Endoscopic evaluation and treatment of esophageal cance

Esophageal cancer is the sixth leading cause of cancer mortality. During the past twenty years the prevalence of adenocarcinoma, which is linked to gastroesophageal reflux and Barrett's metaplasia, has increased precipitously for unclear reasons. Endoscopic ultrasound (EUS) has revolutionized primary tumor (T) and nodal (N) staging. Additionally, the recent introduction of combined computed and positron emission tomography (CT-PET) promises to improve the detection of distant metastasis. While classic surgical approaches have significant morbidity and mortality, the recent widespread introduction of minimally invasive techniques including endoscopic mucosal resection and radiofrequency ablation offer new options to those with limited disease. Finally, endoscopically placed self expandable metal stents have become the primary mode of palliating dysphagia and there is a growing interest in the use of removable stents to optimize nutrition in neoadjuvant chemotherapy patients awaiting esophagectomy. In this article we will review the presentation, staging, and treatment of esophageal cancer with an emphasis on the evolving role of endoscopy to help accomplish these objectives.