Esophageal cancer. Clinical practice guidelines in oncology.

Esophageal cancer is a major health hazard in many parts of the world. The incidence of adenocarcinoma is rising in white men, particularly in the nonendemic areas, such as the West. Barrett's metaplasia, gastroesophageal reflux, hiatal hernia, and obesity are thought to play a role in these cases. In addition, the most common location of esophageal carcinoma has shifted to the lower third of the esophagus. Unfortunately, esophageal carcinoma is often diagnosed late; therefore, most therapeutic approaches are palliative. Advances have been made in staging procedures and in therapeutic approaches. The NCCN Esophageal Cancer Guidelines emphasize that palpable advances have been made in the treatment of locoregional esophageal carcinoma. Similarly, endoscopic palliation of esophageal carcinoma has improved substantially due to improving technology. A number of new chemotherapeutic agents are on the horizon including antireceptor agents, vaccines, gene therapy, and antiangiogenic agents. The panel expects numerous advances in the treatment of esophageal carcinoma in the future.