Adenocarcinoma do Esófago - Abordagem Atual

Abstract

Introduction Esophageal cancer is an aggressive malignancy with an increasing incidence and a poor prognosis. Esophageal adenocarcinoma (EAC) and squamous cell carcinoma (SCC) are the two most common histologic types and make up over 95% of all esophageal malignant tumors. In the past, SCC was the predominating type, while EAC was a rarely seen condition. However, over time, as a result of better quality of life, the incidence of EAC has increased dramatically in Western countries, accounting for the majority of all esophageal cancers in Northern Europe, North America and Australia. Gastroesophageal reflux disease is consensually regarded as the main culprit. Regardless, we explore other less well-established hypothesis. Methods Following the SANRA guidelines, we performed a narrative review of literature regarding epidemiology, pathophysiology, risk factors, clinical manifestations, diagnosis, staging, treatment, and prognosis of Esophageal Adenocarcinoma. We used both Medline and ScienceDirect libraries. Results We identified a total of 353 records. After exclusion of duplicates, unavailable and non- relevant articles, we included 142 papers in our broad scope narrative review. Discussion All contemporary works consider Barrett's Esophagus (BE) as the last preinvasive stage in the metaplasia-dysplasia-neoplasia sequence of EAC, thus remaining the single best surrogate marker for cancer risk. BE surveillance offers the opportunity of early EAC diagnosis. Treatment options include novel direct endoscopic therapies, esophagectomy, perioperative chemotherapy and preoperative radiation therapy - with the most recent and highest-standard evidence pointing towards multimodality therapy & minimally invasive strategies as the standard of care. Conclusion The EAC landscape is for the most part well-described. Nevertheless, prognosis remains substandard and incidence is ever-increasing, which leads to esophageal cancer being the sixth most deadly worldwide.