Cancer of the esophagus

The frequency of adenocarcinoma of the esophagus and of the esophagogastric junction continues to rise dramatically in Western countries for reasons that remain unclear. Both of these tumors are strongly associated with segments of intestinal metaplasia in the distal esophagus, some of which may be short and not conspicuous on endoscopic examination. Recent studies suggest that the risk for developing esophageal cancer may be reduced by the regular use of aspirin and, for alcoholics, by abstinence from alcohol. Recently elucidated molecular events that may contribute to esophageal carcinogenesis include overexpression of cyclin D1 and c-erbB-2, altered expression of E-cadherin, and loss of heterozygosity on chromosomes 9p, 9q, and 3p. Evidence continues to accumulate that altered p53 expression is an early and important event in the development of esophageal cancers. Photodynamic therapy appears to be a promising new treatment for esophageal dysplasia and early esophageal cancers. However, enthusiasm for the use of this new therapy must be tempered by the frequency of complications such as esophageal stricture formation and cutaneous photosensitization. Furthermore, meaningful conclusions regarding the frequency with which photodynamic therapy 'cures' dysplasia and early carcinoma will require studies with far longer durations of follow-up than those presently available.