 23 fractions) administered over 5 weeks. Most patients enrolled in the CROSS trial (75%) had adenocarcinoma.[<a class="bk_pop" href="#CDR0000062741_rl_44_21">21</a>,<a class="bk_pop" href="#CDR0000062741_rl_44_24">24</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>]<ul id="CDR0000062741__280"><li class="half_rhythm"><div>With a median follow-up of 84 months, preoperative chemoradiation was found to improve median overall survival (OS) from 24 months in the surgery-alone group to 48.6 months (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.53–0.88; <i>P</i> = .003). Median OS for patients with squamous cell carcinomas was 81.6 months in the preoperative chemoradiation group compared with 21.1 months in the surgery-alone group (HR, 0.48; 95% CI, 0.28–0.83; log rank <i>P </i>= .008); for patients with adenocarcinomas, median OS was 43.2 months in the preoperative chemoradiation group compared with 27.1 months in the surgery-alone group (HR, 0.73; 95% CI, 0.55–0.98; log rank <i>P </i>= .038).[<a class="bk_pop" href="#CDR0000062741_rl_44_24">24</a>] </div></li><li class="half_rhythm"><div>Additionally, preoperative chemoradiation improved the rate of R0 resections (92% vs. 69%, <i>P</i> < .001). R0 is defined as complete resection with no tumor within 1 mm of resection margins.</div></li><li class="half_rhythm"><div>A complete pathologic response was achieved in 29% of patients who underwent resection after chemoradiation therapy. A pathologic complete response was observed in 23% of patients with adenocarcinoma compared with 49% of patients with squamous cell carcinoma (<i>P</i> = .008).</div></li><li class="half_rhythm"><div>Postoperative complications and in-hospital mortality were equivalent in both groups. The most common hematologic side effects in the chemoradiation group were leukopenia (6%) and neutropenia (2%). The most common nonhematologic side effects were anorexia (5%) and fatigue (3%).</div></li><li class="half_rhythm"><div>With a median follow-up of 84 months, the 5-year progression-free survival (PFS) was 44% in the preoperative chemoradiation group compared with 27% in the surgery-alone group (HR, 0.61 [0.47–0.78]). Preoperative chemoradiation therapy reduced locoregional recurrence from 34% to 14% (<i>P</i> < .001) and peritoneal carcinomatosis from 14% to 4% (<i>P</i> < .001). There was a small but significant effect on hematogenous dissemination in favor of the chemoradiation therapy group (35% vs. 29%; <i>P</i> = .025).[<a class="bk_pop" href="#CDR0000062741_rl_44_22">22</a>,<a class="bk_pop" href="#CDR0000062741_rl_44_24">24</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335129/" class="def">Level of evidence: 1iiDii</a>]</div></li></ul></div></li><li class="half_rhythm"><div>A multicenter
|
|
prospective randomized trial compared preoperative combined chemotherapy
|
|
(i.e., cisplatin) and radiation therapy (37 Gy in 3.7-Gy fractions) versus surgery alone in patients with squamous cell carcinoma.[<a class="bk_pop" href="#CDR0000062741_rl_44_17">17</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>]<ul id="CDR0000062741__385"><li class="half_rhythm"><div>The study showed no improvement in OS and a significantly higher
|
|
postoperative mortality (12% vs. 4%) in the combined-modality arm.</div></li></ul></div></li><li class="half_rhythm"><div>In
|
|
patients with adenocarcinoma of the esophagus, a single-institution phase III
|
|
trial was conducted in patients treated with induction chemoradiation therapy consisting of fluorouracil (5-FU),
|
|
cisplatin, and 40 Gy (in 2.67-Gy fractions) plus surgery compared with resection
|
|
alone.[<a class="bk_pop" href="#CDR0000062741_rl_44_18">18</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>]<ul id="CDR0000062741__386"><li class="half_rhythm"><div>The results demonstrated a modest survival benefit of 16 months for combined modality therapy versus 11 months for
|
|
surgery alone.</div></li></ul></div></li><li class="half_rhythm"><div>A subsequent single-institution trial randomly assigned patients (75% with
|
|
adenocarcinoma) to 5-FU, cisplatin, vinblastine, and radiation
|
|
therapy (1.5 Gy twice daily to a total of 45 Gy) plus resection versus
|
|
esophagectomy alone.[<a class="bk_pop" href="#CDR0000062741_rl_44_19">19</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>]<ul id="CDR0000062741__281"><li class="half_rhythm"><div>At a median follow-up of more than 8 years, there was no
|
|
significant difference between the surgery alone and combined modality therapy
|
|
with respect to median survival (17.6 months vs. 16.9 months), OS (16% vs. 30% at 3 years), or disease-free survival (DFS) (16% vs. 28%
|
|
at 3 years).</div></li></ul></div></li><li class="half_rhythm"><div>An intergroup trial (<a href="https://www.cancer.gov/clinicaltrials/NCT00003118" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">CALGB-9781</a> [<a href="https://clinicaltrials.gov/show/NCT00003118" title="Study NCT00003118" ref="pagearea=body&targetsite=external&targetcat=link&targettype=clinical-trial">NCT00003118</a>]) planned to randomly assign 475 patients with resectable squamous cell or adenocarcinoma of the thoracic esophagus to treatment with preoperative chemoradiation therapy (5-FU, cisplatin, and 50.4 Gy) followed by esophagectomy and nodal dissection or surgery alone. The trial was closed as a result of poor patient accrual; however, results from the 56 enrolled patients, with a median follow-up of 6 years, were reported.[<a class="bk_pop" href="#CDR0000062741_rl_44_20">20</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>]<ul id="CDR0000062741__282"><li class="half_rhythm"><div>The median survival was 4.48 years (95% CI; range, 2.4 years to not estimable) for trimodality therapy versus 1.79 years (95% CI, 1.41–2.59 years) for surgery alone (<i>P</i> = .002), with a 5-year OS rate of 39% for trimodality therapy (95% CI, 21%–57%) versus 16% for surgery alone (95% CI, 5%–33%).</div></li></ul></div></li><li class="half_rhythm"><div> To further evaluate the impact of neoadjuvant chemoradiation therapy for early-stage disease, FFCD 9901 randomly assigned 195 patients with stage I or stage II esophageal cancer to receive surgery alone or neoadjuvant chemoradiation therapy (45 Gy in 25 fractions administered with two courses of 5-FU [800 mg/m<sup>2</sup>] and cisplatin [75 mg/m<sup>2</sup>]) followed by surgery.[<a class="bk_pop" href="#CDR0000062741_rl_44_23">23</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] <ul id="CDR0000062741__412"><li class="half_rhythm"><div> At interim analysis, accrual to the study was stopped early because of futility.</div></li><li class="half_rhythm"><div> With a median follow-up of 94 months, there was no significant improvement in 3-year OS rates with chemoradiation (48% vs. 53%, <i>P</i> = .94); there was a significantly higher postoperative mortality rate of 11.1% versus 3.4% (<i>P</i> = .049).</div></li></ul></div></li></ol></div><div id="CDR0000062741__218"><h3>Preoperative Chemotherapy </h3><p id="CDR0000062741__219">The effects of preoperative chemotherapy are being evaluated in randomized trials. Several studies have demonstrated a survival benefit with preoperative chemotherapy compared with surgery alone.[<a class="bk_pop" href="#CDR0000062741_rl_44_25">25</a>-<a class="bk_pop" href="#CDR0000062741_rl_44_27">27</a>] However, one large randomized study failed to confirm a survival benefit with preoperative chemotherapy.[<a class="bk_pop" href="#CDR0000062741_rl_44_28">28</a>] Compared with preoperative chemotherapy alone, preoperative chemoradiation therapy improves pathologic response and may improve outcomes.[<a class="bk_pop" href="#CDR0000062741_rl_44_29">29</a>]</p><p id="CDR0000062741__283">Evidence (preoperative chemotherapy):</p><ol id="CDR0000062741__284"><li class="half_rhythm"><div class="half_rhythm">An intergroup trial (<a href="https://www.cancer.gov/clinicaltrials/NCT00525785" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCT00525785</a>) randomly assigned 440 patients with local and operable esophageal cancer of any cell type to three cycles of preoperative 5-FU and cisplatin followed by surgery and two additional cycles of chemotherapy versus surgery alone.[<a class="bk_pop" href="#CDR0000062741_rl_44_28">28</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>]<ul id="CDR0000062741__285"><li class="half_rhythm"><div>After a median follow-up of 55 months, there were no significant differences in median survival between the chemotherapy-plus-surgery group (14.9 months) and the surgery-alone group (16.1 months); the median survival rate at 2 years was 35% for the chemotherapy-plus-surgery group and 37% for the surgery-alone group.</div></li><li class="half_rhythm"><div>The addition of chemotherapy did not increase the morbidity associated with surgery.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm">The Medical Research Council Oesophageal Cancer Working Party randomly assigned 802 patients with resectable esophageal cancer, also of any cell type, to two cycles of preoperative 5-FU and cisplatin followed by surgery versus surgery alone.[<a class="bk_pop" href="#CDR0000062741_rl_44_25">25</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>]<ul id="CDR0000062741__286"><li class="half_rhythm"><div>At a median follow-up of 37 months, median survival was significantly improved in the preoperative chemotherapy arm (16.8 months vs. 13.3 months with surgery alone; difference, 3.5 months; 95% CI, 1.0–6.5 months), as was 2-year OS (43% in the preoperative chemotherapy arm and 34% in the surgery-alone arm; difference, 9%; 95% CI, 3–14 months). </div></li></ul></div><div class="half_rhythm">The interpretation of the results from the intergroup and preoperative chemotherapy trials is challenging because T or N staging was not reported, and prerandomization and radiation could be offered at the discretion of the treating oncologist.</div></li><li class="half_rhythm"><div class="half_rhythm">The Japanese Clinical Oncology Group randomly assigned 330 patients with clinical stage II or III, excluding T4, squamous cell carcinomas to receive either two cycles of preoperative cisplatin and 5-FU followed by surgery or surgery followed by postoperative chemotherapy of the same regimen. A planned interim analysis was conducted after patient accrual; although the primary endpoint of PFS was not met, there was a significant benefit in OS among patients treated with preoperative chemotherapy (<i>P</i> = .01). As a result of these findings, the Data and Safety Monitoring Committee recommended early closure of the study.[<a class="bk_pop" href="#CDR0000062741_rl_44_26">26</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335127/" class="def">Level of evidence: 1iiC</a>]<ul id="CDR0000062741__388"><li class="half_rhythm"><div>With a median follow-up of 61 months, the 5-year OS rate was 55% among patients treated with preoperative chemotherapy compared with 43% among patients treated with postoperative chemotherapy (<i>P</i> = .04). However, there was no significant difference between groups with respect to PFS (5-year PFS rate, 39% vs. 44%; <i>P</i> = .22).</div></li><li class="half_rhythm"><div>Additionally, there were no significant differences between the two groups with respect to postoperative complications or treatment-related toxicities.</div></li></ul></div></li><li class="half_rhythm"><div class="half_rhythm"> The Fédération Nationale des Centres de Lutte contre le Cancer and the FFCD randomly assigned 224 patients with resectable adenocarcinoma of the lower esophagus, gastroesophageal junction, or stomach to receive either perioperative chemotherapy and surgery (n = 113) or surgery alone (n = 111). Chemotherapy consisted of two or three preoperative cycles of intravenous (IV) cisplatin (100 mg/m<sup>2</sup>) on day 1 and continuous IV infusion of 5-FU (800 mg/m<sup>2</sup>) for 5 consecutive days (day 1–5) every 28 days, and three or four postoperative cycles of the same regimen.[<a class="bk_pop" href="#CDR0000062741_rl_44_27">27</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] <ul id="CDR0000062741__414"><li class="half_rhythm"><div> Perioperative chemotherapy was associated with improved 5-year OS (5-year OS rate, 38% vs. 24%; HR, 0.69; <i>P</i> = .02). </div></li><li class="half_rhythm"><div> Grade 3 and 4 toxicity occurred in 38% of patients treated with perioperative chemotherapy, but there was no increase in postoperative morbidity.</div></li></ul>
|
|
</div></li><li class="half_rhythm"><div class="half_rhythm"> The Preoperative Chemotherapy or Radiochemotherapy in Esophago-gastric Adenocarcinoma Trial (POET) sought to evaluate the additional benefit of radiation therapy to preoperative chemotherapy. Patients were randomly assigned to receive either induction chemotherapy (15 weeks) followed by surgery or chemotherapy (12 weeks) followed by chemoradiation therapy (3 weeks) followed by surgery.[<a class="bk_pop" href="#CDR0000062741_rl_44_29">29</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] <ul id="CDR0000062741__415"><li class="half_rhythm"><div> The study was closed early because of poor accrual. In total, 126 patients were randomly assigned.</div></li><li class="half_rhythm"><div> Preoperative radiation therapy yielded 3-year survival rates of 27% to 47% (log rank, <i>P</i> = .07). Postoperative mortality was nonsignificantly increased in the chemoradiation therapy group (10.2% vs. 3.8%, <i>P</i> = .26). </div></li></ul></div></li></ol></div><div id="CDR0000062741__416"><h3>Definitive Chemoradiation</h3><p id="CDR0000062741__417">For patients who are deemed either medically inoperable or have tumors that are unresectable, the efficacy of definitive chemoradiation has been established in numerous randomized controlled trials.[<a class="bk_pop" href="#CDR0000062741_rl_44_30">30</a>,<a class="bk_pop" href="#CDR0000062741_rl_44_31">31</a>] For patients with squamous cell carcinomas of the esophagus, definitive chemoradiation may offer equivalent outcomes compared with preoperative chemoradiation followed by surgical resection.[<a class="bk_pop" href="#CDR0000062741_rl_44_32">32</a>,<a class="bk_pop" href="#CDR0000062741_rl_44_33">33</a>]</p><p id="CDR0000062741__418">Evidence (definitive chemoradiation):</p><ol id="CDR0000062741__419"><li class="half_rhythm"><div>A Radiation Therapy Oncology Group trial (RTOG-8501) randomly assigned patients to chemotherapy and radiation therapy versus radiation therapy
|
|
alone. Patients were randomly assigned to receive radiation therapy alone (64 Gy in 32 fractions) or chemoradiation (50 Gy in 25 fractions) with concurrent cisplatin (75 mg/m<sup>2</sup>) and continuous-infusion 5-FU (1,000 mg/m<sup>2</sup> on days 1 to 4 in weeks 1 and 5 followed by two additional cycles of chemotherapy administered 3 weeks apart).[<a class="bk_pop" href="#CDR0000062741_rl_44_30">30</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>]<ul id="CDR0000062741__420"><li class="half_rhythm"><div>There was an improvement in 5-year survival for the combined modality
|
|
group (27% vs. 0%).</div></li><li class="half_rhythm"><div>An 8-year follow-up of this trial
|
|
demonstrated an OS rate of 22% for patients receiving
|
|
chemoradiation therapy.</div></li></ul></div></li><li class="half_rhythm"><div>Intergroup-0123 (<a href="https://www.cancer.gov/clinicaltrials/NCT00002631" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">RTOG-9405 </a> [<a href="https://clinicaltrials.gov/show/NCT00002631" title="Study NCT00002631" ref="pagearea=body&targetsite=external&targetcat=link&targettype=clinical-trial">NCT00002631</a>]) was conducted in an attempt to improve upon the results
|
|
of RTOG-8501. Intergroup-0123 randomly assigned 236 patients with
|
|
localized esophageal tumors to undergo chemoradiation with high-dose radiation therapy
|
|
(64.8 Gy) and four monthly cycles of 5-FU and cisplatin versus conventional-dose radiation therapy (50.4 Gy) and the same chemotherapy schedule.[<a class="bk_pop" href="#CDR0000062741_rl_44_31">31</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>]<ul id="CDR0000062741__421"><li class="half_rhythm"><div>Although originally designed to accrue 298 patients, this trial was closed in 1999 after a planned interim analysis showed that it was statistically unlikely that there would be any advantage to using high-dose radiation.</div></li><li class="half_rhythm"><div>At a 2-year median follow-up, no statistically significant differences in median survival were observed between the high-dose and
|
|
conventional-dose radiation therapy arms (13 months vs.
|
|
18 months), 2-year survival rates (31% vs. 40%), or local and regional failures (56%
|
|
vs. 52%).</div></li><li class="half_rhythm"><div>There was a higher treatment mortality in the higher-dose arm (9% vs. 2%); however, 7 of 11 deaths in the high-dose arm occurred in patients who had received 50.4 Gy or less. </div></li></ul></div></li><li class="half_rhythm"><div>An Eastern Cooperative Oncology Group trial (EST-1282) evaluated 135
|
|
patients.[<a class="bk_pop" href="#CDR0000062741_rl_44_34">34</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>]<ul id="CDR0000062741__422"><li class="half_rhythm"><div> This trial showed that chemotherapy plus radiation therapy provided a better 2-year
|
|
survival rate than did radiation therapy alone, similar to results from the
|
|
intergroup trial.</div></li></ul></div></li><li class="half_rhythm"><div>The <a href="https://www.cancer.gov/clinicaltrials/NCT00861094" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PRODIGE5/ACCORD17</a> (<a href="https://clinicaltrials.gov/show/NCT00861094" title="Study NCT00861094" ref="pagearea=body&targetsite=external&targetcat=link&targettype=clinical-trial">NCT00861094</a>) trial sought to evaluate and compare the efficacy and safety of oxaliplatin, 5-FU, and leucovorin calcium (FOLFOX) versus 5-FU and cisplatin as the chemotherapy backbone among patients treated with definitive chemoradiation for localized esophageal cancer. In this multicenter, randomized, phase II and III trial, 267 patients were randomly assigned to receive either six cycles of FOLFOX (three cycles concomitant with radiation therapy), oxaliplatin (85 mg/m<sup>2</sup>), leucovorin (200 mg/m<sup>2</sup>), bolus 5-FU (400 mg/m<sup>2</sup>) and infusion 5-FU (1,600 mg/m<sup>2</sup> over 46 hours) or four cycles of 5-FU (1,000 mg/m<sup>2</sup> for 4 days) and cisplatin (75 mg/m<sup>2</sup> on day 1). All patients received radiation therapy (50 Gy in 25 fractions).[<a class="bk_pop" href="#CDR0000062741_rl_44_35">35</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335131/" class="def">Level of evidence: 1iiDiii</a>]<ul id="CDR0000062741__423"><li class="half_rhythm"><div> With a median follow-up of 25.3 months, there was no significant difference in PFS (9.7 months with FOLFOX vs. 9.4 months with 5-FU and cisplatin; <i>P</i> = .64). </div></li><li class="half_rhythm"><div> There was one death caused by toxicity in the FOLFOX group versus six deaths in the 5-FU and cisplatin arm (<i>P</i> = .066). </div></li><li class="half_rhythm"><div> There were no significant differences in grade 3 or 4 adverse events between treatment groups. Among toxicities of all grades, paresthesia, sensory neuropathy, and increases in aspartate transaminase and alanine transaminase were more common in the FOLFOX group; whereas, increases in serum creatinine, mucositis, and alopecia were more common in the 5-FU and cisplatin group.</div></li></ul></div></li><li class="half_rhythm"><div>A phase III German trial also compared induction chemotherapy (three courses of bolus 5-FU, leucovorin, etoposide, and cisplatin) followed by chemoradiation therapy (cisplatin, etoposide, and 40 Gy) followed by surgery (arm A), or the same induction chemotherapy followed by chemoradiation therapy (at least 65 Gy) without surgery (arm B) for patients with T3 or T4 squamous cell carcinoma of the esophagus. OS was the primary outcome.[<a class="bk_pop" href="#CDR0000062741_rl_44_32">32</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>]<ul id="CDR0000062741__409"><li class="half_rhythm"><div>The analysis of 172 eligible, randomly assigned patients showed that OS at 2 years was not statistically significantly different between the two treatment groups (arm A, 39.9%; 95% CI, 29.4%–50.4%; arm B, 35.4%; 95% CI, 25.2%–45.6%; log-rank test for equivalence with 0.15, <i>P</i> < .007). </div></li><li class="half_rhythm"><div> Local PFS was higher in the surgery group (2-year PFS, 64.3%; 95% CI, 52.1%–76.5%) than in the chemoradiation therapy group (2-year PFS, 40.7%; 95% CI, 28.9%–52.5%; HR for arm B vs. arm A, 2.1; 95% CI, 1.3–3.5; <i>P</i> < .003). </div></li><li class="half_rhythm"><div> Treatment-related mortality was higher in the surgery group (12.8%) than in the chemoradiation therapy group (3.5%) (<i>P</i> < .03).</div></li></ul></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/clinicaltrials/NCT00416858" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri"> FFCD 9102</a> (<a href="https://clinicaltrials.gov/show/NCT00416858" title="Study NCT00416858" ref="pagearea=body&targetsite=external&targetcat=link&targettype=clinical-trial">NCT00416858</a>) randomly assigned 259 patients with T3N0–1M0 thoracic esophageal cancer to receive either two cycles of 5-FU and cisplatin (days 1–5 and 22–26) and either conventional radiation therapy (46 Gy in 4.5 weeks) or split course (15 Gy, days 1–5 and 22–26). Patients with response were then randomly assigned to receive either surgical resection (arm A) or continuation of chemoradiation (arm B: three cycles of 5-FU plus cisplatin and either conventional 20 Gy or split-course 15 Gy radiation therapy).[<a class="bk_pop" href="#CDR0000062741_rl_44_33">33</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] <ul id="CDR0000062741__424"><li class="half_rhythm"><div> Of the 259 randomly assigned patients, 230 (89%) had squamous cell carcinoma, and 29 patients (11%) had adenocarcinomas.</div></li><li class="half_rhythm"><div> The 2-year OS rate was 34% in patients randomly assigned to receive surgery versus 40% in patients randomly assigned to receive definitive chemoradiation (HR, 0.90; <i>P</i> = .44). Median survival was 17.7 months for surgery and 19.3 months for definitive chemoradiation.</div></li><li class="half_rhythm"><div> The 3-month mortality rate was 9.3% in the surgery arm compared with 0.8% in the chemoradiation arm (<i>P</i> = .002).</div></li></ul></div></li></ol></div><div id="CDR0000062741__500"><h3>Adjuvant Therapy</h3><p id="CDR0000062741__501">Evidence (adjuvant therapy):</p><ol id="CDR0000062741__502"><li class="half_rhythm"><div>A global, randomized, double-blind, placebo-controlled, phase III trial evaluated a checkpoint inhibitor as adjuvant therapy in 794 patients with esophageal or gastroesophageal junction cancer. Adults with a performance status of 0 or 1 and R0 stage II or III disease who had received neoadjuvant chemoradiation therapy and had residual pathological disease were included. Patients were randomly assigned in a 2:1 ratio to receive either nivolumab (240 mg every 2 weeks for 16 weeks) followed by nivolumab (480 mg every 4 weeks) (532 patients) or matching placebo (262 patients). Patients were enrolled regardless of programmed death-ligand 1 (PD-L1) expression. The maximum duration of the trial intervention period was 1 year. The primary endpoint was DFS. The median follow-up was 24.4 months.[<a class="bk_pop" href="#CDR0000062741_rl_44_36">36</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335129/" class="def">Level of evidence: 1iiDii</a>]<ul id="CDR0000062741__503"><li class="half_rhythm"><div> The median DFS was 22.4 months (95% CI, 16.6–34.0) among patients who received nivolumab, compared with 11.0 months (95% CI, 8.3–14.3) among patients who received placebo. The HR for disease recurrence or death was 0.69 (96.4% CI, 0.56–0.86; <i>P</i> < .001). </div></li><li class="half_rhythm"><div>Median DFS was evaluated across a prespecified subgroup according to histologic type. Among patients with adenocarcinoma, the median DFS was 19.4 months in the 376 patients who received nivolumab (95% CI, 15.9–29.4), compared with 11.1 months in the 187 patients who received the placebo (95% CI, 8.3–16.8); the HR for disease recurrence or death was 0.75 (95% CI, 0.59–0.96). Among patients with squamous cell carcinoma, the median DFS was 29.7 months (95% CI, 14.4 to not estimable) in the 155 patients who received nivolumab, compared with 11 months (95% CI, 7.6–17.8) in the 75 patients who received the placebo; the HR for disease recurrence or death was 0.61 (95% CI, 0.42–0.88).</div></li><li class="half_rhythm"><div> HRs for disease recurrence or death were remarkably close between the 570 patients whose tumors expressed less than 1% of PD-L1 (HR, 0.73 [95% CI, 0.57–0.92]) and the 129 patients whose tumors expressed 1% or more of PD-L1 (HR, 0.75 [95% CI, 0.45–1.24]).</div></li><li class="half_rhythm"><div> Grade 3 or 4 adverse events of any cause occurred in 183 of 532 patients (34%) in the nivolumab group and 84 of 260 patients (32%) in the placebo group, and serious adverse events of any grade occurred in 30% of the patients in each group (nivolumab: 158 of 532; placebo: 78 of 260). Adverse events that were considered by the investigators to be related to the trial regimen were more common with nivolumab than with placebo, including grade 3 or 4 events (nivolumab: 71 of 532 patients [13%]; placebo: 15 of 260 patients [6%]) and events leading to discontinuation of therapy (nivolumab: 48 of 532 patients [9%]; placebo: 8 of 260 patients [3%]).</div></li><li class="half_rhythm"><div>OS data have not been reported for this study.</div></li></ul></div></li></ol><p id="CDR0000062741__504">Given the positive results with the use of nivolumab after chemoradiation therapy and surgery in patients with esophageal cancer, there is an ongoing study to determine whether the adjuvant use of checkpoint inhibitor therapy improves outcomes in patients undergoing definitive chemoradiation therapy without surgery (<a href="https://www.cancer.gov/clinicaltrials/NCT04210115" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">KEYNOTE-975</a> [<a href="https://clinicaltrials.gov/show/NCT04210115" title="Study NCT04210115" ref="pagearea=body&targetsite=external&targetcat=link&targettype=clinical-trial">NCT04210115</a>]). Studies are also evaluating potential benefits in patients undergoing perioperative chemotherapy without radiation therapy (e.g., <a href="https://www.cancer.gov/clinicaltrials/NCT03221426" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">KEYNOTE-585</a> [<a href="https://clinicaltrials.gov/show/NCT03221426" title="Study NCT03221426" ref="pagearea=body&targetsite=external&targetcat=link&targettype=clinical-trial">NCT03221426</a>]).[<a class="bk_pop" href="#CDR0000062741_rl_44_37">37</a>]</p></div><div id="CDR0000062741__293"><h3>Postoperative Radiation Therapy</h3><p id="CDR0000062741__294">Two randomized trials have shown no significant OS benefit
|
|
for postoperative radiation therapy compared with surgery alone.[<a class="bk_pop" href="#CDR0000062741_rl_44_38">38</a>,<a class="bk_pop" href="#CDR0000062741_rl_44_39">39</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] All newly
|
|
diagnosed patients should be considered candidates for therapies and
|
|
clinical trials comparing various treatment modalities.
|
|
Information about ongoing clinical trials is available from the <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000062741_rl_44"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062741_rl_44_1">Tietjen TG, Pasricha PJ, Kalloo AN: Management of malignant esophageal stricture with esophageal dilation and esophageal stents. Gastrointest Endosc Clin N Am 4 (4): 851-62, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/7529118" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7529118</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_2">Lightdale CJ, Heier SK, Marcon NE, et al.: Photodynamic therapy with porfimer sodium versus thermal ablation therapy with Nd:YAG laser for palliation of esophageal cancer: a multicenter randomized trial. Gastrointest Endosc 42 (6): 507-12, 1995. [<a href="https://pubmed.ncbi.nlm.nih.gov/8674919" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8674919</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_3">Kubba AK: Role of photodynamic therapy in the management of gastrointestinal cancer. Digestion 60 (1): 1-10, 1999 Jan-Feb. [<a href="https://pubmed.ncbi.nlm.nih.gov/9892792" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9892792</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_4">Heier SK, Heier LM: Tissue sensitizers. Gastrointest Endosc Clin N Am 4 (2): 327-52, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/8193868" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8193868</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_5">Bourke MJ, Hope RL, Chu G, et al.: Laser palliation of inoperable malignant dysphagia: initial and at death. Gastrointest Endosc 43 (1): 29-32, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8903814" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8903814</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_6">Lerut T, Coosemans W, Van Raemdonck D, et al.: Surgical treatment of Barrett's carcinoma. Correlations between morphologic findings and prognosis. J Thorac Cardiovasc Surg 107 (4): 1059-65; discussion 1065-6, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/8159027" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8159027</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_7">Kelsen DP, Bains M, Burt M: Neoadjuvant chemotherapy and surgery of cancer of the esophagus. Semin Surg Oncol 6 (5): 268-73, 1990. [<a href="https://pubmed.ncbi.nlm.nih.gov/2237085" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2237085</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_8">Saxon RR, Morrison KE, Lakin PC, et al.: Malignant esophageal obstruction and esophagorespiratory fistula: palliation with a polyethylene-covered Z-stent. Radiology 202 (2): 349-54, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9015055" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9015055</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_9">Campbell WR, Taylor SA, Pierce GE, et al.: Therapeutic alternatives in patients with esophageal cancer. Am J Surg 150 (6): 665-8, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/4073357" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4073357</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_10">Mellow MH, Pinkas H: Endoscopic therapy for esophageal carcinoma with Nd:YAG laser: prospective evaluation of efficacy, complications, and survival. Gastrointest Endosc 30 (6): 334-9, 1984. [<a href="https://pubmed.ncbi.nlm.nih.gov/6210226" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6210226</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_11">Karlin DA, Fisher RS, Krevsky B: Prolonged survival and effective palliation in patients with squamous cell carcinoma of the esophagus following endoscopic laser therapy. Cancer 59 (11): 1969-72, 1987. [<a href="https://pubmed.ncbi.nlm.nih.gov/2436743" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2436743</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_12">Hulscher JB, van Sandick JW, de Boer AG, et al.: Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347 (21): 1662-9, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12444180" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12444180</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_13">de Boer AG, van Lanschot JJ, van Sandick JW, et al.: Quality of life after transhiatal compared with extended transthoracic resection for adenocarcinoma of the esophagus. J Clin Oncol 22 (20): 4202-8, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15483031" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15483031</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_14">Santillan AA, Farma JM, Meredith KL, et al.: Minimally invasive surgery for esophageal cancer. J Natl Compr Canc Netw 6 (9): 879-84, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18926097" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18926097</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_15">National Cancer Institute: SEER Cancer Stat Facts: Esophageal Cancer. Bethesda, Md: National Cancer Institute. <a href="https://seer.cancer.gov/statfacts/html/esoph.html" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed April 5, 2021.</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_16">Ellis FH, Williamson WA, Heatley GJ: Cancer of the esophagus and cardia: does age influence treatment selection and surgical outcomes? J Am Coll Surg 187 (4): 345-51, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9783779" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9783779</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_17">Bosset JF, Gignoux M, Triboulet JP, et al.: Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 337 (3): 161-7, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9219702" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9219702</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_18">Walsh TN, Noonan N, Hollywood D, et al.: A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 335 (7): 462-7, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8672151" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8672151</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_19">Urba SG, Orringer MB, Turrisi A, et al.: Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 19 (2): 305-13, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11208820" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11208820</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_20">Tepper J, Krasna MJ, Niedzwiecki D, et al.: Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol 26 (7): 1086-92, 2008. [<a href="/pmc/articles/PMC5126644/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5126644</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18309943" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18309943</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_21">van Hagen P, Hulshof MC, van Lanschot JJ, et al.: Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366 (22): 2074-84, 2012. [<a href="https://pubmed.ncbi.nlm.nih.gov/22646630" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22646630</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_22">Oppedijk V, van der Gaast A, van Lanschot JJ, et al.: Patterns of recurrence after surgery alone versus preoperative chemoradiotherapy and surgery in the CROSS trials. J Clin Oncol 32 (5): 385-91, 2014. [<a href="https://pubmed.ncbi.nlm.nih.gov/24419108" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24419108</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_23">Mariette C, Dahan L, Mornex F, et al.: Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol 32 (23): 2416-22, 2014. [<a href="https://pubmed.ncbi.nlm.nih.gov/24982463" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24982463</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_24">Shapiro J, van Lanschot JJ, Hulshof MC, et al.: Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol 16 (9): 1090-8, 2015. [<a href="https://pubmed.ncbi.nlm.nih.gov/26254683" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26254683</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_25">Medical Research Council Oesophageal Cancer Working Group: Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 359 (9319): 1727-33, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12049861" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12049861</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_26">Ando N, Kato H, Igaki H, et al.: A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol 19 (1): 68-74, 2012. [<a href="https://pubmed.ncbi.nlm.nih.gov/21879261" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21879261</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_27">Ychou M, Boige V, Pignon JP, et al.: Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 29 (13): 1715-21, 2011. [<a href="https://pubmed.ncbi.nlm.nih.gov/21444866" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21444866</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_28">Kelsen DP, Ginsberg R, Pajak TF, et al.: Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 339 (27): 1979-84, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9869669" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9869669</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_29">Stahl M, Walz MK, Stuschke M, et al.: Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol 27 (6): 851-6, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19139439" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19139439</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_30">Cooper JS, Guo MD, Herskovic A, et al.: Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA 281 (17): 1623-7, 1999. [<a href="https://pubmed.ncbi.nlm.nih.gov/10235156" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10235156</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_31">Minsky BD, Pajak TF, Ginsberg RJ, et al.: INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 20 (5): 1167-74, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/11870157" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11870157</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_32">Stahl M, Stuschke M, Lehmann N, et al.: Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 23 (10): 2310-7, 2005. [<a href="https://pubmed.ncbi.nlm.nih.gov/15800321" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15800321</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_33">Bedenne L, Michel P, Bouché O, et al.: Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol 25 (10): 1160-8, 2007. [<a href="https://pubmed.ncbi.nlm.nih.gov/17401004" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17401004</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_34">Smith TJ, Ryan LM, Douglass HO, et al.: Combined chemoradiotherapy vs. radiotherapy alone for early stage squamous cell carcinoma of the esophagus: a study of the Eastern Cooperative Oncology Group. Int J Radiat Oncol Biol Phys 42 (2): 269-76, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9788404" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9788404</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_35">Conroy T, Galais MP, Raoul JL, et al.: Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer (PRODIGE5/ACCORD17): final results of a randomised, phase 2/3 trial. Lancet Oncol 15 (3): 305-14, 2014. [<a href="https://pubmed.ncbi.nlm.nih.gov/24556041" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24556041</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_36">Kelly RJ, Ajani JA, Kuzdzal J, et al.: Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer. N Engl J Med 384 (13): 1191-1203, 2021. [<a href="https://pubmed.ncbi.nlm.nih.gov/33789008" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33789008</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_37">Ilson DH: Adjuvant Nivolumab in Esophageal Cancer - A New Standard of Care. N Engl J Med 384 (13): 1269-1271, 2021. [<a href="https://pubmed.ncbi.nlm.nih.gov/33789017" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33789017</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_38">Ténière P, Hay JM, Fingerhut A, et al.: Postoperative radiation therapy does not increase survival after curative resection for squamous cell carcinoma of the middle and lower esophagus as shown by a multicenter controlled trial. French University Association for Surgical Research. Surg Gynecol Obstet 173 (2): 123-30, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1925862" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1925862</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_44_39">Fok M, Sham JS, Choy D, et al.: Postoperative radiotherapy for carcinoma of the esophagus: a prospective, randomized controlled study. Surgery 113 (2): 138-47, 1993. [<a href="https://pubmed.ncbi.nlm.nih.gov/8430362" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8430362</span></a>]</div></li></ol></div></div><div id="CDR0000062741__53"><h2 id="_CDR0000062741__53_">Stage 0 Esophageal Cancer Treatment</h2><div id="CDR0000062741__297"><h3>Standard Treatment Options for Stage 0 Esophageal Cancer</h3><p id="CDR0000062741__299">Stage 0 squamous cell esophageal cancer is rarely seen in the United States, but
|
|
surgery has been used.[<a class="bk_pop" href="#CDR0000062741_rl_53_1">1</a>,<a class="bk_pop" href="#CDR0000062741_rl_53_2">2</a>] For early-stage minimally invasive esophageal cancer, surgical and endoscopic techniques offer high rates of cure.[<a class="bk_pop" href="#CDR0000062741_rl_53_3">3</a>,<a class="bk_pop" href="#CDR0000062741_rl_53_4">4</a>] </p><ol id="CDR0000062741__397"><li class="half_rhythm"><div><a href="#CDR0000062741__265">Surgery</a>.</div></li><li class="half_rhythm"><div> Endoscopic resection.</div></li></ol></div><div id="CDR0000062741__TrialSearch_53_sid_5"><h3>Current Clinical Trials</h3><p id="CDR0000062741__TrialSearch_53_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062741_rl_53"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062741_rl_53_1">Rusch VW, Levine DS, Haggitt R, et al.: The management of high grade dysplasia and early cancer in Barrett's esophagus. A multidisciplinary problem. Cancer 74 (4): 1225-9, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/8055442" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8055442</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_53_2">Heitmiller RF, Redmond M, Hamilton SR: Barrett's esophagus with high-grade dysplasia. An indication for prophylactic esophagectomy. Ann Surg 224 (1): 66-71, 1996. [<a href="/pmc/articles/PMC1235248/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1235248</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/8678620" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8678620</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_53_3">Pech O, Bollschweiler E, Manner H, et al.: Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett's esophagus at two high-volume centers. Ann Surg 254 (1): 67-72, 2011. [<a href="https://pubmed.ncbi.nlm.nih.gov/21532466" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21532466</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_53_4">Prasad GA, Wu TT, Wigle DA, et al.: Endoscopic and surgical treatment of mucosal (T1a) esophageal adenocarcinoma in Barrett's esophagus. Gastroenterology 137 (3): 815-23, 2009. [<a href="/pmc/articles/PMC3815672/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3815672</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19524578" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19524578</span></a>]</div></li></ol></div></div><div id="CDR0000062741__55"><h2 id="_CDR0000062741__55_">Stage I Esophageal Cancer Treatment</h2><div id="CDR0000062741__300"><h3>Standard Treatment Options for Stage I Esophageal Cancer</h3><p id="CDR0000062741__301">Standard treatment options for stage I esophageal cancer include the following:[<a class="bk_pop" href="#CDR0000062741_rl_55_1">1</a>-<a class="bk_pop" href="#CDR0000062741_rl_55_5">5</a>]</p><ol id="CDR0000062741__390"><li class="half_rhythm"><div><a href="#CDR0000062741__212">Chemoradiation therapy followed by surgery</a>.</div></li><li class="half_rhythm"><div><a href="#CDR0000062741__267">Surgery alone</a>. </div></li></ol></div><div id="CDR0000062741__TrialSearch_55_sid_6"><h3>Current Clinical Trials</h3><p id="CDR0000062741__TrialSearch_55_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062741_rl_55"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062741_rl_55_1">Bosset JF, Gignoux M, Triboulet JP, et al.: Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 337 (3): 161-7, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9219702" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9219702</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_55_2">Walsh TN, Noonan N, Hollywood D, et al.: A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 335 (7): 462-7, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8672151" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8672151</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_55_3">Urba SG, Orringer MB, Turrisi A, et al.: Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 19 (2): 305-13, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11208820" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11208820</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_55_4">Tepper J, Krasna MJ, Niedzwiecki D, et al.: Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol 26 (7): 1086-92, 2008. [<a href="/pmc/articles/PMC5126644/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5126644</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18309943" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18309943</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_55_5">van Hagen P, Hulshof MC, van Lanschot JJ, et al.: Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366 (22): 2074-84, 2012. [<a href="https://pubmed.ncbi.nlm.nih.gov/22646630" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22646630</span></a>]</div></li></ol></div></div><div id="CDR0000062741__60"><h2 id="_CDR0000062741__60_">Stage II Esophageal Cancer Treatment</h2><div id="CDR0000062741__305"><h3>Standard Treatment Options for Stage II Esophageal Cancer</h3><p id="CDR0000062741__306">Standard treatment options for stage II esophageal cancer include the following:[<a class="bk_pop" href="#CDR0000062741_rl_60_1">1</a>]</p><ol id="CDR0000062741__391"><li class="half_rhythm"><div><a href="#CDR0000062741__212">Chemoradiation therapy followed by surgery</a>.[<a class="bk_pop" href="#CDR0000062741_rl_60_1">1</a>-<a class="bk_pop" href="#CDR0000062741_rl_60_3">3</a>] </div></li><li class="half_rhythm"><div><a href="#CDR0000062741__267">Surgery alone</a>.[<a class="bk_pop" href="#CDR0000062741_rl_60_4">4</a>-<a class="bk_pop" href="#CDR0000062741_rl_60_7">7</a>] </div></li><li class="half_rhythm"><div>Chemotherapy followed by surgery.[<a class="bk_pop" href="#CDR0000062741_rl_60_8">8</a>-<a class="bk_pop" href="#CDR0000062741_rl_60_10">10</a>]</div></li><li class="half_rhythm"><div><a href="#CDR0000062741__416">Definitive chemoradiation</a>.[<a class="bk_pop" href="#CDR0000062741_rl_60_11">11</a>,<a class="bk_pop" href="#CDR0000062741_rl_60_12">12</a>]</div></li></ol></div><div id="CDR0000062741__TrialSearch_60_sid_7"><h3>Current Clinical Trials</h3><p id="CDR0000062741__TrialSearch_60_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062741_rl_60"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062741_rl_60_1">Walsh TN, Noonan N, Hollywood D, et al.: A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 335 (7): 462-7, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8672151" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8672151</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_60_2">Tepper J, Krasna MJ, Niedzwiecki D, et al.: Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol 26 (7): 1086-92, 2008. [<a href="/pmc/articles/PMC5126644/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5126644</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18309943" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18309943</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_60_3">van Hagen P, Hulshof MC, van Lanschot JJ, et al.: Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366 (22): 2074-84, 2012. [<a href="https://pubmed.ncbi.nlm.nih.gov/22646630" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22646630</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_60_4">Urba SG, Orringer MB, Turrisi A, et al.: Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 19 (2): 305-13, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11208820" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11208820</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_60_5">Bosset JF, Gignoux M, Triboulet JP, et al.: Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 337 (3): 161-7, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9219702" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9219702</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_60_6">Conroy T, Galais MP, Raoul JL, et al.: Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer (PRODIGE5/ACCORD17): final results of a randomised, phase 2/3 trial. Lancet Oncol 15 (3): 305-14, 2014. [<a href="https://pubmed.ncbi.nlm.nih.gov/24556041" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24556041</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_60_7">Mariette C, Dahan L, Mornex F, et al.: Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol 32 (23): 2416-22, 2014. [<a href="https://pubmed.ncbi.nlm.nih.gov/24982463" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24982463</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_60_8">Medical Research Council Oesophageal Cancer Working Group: Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 359 (9319): 1727-33, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12049861" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12049861</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_60_9">Ando N, Kato H, Igaki H, et al.: A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol 19 (1): 68-74, 2012. [<a href="https://pubmed.ncbi.nlm.nih.gov/21879261" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21879261</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_60_10">Ychou M, Boige V, Pignon JP, et al.: Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 29 (13): 1715-21, 2011. [<a href="https://pubmed.ncbi.nlm.nih.gov/21444866" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21444866</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_60_11">Stahl M, Stuschke M, Lehmann N, et al.: Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 23 (10): 2310-7, 2005. [<a href="https://pubmed.ncbi.nlm.nih.gov/15800321" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15800321</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_60_12">Bedenne L, Michel P, Bouché O, et al.: Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol 25 (10): 1160-8, 2007. [<a href="https://pubmed.ncbi.nlm.nih.gov/17401004" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17401004</span></a>]</div></li></ol></div></div><div id="CDR0000062741__65"><h2 id="_CDR0000062741__65_">Stage III Esophageal Cancer Treatment</h2><div id="CDR0000062741__308"><h3>Standard Treatment Options for Stage III Esophageal Cancer</h3><p id="CDR0000062741__309">Standard treatment options for stage III esophageal cancer include the following:</p><ol id="CDR0000062741__140"><li class="half_rhythm"><div><a href="#CDR0000062741__212">Chemoradiation therapy followed by surgery</a>.[<a class="bk_pop" href="#CDR0000062741_rl_65_1">1</a>-<a class="bk_pop" href="#CDR0000062741_rl_65_3">3</a>] </div></li><li class="half_rhythm"><div>
|
|
<a href="#CDR0000062741__218">Preoperative chemotherapy followed by surgery</a>.[<a class="bk_pop" href="#CDR0000062741_rl_65_4">4</a>-<a class="bk_pop" href="#CDR0000062741_rl_65_6">6</a>]</div></li><li class="half_rhythm"><div><a href="#CDR0000062741__416">Definitive chemoradiation</a>.[<a class="bk_pop" href="#CDR0000062741_rl_65_7">7</a>-<a class="bk_pop" href="#CDR0000062741_rl_65_9">9</a>]</div></li></ol></div><div id="CDR0000062741__TrialSearch_65_sid_8"><h3>Current Clinical Trials</h3><p id="CDR0000062741__TrialSearch_65_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062741_rl_65"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062741_rl_65_1">Walsh TN, Noonan N, Hollywood D, et al.: A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 335 (7): 462-7, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8672151" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8672151</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_65_2">Tepper J, Krasna MJ, Niedzwiecki D, et al.: Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol 26 (7): 1086-92, 2008. [<a href="/pmc/articles/PMC5126644/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5126644</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18309943" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18309943</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_65_3">van Hagen P, Hulshof MC, van Lanschot JJ, et al.: Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366 (22): 2074-84, 2012. [<a href="https://pubmed.ncbi.nlm.nih.gov/22646630" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22646630</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_65_4">Medical Research Council Oesophageal Cancer Working Group: Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 359 (9319): 1727-33, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12049861" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12049861</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_65_5">Ando N, Kato H, Igaki H, et al.: A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol 19 (1): 68-74, 2012. [<a href="https://pubmed.ncbi.nlm.nih.gov/21879261" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21879261</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_65_6">Ychou M, Boige V, Pignon JP, et al.: Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol 29 (13): 1715-21, 2011. [<a href="https://pubmed.ncbi.nlm.nih.gov/21444866" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21444866</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_65_7">Conroy T, Galais MP, Raoul JL, et al.: Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer (PRODIGE5/ACCORD17): final results of a randomised, phase 2/3 trial. Lancet Oncol 15 (3): 305-14, 2014. [<a href="https://pubmed.ncbi.nlm.nih.gov/24556041" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24556041</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_65_8">Stahl M, Stuschke M, Lehmann N, et al.: Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 23 (10): 2310-7, 2005. [<a href="https://pubmed.ncbi.nlm.nih.gov/15800321" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15800321</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_65_9">Bedenne L, Michel P, Bouché O, et al.: Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol 25 (10): 1160-8, 2007. [<a href="https://pubmed.ncbi.nlm.nih.gov/17401004" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17401004</span></a>]</div></li></ol></div></div><div id="CDR0000062741__70"><h2 id="_CDR0000062741__70_">Stage IV Esophageal Cancer Treatment</h2><div id="CDR0000062741__311"><h3>Treatment Options for Stage IV Esophageal Cancer</h3><p id="CDR0000062741__312">At diagnosis, approximately 50% of patients with esophageal cancer will have
|
|
metastatic disease and will be candidates for palliative therapy.[<a class="bk_pop" href="#CDR0000062741_rl_70_1">1</a>]
|
|
</p><p id="CDR0000062741__313">Treatment options for stage IV esophageal cancer include the following:</p><ol id="CDR0000062741__314"><li class="half_rhythm"><div><a href="#CDR0000062741__212">Chemoradiation therapy followed by surgery</a> (for patients with stage IVA disease).</div></li><li class="half_rhythm"><div>Chemotherapy, which has provided partial responses for patients with metastatic
|
|
distal esophageal adenocarcinomas.[<a class="bk_pop" href="#CDR0000062741_rl_70_2">2</a>-<a class="bk_pop" href="#CDR0000062741_rl_70_4">4</a>]
|
|
</div></li><li class="half_rhythm"><div>Nd:YAG endoluminal tumor destruction or electrocoagulation.[<a class="bk_pop" href="#CDR0000062741_rl_70_5">5</a>]</div></li><li class="half_rhythm"><div>Endoscopic-placed stents to provide palliation of dysphagia.[<a class="bk_pop" href="#CDR0000062741_rl_70_6">6</a>]</div></li><li class="half_rhythm"><div>Radiation therapy with or without intraluminal intubation and dilation.
|
|
</div></li><li class="half_rhythm"><div>Intraluminal brachytherapy to provide palliation of dysphagia.[<a class="bk_pop" href="#CDR0000062741_rl_70_7">7</a>,<a class="bk_pop" href="#CDR0000062741_rl_70_8">8</a>]</div></li></ol><p id="CDR0000062741__78"><b>Treatment options under clinical evaluation:</b>
|
|
</p><p id="CDR0000062741__79">Esophageal cancer responds to many anticancer agents. Objective response rates of 30%
|
|
to 60% and median survivals of less than 1 year are commonly reported with
|
|
platinum-based combination regimens with fluorouracil, taxanes, topoisomerase inhibitors, hydroxyurea, or vinorelbine.[<a class="bk_pop" href="#CDR0000062741_rl_70_1">1</a>,<a class="bk_pop" href="#CDR0000062741_rl_70_4">4</a>,<a class="bk_pop" href="#CDR0000062741_rl_70_9">9</a>] Trastuzumab may be effective in combination with chemotherapy among patients with tumors that overexpress HER2-neu.[<a class="bk_pop" href="#CDR0000062741_rl_70_10">10</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>]
|
|
</p><ul id="CDR0000062741__118"><li class="half_rhythm"><div>Clinical trials evaluating single-agent or combination chemotherapy.
|
|
</div></li></ul></div><div id="CDR0000062741__TrialSearch_70_sid_9"><h3>Current Clinical Trials</h3><p id="CDR0000062741__TrialSearch_70_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062741_rl_70"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062741_rl_70_1">Enzinger PC, Ilson DH, Kelsen DP: Chemotherapy in esophageal cancer. Semin Oncol 26 (5 Suppl 15): 12-20, 1999. [<a href="https://pubmed.ncbi.nlm.nih.gov/10566606" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10566606</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_2">Waters JS, Norman A, Cunningham D, et al.: Long-term survival after epirubicin, cisplatin and fluorouracil for gastric cancer: results of a randomized trial. Br J Cancer 80 (1-2): 269-72, 1999. [<a href="/pmc/articles/PMC2363002/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2363002</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10390007" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10390007</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_3">Ross P, Nicolson M, Cunningham D, et al.: Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) With epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer. J Clin Oncol 20 (8): 1996-2004, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/11956258" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11956258</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_4">Taïeb J, Artru P, Baujat B, et al.: Optimisation of 5-fluorouracil (5-FU)/cisplatin combination chemotherapy with a new schedule of hydroxyurea, leucovorin, 5-FU and cisplatin (HLFP regimen) for metastatic oesophageal cancer. Eur J Cancer 38 (5): 661-6, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/11916548" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11916548</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_5">Bourke MJ, Hope RL, Chu G, et al.: Laser palliation of inoperable malignant dysphagia: initial and at death. Gastrointest Endosc 43 (1): 29-32, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8903814" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8903814</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_6">Baron TH: Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 344 (22): 1681-7, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11386268" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11386268</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_7">Sur RK, Levin CV, Donde B, et al.: Prospective randomized trial of HDR brachytherapy as a sole modality in palliation of advanced esophageal carcinoma--an International Atomic Energy Agency study. Int J Radiat Oncol Biol Phys 53 (1): 127-33, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12007950" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12007950</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_8">Gaspar LE, Nag S, Herskovic A, et al.: American Brachytherapy Society (ABS) consensus guidelines for brachytherapy of esophageal cancer. Clinical Research Committee, American Brachytherapy Society, Philadelphia, PA. Int J Radiat Oncol Biol Phys 38 (1): 127-32, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9212013" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9212013</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_9">Conroy T, Etienne PL, Adenis A, et al.: Vinorelbine and cisplatin in metastatic squamous cell carcinoma of the oesophagus: response, toxicity, quality of life and survival. Ann Oncol 13 (5): 721-9, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12075740" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12075740</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062741_rl_70_10">Bang YJ, Van Cutsem E, Feyereislova A, et al.: Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 376 (9742): 687-97, 2010. [<a href="https://pubmed.ncbi.nlm.nih.gov/20728210" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20728210</span></a>]</div></li></ol></div></div><div id="CDR0000062741__81"><h2 id="_CDR0000062741__81_">Recurrent Esophageal Cancer Treatment</h2><p id="CDR0000062741__82">Palliation presents difficult problems for all patients with recurrent esophageal cancer. All patients should be considered candidates
|
|
for clinical trials as outlined in the <a href="#CDR0000062741__44">Treatment Option Overview for Esophageal Cancer</a> section of this summary.</p><p id="CDR0000062741__83"><b>Standard treatment options:</b>
|
|
</p><ul id="CDR0000062741__94"><li class="half_rhythm"><div>
|
|
Palliative use of any of the standard therapies, including supportive care.
|
|
</div></li></ul><div id="CDR0000062741__TrialSearch_81_sid_10"><h3>Current Clinical Trials</h3><p id="CDR0000062741__TrialSearch_81_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div></div><div id="CDR0000062741__110"><h2 id="_CDR0000062741__110_">Changes to This Summary (06/17/2021)</h2><p id="CDR0000062741__111">The PDQ cancer information summaries are reviewed regularly and updated as
|
|
new information becomes available. This section describes the latest
|
|
changes made to this summary as of the date above.</p><p id="CDR0000062741__495"><b><a href="#CDR0000062741__1">General Information About Esophageal Cancer</a></b></p><p id="CDR0000062741__496">Revised <a href="#CDR0000062741__247">text</a> to state that in the United States, the median age of patients who present with esophageal cancer is 68 years (cited National Cancer Institute [NCI] as reference 6).</p><p id="CDR0000062741__499">Revised <a href="#CDR0000062741__252">text</a> to state that the 5-year relative survival rate for esophageal cancer is 19.9% and that patients with early-stage disease have a better chance of survival; 17.5% of patients are diagnosed at the local stage and have a 5-year relative survival rate of 46.4%.</p><p id="CDR0000062741__505"><b><a href="#CDR0000062741__9">Cellular Classification of Esophageal Cancer</a></b></p><p id="CDR0000062741__506">Revised <a href="#CDR0000062741__373">text</a> to state that fewer than 50% of esophageal cancers in the United States are squamous cell carcinomas (cited Howlader et al. as reference 1).</p><p id="CDR0000062741__497"><b><a href="#CDR0000062741__44">Treatment Option Overview for Esophageal Cancer</a></b></p><p id="CDR0000062741__498">Revised <a href="#CDR0000062741__379">text</a> to state that in the United States, the median age of patients who present with esophageal cancer is 68 years (cited NCI as reference 15).</p><p id="CDR0000062741__507">Added <a href="#CDR0000062741__500">Adjuvant Therapy</a> as a new subsection.</p><p id="CDR0000062741__disclaimerHP_3">This summary is written and maintained by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is
|
|
editorially independent of NCI. The summary reflects an independent review of
|
|
the literature and does not represent a policy statement of NCI or NIH. More
|
|
information about summary policies and the role of the PDQ Editorial Boards in
|
|
maintaining the PDQ summaries can be found on the <a href="#CDR0000062741__AboutThis_1">About This PDQ Summary</a> and <a href="https://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® - NCI's Comprehensive Cancer Database</a> pages.
|
|
</p></div><div id="CDR0000062741__AboutThis_1"><h2 id="_CDR0000062741__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062741__AboutThis_2"><h3>Purpose of This Summary</h3><p id="CDR0000062741__AboutThis_3">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about treatment of adult esophageal cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p></div><div id="CDR0000062741__AboutThis_4"><h3>Reviewers and Updates</h3><p id="CDR0000062741__AboutThis_5">This summary is reviewed regularly and updated as necessary by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p><p id="CDR0000062741__AboutThis_22"> Board members review recently published articles each month to determine whether an article should:</p><ul id="CDR0000062741__AboutThis_6"><li class="half_rhythm"><div>be discussed at a meeting,</div></li><li class="half_rhythm"><div>be cited with text, or</div></li><li class="half_rhythm"><div>replace or update an existing article that is already cited.</div></li></ul><p id="CDR0000062741__AboutThis_7">Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.</p><p id="CDR0000062741__AboutThis_9">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.</p></div><div id="CDR0000062741__AboutThis_10"><h3>Levels of Evidence</h3><p id="CDR0000062741__AboutThis_11">Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a <a href="/books/n/pdqcis/CDR0000062796/">formal evidence ranking system</a> in developing its level-of-evidence designations.</p></div><div id="CDR0000062741__AboutThis_12"><h3>Permission to Use This Summary</h3><p id="CDR0000062741__AboutThis_13">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”</p><p id="CDR0000062741__AboutThis_14">The preferred citation for this PDQ summary is:</p><p id="CDR0000062741__AboutThis_15">PDQ® Adult Treatment Editorial Board. PDQ Esophageal Cancer Treatment (Adult). Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/esophageal/hp/esophageal-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/esophageal/hp/esophageal-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389338]</p><p id="CDR0000062741__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>, a collection of over 2,000 scientific images.
|
|
</p></div><div id="CDR0000062741__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062741__AboutThis_18">Based on the strength of the available evidence, treatment options may be described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062741__AboutThis_20"><h3>Contact Us</h3><p id="CDR0000062741__AboutThis_21">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>.</p></div></div></div></div>
|
|
<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65900</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389338" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389338</a></span></div></div></div>
|
|
|
|
</div>
|
|
|
|
<!-- Custom content below content -->
|
|
<div class="col4">
|
|
|
|
</div>
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<!-- Custom contetnt below bottom nav -->
|
|
<div class="col5">
|
|
|
|
</div>
|
|
</div>
|
|
|
|
<div id="rightcolumn" class="four_col col last">
|
|
<!-- Custom content above discovery portlets -->
|
|
<div class="col6">
|
|
<div id="ncbi_share_book"><a href="#" class="ncbi_share" data-ncbi_share_config="popup:false,shorten:true" ref="id=NBK65900&db=books">Share</a></div>
|
|
|
|
</div>
|
|
<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65900.19/?report=reader">PubReader</a></li><li><a href="/books/NBK65900.19/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65900" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65900" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Esophageal Cancer Treatment (Adult) (PDQ®): Health Professional Version. 2021 Jun 17. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65900.27/">NBK65900.27</a></span> August 9, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65900.26/">NBK65900.26</a></span> February 6, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65900.25/">NBK65900.25</a></span> January 26, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65900.24/">NBK65900.24</a></span> May 11, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65900.23/">NBK65900.23</a></span> March 30, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65900.22/">NBK65900.22</a></span> October 14, 2022</li><li><span class="bk_col_itm"><a href="/books/NBK65900.21/">NBK65900.21</a></span> September 8, 2022</li><li><span class="bk_col_itm"><a href="/books/NBK65900.20/">NBK65900.20</a></span> July 15, 2021</li><li><span class="bk_col_itm">NBK65900.19</span> June 17, 2021 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65900.18/">NBK65900.18</a></span> May 21, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65900.17/">NBK65900.17</a></span> January 27, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65900.16/">NBK65900.16</a></span> July 31, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK65900.15/">NBK65900.15</a></span> May 7, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK65900.14/">NBK65900.14</a></span> January 22, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK65900.13/">NBK65900.13</a></span> November 12, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65900.12/">NBK65900.12</a></span> October 11, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65900.11/">NBK65900.11</a></span> September 25, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65900.10/">NBK65900.10</a></span> July 3, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65900.9/">NBK65900.9</a></span> March 7, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65900.8/">NBK65900.8</a></span> January 29, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65900.7/">NBK65900.7</a></span> September 7, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65900.6/">NBK65900.6</a></span> February 6, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65900.5/">NBK65900.5</a></span> February 2, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65900.4/">NBK65900.4</a></span> February 4, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65900.3/">NBK65900.3</a></span> December 3, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65900.2/">NBK65900.2</a></span> October 2, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65900.1/">NBK65900.1</a></span> July 8, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062741__1" ref="log$=inpage&link_id=inpage">General Information About Esophageal Cancer</a></li><li><a href="#CDR0000062741__9" ref="log$=inpage&link_id=inpage">Cellular Classification of Esophageal Cancer</a></li><li><a href="#CDR0000062741__12" ref="log$=inpage&link_id=inpage">Stage Information for Esophageal Cancer</a></li><li><a href="#CDR0000062741__44" ref="log$=inpage&link_id=inpage">Treatment Option Overview for Esophageal Cancer</a></li><li><a href="#CDR0000062741__53" ref="log$=inpage&link_id=inpage">Stage 0 Esophageal Cancer Treatment</a></li><li><a href="#CDR0000062741__55" ref="log$=inpage&link_id=inpage">Stage I Esophageal Cancer Treatment</a></li><li><a href="#CDR0000062741__60" ref="log$=inpage&link_id=inpage">Stage II Esophageal Cancer Treatment</a></li><li><a href="#CDR0000062741__65" ref="log$=inpage&link_id=inpage">Stage III Esophageal Cancer Treatment</a></li><li><a href="#CDR0000062741__70" ref="log$=inpage&link_id=inpage">Stage IV Esophageal Cancer Treatment</a></li><li><a href="#CDR0000062741__81" ref="log$=inpage&link_id=inpage">Recurrent Esophageal Cancer Treatment</a></li><li><a href="#CDR0000062741__110" ref="log$=inpage&link_id=inpage">Changes to This Summary (06/17/2021)</a></li><li><a href="#CDR0000062741__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK66028/">Patient Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related information</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="discovery_db_links" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper"><a class="brieflinkpopperctrl" href="/books/?Db=pmc&DbFrom=books&Cmd=Link&LinkName=books_pmc_refs&IdsFromResult=2827280" ref="log$=recordlinks">PMC</a><div class="brieflinkpop offscreen_noflow">PubMed Central citations</div></li><li class="brieflinkpopper"><a class="brieflinkpopperctrl" href="/books/?Db=pubmed&DbFrom=books&Cmd=Link&LinkName=books_pubmed_refs&IdsFromResult=2827280" ref="log$=recordlinks">PubMed</a><div class="brieflinkpop offscreen_noflow">Links to PubMed</div></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31593387" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Esophageal Cancer Treatment (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Esophageal Cancer Treatment (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389392" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Esophageal Cancer Prevention (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Esophageal Cancer Prevention (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Screening and Prevention Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389241" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Esophageal Cancer Screening (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Esophageal Cancer Screening (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Screening and Prevention Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389244" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Lymphedema (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Lymphedema (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Supportive and Palliative Care Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389442" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Retinoblastoma Treatment (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Retinoblastoma Treatment (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=26389338" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=26389338" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a href="javascript:historyDisplayState('HTOff')" class="HTOn">Turn Off</a><a href="javascript:historyDisplayState('HTOn')" class="HTOff">Turn On</a></div><ul id="activity"><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67c9588cab82281a805899e7">Esophageal Cancer Treatment (Adult) (PDQ®) - PDQ Cancer Information Summaries</a><div class="ralinkpop offscreen_noflow">Esophageal Cancer Treatment (Adult) (PDQ®) - PDQ Cancer Information Summaries<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=2" href="/portal/utils/pageresolver.fcgi?recordid=67c9588af4a390645e4bdf04">Esophageal Cancer Treatment (PDQ®) - PDQ Cancer Information Summaries</a><div class="ralinkpop offscreen_noflow">Esophageal Cancer Treatment (PDQ®) - PDQ Cancer Information Summaries<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_qry two_line"><a class="htb" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67c95865a68b6b5afc8931d0">PMC Links for Books (Select 2826880) <span class="number">(65)</span></a><div class="tertiary">PMC</div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67c95863b15b832ebc27c3de">Prostate Cancer Treatment (PDQ®) - PDQ Cancer Information Summaries</a><div class="ralinkpop offscreen_noflow">Prostate Cancer Treatment (PDQ®) - PDQ Cancer Information Summaries<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li></ul><p class="HTOn">Your browsing activity is empty.</p><p class="HTOff">Activity recording is turned off.</p><p id="turnOn" class="HTOff"><a href="javascript:historyDisplayState('HTOn')">Turn recording back on</a></p><a class="seemore" href="/sites/myncbi/recentactivity">See more...</a></div></div></div>
|
|
|
|
<!-- Custom content below discovery portlets -->
|
|
<div class="col7">
|
|
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
<!-- Custom content after all -->
|
|
<div class="col8">
|
|
|
|
</div>
|
|
<div class="col9">
|
|
|
|
</div>
|
|
|
|
<script type="text/javascript" src="/corehtml/pmc/js/jquery.scrollTo-1.4.2.js"></script>
|
|
<script type="text/javascript">
|
|
(function($){
|
|
$('.skiplink').each(function(i, item){
|
|
var href = $($(item).attr('href'));
|
|
href.attr('tabindex', '-1').addClass('skiptarget'); // ensure the target can receive focus
|
|
$(item).on('click', function(event){
|
|
event.preventDefault();
|
|
$.scrollTo(href, 0, {
|
|
onAfter: function(){
|
|
href.focus();
|
|
}
|
|
});
|
|
});
|
|
});
|
|
})(jQuery);
|
|
</script>
|
|
</div>
|
|
<div class="bottom">
|
|
|
|
<div id="NCBIFooter_dynamic">
|
|
<!--<component id="Breadcrumbs" label="breadcrumbs"/>
|
|
<component id="Breadcrumbs" label="helpdesk"/>-->
|
|
|
|
</div>
|
|
|
|
<div class="footer" id="footer">
|
|
<section class="icon-section">
|
|
<div id="icon-section-header" class="icon-section_header">Follow NCBI</div>
|
|
<div class="grid-container container">
|
|
<div class="icon-section_container">
|
|
<a class="footer-icon" id="footer_twitter" href="https://twitter.com/ncbi" aria-label="Twitter"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<defs>
|
|
<style>
|
|
.cls-11 {
|
|
fill: #737373;
|
|
}
|
|
</style>
|
|
</defs>
|
|
<title>Twitter</title>
|
|
<path class="cls-11" d="M250.11,105.48c-7,3.14-13,3.25-19.27.14,8.12-4.86,8.49-8.27,11.43-17.46a78.8,78.8,0,0,1-25,9.55,39.35,39.35,0,0,0-67,35.85,111.6,111.6,0,0,1-81-41.08A39.37,39.37,0,0,0,81.47,145a39.08,39.08,0,0,1-17.8-4.92c0,.17,0,.33,0,.5a39.32,39.32,0,0,0,31.53,38.54,39.26,39.26,0,0,1-17.75.68,39.37,39.37,0,0,0,36.72,27.3A79.07,79.07,0,0,1,56,223.34,111.31,111.31,0,0,0,116.22,241c72.3,0,111.83-59.9,111.83-111.84,0-1.71,0-3.4-.1-5.09C235.62,118.54,244.84,113.37,250.11,105.48Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_facebook" href="https://www.facebook.com/ncbi.nlm" aria-label="Facebook"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<title>Facebook</title>
|
|
<path class="cls-11" d="M210.5,115.12H171.74V97.82c0-8.14,5.39-10,9.19-10h27.14V52l-39.32-.12c-35.66,0-42.42,26.68-42.42,43.77v19.48H99.09v36.32h27.24v109h45.41v-109h35Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_linkedin" href="https://www.linkedin.com/company/ncbinlm" aria-label="LinkedIn"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<title>LinkedIn</title>
|
|
<path class="cls-11" d="M101.64,243.37H57.79v-114h43.85Zm-22-131.54h-.26c-13.25,0-21.82-10.36-21.82-21.76,0-11.65,8.84-21.15,22.33-21.15S101.7,78.72,102,90.38C102,101.77,93.4,111.83,79.63,111.83Zm100.93,52.61A17.54,17.54,0,0,0,163,182v61.39H119.18s.51-105.23,0-114H163v13a54.33,54.33,0,0,1,34.54-12.66c26,0,44.39,18.8,44.39,55.29v58.35H198.1V182A17.54,17.54,0,0,0,180.56,164.44Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_github" href="https://github.com/ncbi" aria-label="GitHub"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<defs>
|
|
<style>
|
|
.cls-11,
|
|
.cls-12 {
|
|
fill: #737373;
|
|
}
|
|
|
|
.cls-11 {
|
|
fill-rule: evenodd;
|
|
}
|
|
</style>
|
|
</defs>
|
|
<title>GitHub</title>
|
|
<path class="cls-11" d="M151.36,47.28a105.76,105.76,0,0,0-33.43,206.1c5.28,1,7.22-2.3,7.22-5.09,0-2.52-.09-10.85-.14-19.69-29.42,6.4-35.63-12.48-35.63-12.48-4.81-12.22-11.74-15.47-11.74-15.47-9.59-6.56.73-6.43.73-6.43,10.61.75,16.21,10.9,16.21,10.9,9.43,16.17,24.73,11.49,30.77,8.79,1-6.83,3.69-11.5,6.71-14.14C108.57,197.1,83.88,188,83.88,147.51a40.92,40.92,0,0,1,10.9-28.39c-1.1-2.66-4.72-13.42,1-28,0,0,8.88-2.84,29.09,10.84a100.26,100.26,0,0,1,53,0C198,88.3,206.9,91.14,206.9,91.14c5.76,14.56,2.14,25.32,1,28a40.87,40.87,0,0,1,10.89,28.39c0,40.62-24.74,49.56-48.29,52.18,3.79,3.28,7.17,9.71,7.17,19.58,0,14.15-.12,25.54-.12,29,0,2.82,1.9,6.11,7.26,5.07A105.76,105.76,0,0,0,151.36,47.28Z">
|
|
</path>
|
|
<path class="cls-12" d="M85.66,199.12c-.23.52-1.06.68-1.81.32s-1.2-1.06-.95-1.59,1.06-.69,1.82-.33,1.21,1.07.94,1.6Zm-1.3-1">
|
|
</path>
|
|
<path class="cls-12" d="M90,203.89c-.51.47-1.49.25-2.16-.49a1.61,1.61,0,0,1-.31-2.19c.52-.47,1.47-.25,2.17.49s.82,1.72.3,2.19Zm-1-1.08">
|
|
</path>
|
|
<path class="cls-12" d="M94.12,210c-.65.46-1.71,0-2.37-.91s-.64-2.07,0-2.52,1.7,0,2.36.89.65,2.08,0,2.54Zm0,0"></path>
|
|
<path class="cls-12" d="M99.83,215.87c-.58.64-1.82.47-2.72-.41s-1.18-2.06-.6-2.7,1.83-.46,2.74.41,1.2,2.07.58,2.7Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M107.71,219.29c-.26.82-1.45,1.2-2.64.85s-2-1.34-1.74-2.17,1.44-1.23,2.65-.85,2,1.32,1.73,2.17Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M116.36,219.92c0,.87-1,1.59-2.24,1.61s-2.29-.68-2.3-1.54,1-1.59,2.26-1.61,2.28.67,2.28,1.54Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M124.42,218.55c.15.85-.73,1.72-2,1.95s-2.37-.3-2.52-1.14.73-1.75,2-2,2.37.29,2.53,1.16Zm0,0"></path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_blog" href="https://ncbiinsights.ncbi.nlm.nih.gov/" aria-label="Blog">
|
|
<svg xmlns="http://www.w3.org/2000/svg" id="Layer_1" data-name="Layer 1" viewBox="0 0 40 40">
|
|
<defs><style>.cls-1{fill:#737373;}</style></defs>
|
|
<title>NCBI Insights Blog</title>
|
|
<path class="cls-1" d="M14,30a4,4,0,1,1-4-4,4,4,0,0,1,4,4Zm11,3A19,19,0,0,0,7.05,15a1,1,0,0,0-1,1v3a1,1,0,0,0,.93,1A14,14,0,0,1,20,33.07,1,1,0,0,0,21,34h3a1,1,0,0,0,1-1Zm9,0A28,28,0,0,0,7,6,1,1,0,0,0,6,7v3a1,1,0,0,0,1,1A23,23,0,0,1,29,33a1,1,0,0,0,1,1h3A1,1,0,0,0,34,33Z"></path>
|
|
</svg>
|
|
</a>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
|
|
<section class="container-fluid bg-primary">
|
|
<div class="container pt-5">
|
|
<div class="row mt-3">
|
|
<div class="col-lg-3 col-12">
|
|
<p><a class="text-white" href="https://www.nlm.nih.gov/socialmedia/index.html">Connect with NLM</a></p>
|
|
<ul class="list-inline social_media">
|
|
<li class="list-inline-item"><a href="https://twitter.com/NLM_NIH" aria-label="Twitter" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<style type="text/css">
|
|
.st20 {
|
|
fill: #FFFFFF;
|
|
}
|
|
|
|
.st30 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
</style>
|
|
<title>Twitter</title>
|
|
<g>
|
|
<g>
|
|
<g>
|
|
<path class="st20" d="M192.9,88.1c-5,2.2-9.2,2.3-13.6,0.1c5.7-3.4,6-5.8,8.1-12.3c-5.4,3.2-11.4,5.5-17.6,6.7 c-10.5-11.2-28.1-11.7-39.2-1.2c-7.2,6.8-10.2,16.9-8,26.5c-22.3-1.1-43.1-11.7-57.2-29C58,91.6,61.8,107.9,74,116 c-4.4-0.1-8.7-1.3-12.6-3.4c0,0.1,0,0.2,0,0.4c0,13.2,9.3,24.6,22.3,27.2c-4.1,1.1-8.4,1.3-12.5,0.5c3.6,11.3,14,19,25.9,19.3 c-11.6,9.1-26.4,13.2-41.1,11.5c12.7,8.1,27.4,12.5,42.5,12.5c51,0,78.9-42.2,78.9-78.9c0-1.2,0-2.4-0.1-3.6 C182.7,97.4,189.2,93.7,192.9,88.1z"></path>
|
|
</g>
|
|
</g>
|
|
<circle class="st30" cx="124.4" cy="128.8" r="108.2"></circle>
|
|
</g>
|
|
</svg></a></li>
|
|
<li class="list-inline-item"><a href="https://www.facebook.com/nationallibraryofmedicine" aria-label="Facebook" rel="noopener noreferrer" target="_blank">
|
|
<svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<style type="text/css">
|
|
.st10 {
|
|
fill: #FFFFFF;
|
|
}
|
|
|
|
.st110 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
</style>
|
|
<title>Facebook</title>
|
|
<g>
|
|
<g>
|
|
<path class="st10" d="M159,99.1h-24V88.4c0-5,3.3-6.2,5.7-6.2h16.8V60l-24.4-0.1c-22.1,0-26.2,16.5-26.2,27.1v12.1H90v22.5h16.9 v67.5H135v-67.5h21.7L159,99.1z"></path>
|
|
</g>
|
|
</g>
|
|
<circle class="st110" cx="123.6" cy="123.2" r="108.2"></circle>
|
|
</svg>
|
|
</a></li>
|
|
<li class="list-inline-item"><a href="https://www.youtube.com/user/NLMNIH" aria-label="Youtube" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<title>Youtube</title>
|
|
<style type="text/css">
|
|
.st4 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
|
|
.st5 {
|
|
fill: #FFFFFF;
|
|
}
|
|
</style>
|
|
<circle class="st4" cx="124.2" cy="123.4" r="108.2"></circle>
|
|
<g transform="translate(0,-952.36218)">
|
|
<path class="st5" d="M88.4,1037.4c-10.4,0-18.7,8.3-18.7,18.7v40.1c0,10.4,8.3,18.7,18.7,18.7h72.1c10.4,0,18.7-8.3,18.7-18.7 v-40.1c0-10.4-8.3-18.7-18.7-18.7H88.4z M115.2,1058.8l29.4,17.4l-29.4,17.4V1058.8z"></path>
|
|
</g>
|
|
</svg></a></li>
|
|
</ul>
|
|
</div>
|
|
<div class="col-lg-3 col-12">
|
|
<p class="address_footer text-white">National Library of Medicine<br />
|
|
<a href="https://www.google.com/maps/place/8600+Rockville+Pike,+Bethesda,+MD+20894/@38.9959508,-77.101021,17z/data=!3m1!4b1!4m5!3m4!1s0x89b7c95e25765ddb:0x19156f88b27635b8!8m2!3d38.9959508!4d-77.0988323" class="text-white" target="_blank" rel="noopener noreferrer">8600 Rockville Pike<br />
|
|
Bethesda, MD 20894</a></p>
|
|
</div>
|
|
<div class="col-lg-3 col-12 centered-lg">
|
|
<p><a href="https://www.nlm.nih.gov/web_policies.html" class="text-white">Web Policies</a><br />
|
|
<a href="https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/freedom-information-act-office" class="text-white">FOIA</a><br />
|
|
<a href="https://www.hhs.gov/vulnerability-disclosure-policy/index.html" class="text-white" id="vdp">HHS Vulnerability Disclosure</a></p>
|
|
</div>
|
|
<div class="col-lg-3 col-12 centered-lg">
|
|
<p><a class="supportLink text-white" href="https://support.nlm.nih.gov/">Help</a><br />
|
|
<a href="https://www.nlm.nih.gov/accessibility.html" class="text-white">Accessibility</a><br />
|
|
<a href="https://www.nlm.nih.gov/careers/careers.html" class="text-white">Careers</a></p>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="col-lg-12 centered-lg">
|
|
<nav class="bottom-links">
|
|
<ul class="mt-3">
|
|
<li>
|
|
<a class="text-white" href="//www.nlm.nih.gov/">NLM</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.nih.gov/">NIH</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.hhs.gov/">HHS</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.usa.gov/">USA.gov</a>
|
|
</li>
|
|
</ul>
|
|
</nav>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentOmnitureBaseJS/InstrumentNCBIConfigJS/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js?v=1"> </script>
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/static/js/hfjs2.js"> </script>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<!--/.page-->
|
|
</div>
|
|
<!--/.wrap-->
|
|
</div><!-- /.twelve_col -->
|
|
</div>
|
|
<!-- /.grid -->
|
|
|
|
<span class="PAFAppResources"></span>
|
|
|
|
<!-- BESelector tab -->
|
|
|
|
|
|
|
|
<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-part&ncbi_acc=NBK65900&ncbi_domain=pdqcis&ncbi_report=record&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK65900.19/&ncbi_pagename=Esophageal Cancer Treatment (Adult) (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf&ncbi_bookparttype=chapter&ncbi_app=bookshelf" /></noscript>
|
|
|
|
|
|
<!-- usually for JS scripts at page bottom -->
|
|
<!--<component id="PageFixtures" label="styles"></component>-->
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal104 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3879255/4121861/3501987/4008961/3893018/3821238/4062932/4209313/4212053/4076480/3921943/3400083/3426610.js" snapshot="books"></script></body>
|
|
</html> |