Esophageal cancer natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: mHadeel Maksoud M.D.[2]
Overview
Complications of esophageal cancer include dysphagia, anemia, and tracheoesophageal fistula. The incidence of esophageal dysplasia turning malignant is very low, especially outside the United States. This finding has caused some uncertainty as to the usefulness of screening. Esophageal cancer is associated with a 5 year survival rate of 20%.
Natural history
- From May 2012 to February 2014, 2093 patients were screened endoscopically to record the natural history of esophageal cancer, from dysplasia to cancer.
- In total, 39 were diagnosed with severe dysplasia.
- Of the 39 severe dysplasia cases diagnosed by endoscopy, only 8 progressed to carcinoma with a mean time of 33.8 months and a median time of 30 months.
- Excessively frequent endoscopy follow-up was found to waste medical resources and also lowered the compliance, while long, overdue follow-up intervals may cause unacceptable disease progression.
- The study concluded that severe dysplasia cases may have much lower carcinoma progression rate than other dysplasia due to some cases remaining stable or due to the phenomenon of dysplasia reversal.[1]
Complications
Complications can occur as a product of esophageal cancer or because of radiotherapeutic treatment.
Complications due to esophageal cancer
- Anemia
- Weight loss
- Dysphagia
- Cachexia
- Aspiration pneumonia
- Metastases
Complications of radiotherapy
- Tracheoesophageal fistula
- Postradiotherapy esophageal strictures, may lead to recurrent dysphagia.[2]
Prognosis
5-Year Survival
- Between 2004 and 2010, the 5-year relative survival of patients with esophageal cancer was 20 %.[3]
- When stratified by age, the 5-year relative survival of patients with esophageal cancer was 19.8 % and 15.5 % for patients <65 and ≥ 65 years of age respectively.[3]
- The survival of patients with esophageal cancer varies with the stage of the disease.
- Shown below is a table depicting the 5-year relative survival by the stage of esophageal cancer:[3]
| Stage | 5-year relative survival (%), (2004-2010) |
| All stages | 17.5% |
| Localized | 39.6% |
| Regional | 21.1% |
| Distant | 3.8% |
| Unstaged | 11.5% |
Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years) between 1998 and 2010 of esophageal cancer by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.[3]
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References
- ↑ Wang JW, Guan CT, Wang LL, Chang LY, Hao CQ, Li BY, Lu N, Wei WQ (2017). "Natural History Analysis of 101 Severe Dysplasia and Esophageal Carcinoma Cases by Endoscopy". Gastroenterol Res Pract. 2017: 9612854. doi:10.1155/2017/9612854. PMC 5390561. PMID 28465681.
- ↑ O'Rourke IC, Tiver K, Bull C, Gebski V, Langlands AO (1988). "Swallowing performance after radiation therapy for carcinoma of the esophagus". Cancer. 61 (10): 2022–6. PMID 2452006.
- ↑ 3.0 3.1 3.2 3.3 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.