Changing patterns in the treatment of carcinoma of the esophagus.

BACKGROUND: Decision-making in esophageal carcinoma. Treatment of carcinoma of the esophagus knows a great variety of modalities, ranging from simple palliative endoscopic pertubation to extensive curative operations.

METHODS: Retrospective review.

RESULTS: The three main groups of tumors are squamous cell carcinoma related to alcohol and tobacco abuse; adenocarcinoma in Barrett's esophagus related to long-standing gastroesophageal reflux; and adenocarcinoma of the cardia the origin of which is still unknown. Dysphagia and retrosternal pain are not only the most important symptoms but also the most important factors regarding survival. Diagnosis is made by endoscopy and biopsy. In the pretreatment staging a careful selection of the great variety of available diagnostic tools should be made. The ever-increasing diversity of local palliative procedures: tubing, photoablation, brachytherapy all have their place, but should not be allowed to distract us from the fact that surgery is the only hope for cure in these patients. Surgery should only be performed with curative intent and even then the long-term results are modest, with a 5-year survival of about 40% in node-negative and 18% in node-positive patients.

CONCLUSION: In patients with carcinoma of the esophagus a polydisciplinary treatment approach is mandatory.