From the Saint Joseph Cancer Institute
Address reprint requests to Mark J. Krasna, MD, The Cancer Institute at St. Joseph Medical Center, 7501 Osler Drive, Ste. 104, Towson, MD 21204; e-mail: markkrasna{at}catholichealth.net
Overview: Patients with esophageal cancer rarely present at an early stage of their disease. Symptoms do not usually arise until the tumor becomes large enough to cause obstruction or invasion of adjacent structures. The lack of an esophageal serosal layer may allow early tumor invasion into adjacent structures such as the trachea, aorta, and spine. Esophageal cancer can metastasize to virtually any organ in the body. Widespread distant metastases are almost always present at the time of death. The extensive lymphatic drainage pathways in the esophagus and the long time interval during which tumors typically remain asymptomatic may contribute to the high incidence of lymph node metastases. In most cases of esophageal cancer presenting with dysphagia, however, management is complicated by the prevalence of locally advanced disease (T3 or T4), involvement of regional lymph nodes (N1), or distant (often occult) metastases (M1). Curative treatment of esophageal cancer must address local control of the primary lesion as well as the control and/or prevention of metastases.
