Primer

Oesophageal cancer

  • Nature Reviews Disease Primers 3, Article number: 17048 (2017)
  • doi:10.1038/nrdp.2017.48
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Abstract

Oesophageal cancer is the sixth most common cause of cancer-related death worldwide and is therefore a major global health challenge. The two major subtypes of oesophageal cancer are oesophageal squamous cell carcinoma (OSCC) and oesophageal adenocarcinoma (OAC), which are epidemiologically and biologically distinct. OSCC accounts for 90% of all cases of oesophageal cancer globally and is highly prevalent in the East, East Africa and South America. OAC is more common in developed countries than in developing countries. Preneoplastic lesions are identifiable for both OSCC and OAC; these are frequently amenable to endoscopic ablative therapies. Most patients with oesophageal cancer require extensive treatment, including chemotherapy, chemoradiotherapy and/or surgical resection. Patients with advanced or metastatic oesophageal cancer are treated with palliative chemotherapy; those who are human epidermal growth factor receptor 2 (HER2)-positive may also benefit from trastuzumab treatment. Immuno-oncology therapies have also shown promising early results in OSCC and OAC. In this Primer, we review state-of-the-art knowledge on the biology and treatment of oesophageal cancer, including screening, endoscopic ablative therapies and emerging molecular targets, and we discuss best practices in chemotherapy, chemoradiotherapy, surgery and the maintenance of patient quality of life.

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Acknowledgements

E.C.S. and D.C. acknowledge funding support from the Royal Marsden Institute of Cancer Research National Institute of Health Research Biomedical Research Centre, London, UK.

Author information

Affiliations

  1. Department of Gastrointestinal Oncology, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.

    • Elizabeth C. Smyth
    •  & David Cunningham
  2. Division of Cancer Studies, King's College London, London, UK.

    • Jesper Lagergren
  3. Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.

    • Jesper Lagergren
  4. MRC Cancer Unit, Hutchison–MRC Research Centre, University of Cambridge, Cambridge, UK.

    • Rebecca C. Fitzgerald
  5. University Cancer Center Leipzig, University Medicine Leipzig, Leipzig, Germany.

    • Florian Lordick
  6. Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine, New York–Presbyterian Hospital, New York, New York, USA.

    • Manish A. Shah
  7. Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.

    • Pernilla Lagergren

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Contributions

Introduction (E.C.S. and D.C.); Epidemiology (E.C.S. and D.C.); Mechanisms/pathophysiology (R.C.F.); Diagnosis, screening and prevention (R.C.F.); Management (E.C.S., J.L., F.L. and M.A.S.); Quality of life (P.L.); Outlook (All); Overview of Primer (E.C.S. and D.C.).

Competing interests

E.C.S. declares honoraria for an advisory role from Five Prime Therapeutics and Bristol-Myers Squibb. D.C. declares institutional research funding from Amgen, AstraZeneca, Bayer, Celgene, MedImmune, Merck Serono, Merrimack and Sanofi. F.L. has received research support from GlaxoSmithKline and Fresenius Biotech; lecture and advisory honoraria from Amgen, Biontech, Bristol-Myers Squibb, Eli Lilly, Ganymed, Merck Serono, MSD, Nordic and Roche; and travel support from Amgen, Bayer, Roche and Taiho. M.A.S. declares institutional research funding from Genentech, Sanofi and Lilly. J.L., P.L. and R.C.F. are named on patents related to the Cytosponge and associated assays, which have been licensed by the Medical Research Council to Covidien (now Medtronic).

Corresponding author

Correspondence to David Cunningham.