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  • Review Article
  • Published:

Improving outcomes in patients with oesophageal cancer

Nature Reviews Clinical Oncology volume 20, pages 390–407 (2023)Cite this article

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Abstract

The care of patients with oesophageal cancer or of individuals who have an elevated risk of oesophageal cancer has changed dramatically. The epidemiology of squamous cell and adenocarcinoma of the oesophagus has diverged over the past several decades, with a marked increase in incidence only for oesophageal adenocarcinoma. Only in the past decade, however, have molecular features that distinguish these two forms of the disease been identified. This advance has the potential to improve screening for oesophageal cancers through the development of novel minimally invasive diagnostic technologies predicated on cancer-specific genomic or epigenetic alterations. Surgical techniques have also evolved towards less invasive approaches associated with less morbidity, without compromising oncological outcomes. With improvements in multidisciplinary care, advances in radiotherapy and new tools to detect minimal residual disease, certain patients may no longer even require surgical tumour resection. However, perhaps the most anticipated advance in the treatment of patients with oesophageal cancer is the advent of immune-checkpoint inhibitors, which harness and enhance the host immune response against cancer. In this Review, we discuss all these advances in the management of oesophageal cancer, representing only the beginning of a transformation in our quest to improve patient outcomes.

Key points

  • With advances in molecular profiling technologies, the differential mechanistic underpinnings of oesophageal adenocarcinoma and oesophageal squamous cell cancer have been better defined. Improved definition and understanding of the molecular alterations will lead to the discovery of exploitable therapeutic vulnerabilities.

  • Novel technologies are being developed for the screening and surveillance of premalignant lesions, relying on the identification of the earliest molecular changes in neoplastic transformation.

  • The optimal management approach for localized oesophageal cancer continues to rely on a multidisciplinary team approach, and advances have been made in each of the subspecialties involved in the care of patients with this disease.

  • Endoscopic resection is a curative option for patients with low-risk stage T1a–b cancers; for other patients with localized oesophageal cancers, minimally invasive surgical techniques, improved perioperative care and improved radiotherapy techniques can reduce surgical morbidity without compromising oncological outcomes.

  • Immune-checkpoint inhibitors and their combinations with chemotherapy improve survival in patients with advanced-stage oesophageal cancers.

  • The development of novel targeted therapies and immunotherapies will continue to shape the treatment paradigms of oesophageal cancers for years to come.

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Fig. 1: The divergent pathways of ESCC and EAC carcinogenesis.
Fig. 2: Transthoracic compared with transhiatal oesophagectomy.

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Authors and Affiliations

  1. Department of Medicine, Weill Cornell Medicine, New York, NY, USA

    Manish A. Shah

  2. Department of Surgery, Weill Cornell Medicine, New York, NY, USA

    Nasser Altorki & Sebron Harrison

  3. Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA

    Pretish Patel

  4. Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA

    Adam Bass & Julian A. Abrams

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M.A.S., N.A., P.P., A.B. and J.A.A. researched data for the article and reviewed and/or edited the manuscript before submission. All authors contributed to the discussion of content and writing of the manuscript.

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Shah, M.A., Altorki, N., Patel, P. et al. Improving outcomes in patients with oesophageal cancer. Nat Rev Clin Oncol 20, 390–407 (2023). https://doi.org/10.1038/s41571-023-00757-y

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