Esophageal Cancer: An Updated Review

Michael DiSiena, MD; Alexander Perelman, DO; John Birk, MD; Houman Rezaizadeh, MD


South Med J. 2021;114(3):161-168. 

In This Article


As our efforts continue to reduce the incidence and mortality in EC, it is essential to understand that our poor outcomes are based mainly on advanced stages of disease at the time of diagnosis.[94] Data have failed thus far to support universal screening or specific risk factors to use for screening due to the heterogeneous nature of EC as well as the safety and economic considerations;[104] however, if a significant risk factor for AC or SCC has been identified, then a more aggressive approach with surveillance may help reduce the EC disease burden. Partnering with primary care providers to target cohorts with risk factors for screening modalities such as endoscopy seems reasonable.

In the United States, where AC is the predominant subtype of EC, professional societies have focused on Barrett's esophagus identification and eradication when appropriate to affect outcomes in EC. Recent guidelines have provided recommendations on screening and surveillance for Barrett's esophagus as a means to that end.[42,105,106] Although a step forward, it remains unclear whether this strategy will yield significant improvement for the population.

As has been seen in the success of CRC screening, a multidisciplinary approach needs to be implemented in the identification of patients at risk for EC, and then they can be referred for appropriate screening/surveillance thereafter.