| Esophageal cancer | |
|---|---|
| Other names | Oesophageal cancer |
 | |
| Endoscopic image of an esophageal adenocarcinoma | |
| Specialty | GastroenterologyGeneral surgeryoncology |
| Symptoms | Difficulty swallowing, weight loss,hoarse voice,enlarged lymph nodes around thecollarbone,vomiting blood,[1]blood in the stool |
| Types | Esophagealsquamous-cell carcinoma, esophagealadenocarcinoma[2] |
| Risk factors | Smoking tobacco,alcohol, very hot drinks,betel nut chewing,obesity,acid reflux[3][4] |
| Diagnostic method | Tissue biopsy[5] |
| Treatment | Surgery,chemotherapy,radiation therapy[5] |
| Prognosis | Five-year survival rates ~15%[1][6] |
| Frequency | 746,000 affected as of 2015[7] |
| Deaths | 509,000 (2018)[8] |
Esophageal cancer (American English) oroesophageal cancer (British English) iscancer arising from theesophagus—the food pipe that runs between the throat and the stomach.[2] Symptoms often includedifficulty in swallowing and weight loss.[1] Other symptoms may includepain when swallowing, ahoarse voice,enlarged lymph nodes ("glands") around thecollarbone, a dry cough, and possiblycoughing up orvomiting blood.[1]
The two mainsub-types of the disease are esophagealsquamous-cell carcinoma (often abbreviated to ESCC),[9] which is more common in thedeveloping world, and esophagealadenocarcinoma (EAC), which is more common in thedeveloped world.[2] A number of less common types also occur.[2] Squamous-cell carcinoma arises from theepithelial cells that line the esophagus.[10] Adenocarcinoma arises fromglandular cells present in the lower third of the esophagus, often where they have alreadytransformed to intestinal cell type (a condition known asBarrett's esophagus).[2][11]
Causes of the squamous-cell type includetobacco,alcohol, very hot drinks, poor diet, and chewingbetel nut.[3][4] The most common causes of the adenocarcinoma type are smoking tobacco,obesity, andacid reflux.[3] In addition, for patients withachalasia,candidiasis (overgrowth of the esophagus with the funguscandida) is the most important risk factor.[12]
The disease is diagnosed bybiopsy done by anendoscope (afiberoptic camera).[5] Prevention includes stopping smoking and eating ahealthy diet.[1][2] Treatment is based on thecancer's stage and location, together with the person's general condition and individual preferences.[5] Small localized squamous-cell cancers may be treated withsurgery alone with the hope of acure.[5] In most other cases,chemotherapy with or withoutradiation therapy is used along with surgery.[5] Larger tumors may have their growth slowed with chemotherapy and radiation therapy.[2] In the presence of extensive disease or if the affected person is not fit enough to undergo surgery,palliative care is often recommended.[5]
As of 2018, esophageal cancer was the eighth-most common cancer globally with 572,000 new cases during the year. It caused about 509,000 deaths that year, up from 345,000 in 1990.[8][13] Rates vary widely among countries, with about half of all cases occurring in China.[2] It is around three times more common in men than in women.[2] Outcomes are related to the extent of the disease andother medical conditions, but generally tend to be fairly poor, as diagnosis is often late.[2][14]Five-year survival rates are around 13% to 18%.[1][6]
Prominent symptoms usually do not appear until the cancer hasinfiltrated over 60% of the circumference of the esophageal tube, by which time the tumor is already in anadvanced stage.[15] Onset of symptoms is usually caused bynarrowing of the tube due to the physical presence of the tumor.[16]
The first and the most common symptom is usuallydifficulty in swallowing, which is often experienced first with solid foods and later with softer foods and liquids.[1]Pain when swallowing is less usual at first.[1]Weight loss is often an initial sign in cases of squamous-cell carcinoma, though not usually in cases of adenocarcinoma.[17] Eventual weight loss due to reduced appetite andundernutrition is common.[18]Pain behind thebreastbone or in theregion around the stomach often feels likeheartburn. The pain can frequently be severe, worsening when food of any sort is swallowed. Another sign may be an unusually husky, raspy, or hoarse-sounding cough, a result of the tumor affecting therecurrent laryngeal nerve.
The presence of the tumor may disrupt the normalcontractions of the esophagus when swallowing. This can lead tonausea andvomiting,regurgitation of food and coughing.[15] There is also an increased risk ofaspiration pneumonia[15] due to food entering the airways through the abnormal connections (fistulas) that may develop between the esophagus and thetrachea (windpipe).[14] Early signs of this serious complication may be coughing on drinking or eating.[19] The tumor surface may be fragile andbleed, causingvomiting of blood. Compression of local structures occurs in advanced disease, leading to such problems asupper airway obstruction andsuperior vena cava syndrome.Hypercalcemia (excess calcium in the blood) may occur.[15]
If the cancer has spread elsewhere, symptoms related tometastatic disease may appear. Common sites of spread include nearbylymph nodes, theliver,lungs and bone.[15]Liver metastasis can causejaundice and abdominal swelling (ascites). Lung metastasis can cause, among other symptoms, impaired breathing due to excess fluid around the lungs (pleural effusion), anddyspnea (the feelings often associated with impaired breathing).
The two main types (i.e.squamous-cell carcinoma andadenocarcinoma) have distinct sets ofrisk factors.[17] Squamous-cell carcinoma is linked to lifestyle factors such as smoking and alcohol.[20] Adenocarcinoma has been linked to effects of long-termacid reflux.[20] Tobacco is a risk factor for both types.[17] Both types are more common in people over 60 years of age.[21]
The two major risk factors for esophageal squamous-cell carcinoma are tobacco (smoking orchewing) and alcohol.[2] The combination of tobacco and alcohol has a strongsynergistic effect.[22] Some data suggest that about half of all cases are due to tobacco and about one-third to alcohol, while over three-quarters of the cases in men are due to the combination of smoking and heavy drinking.[2]Risks associated with alcohol appear to be linked to itsaldehyde metabolite and to mutations in certainrelated enzymes.[17] Such metabolicvariants are relatively common in Asia.[2]
Other relevant risk factors include regular consumption of very hot drinks (over 65 °C or 149 °F)[23][24] and ingestion ofcaustic substances.[2] High levels of dietary exposure tonitrosamines (chemical compounds found both in tobacco smoke and certain foodstuffs) also appear to be a relevant risk factor.[17] Unfavorable dietary patterns seem to involve exposure to nitrosamines throughprocessed and barbecued meats, pickled vegetables, etc., and a low intake of fresh foods.[2] Other associated factors includenutritional deficiencies, lowsocioeconomic status, and poororal hygiene.[17] Chewingbetel nut (areca) is an important risk factor in Asia.[4]
Physical trauma may increase the risk.[25] This may include the drinking of very hot drinks.[3]
Male predominance is particularly strong in esophagealadenocarcinoma, occurring about 7 to 10 times more frequently in men.[26] This imbalance may be related to the characteristics andinteractions of other known risk factors, including acid reflux andobesity.[26]
The long-term erosive effects of acid reflux (an extremely common condition, also known asgastroesophageal reflux disease or GERD) have been strongly linked to this type of cancer.[27] Longstanding GERD can induce achange of cell type in the lower portion of the esophagus in response to erosion of itssquamous lining.[27] This phenomenon, known asBarrett's esophagus, seems to appear about 20 years later in women than in men, possibly due tohormonal factors.[27]
At a mechanistic level, in the esophagus there is a smallHOXA13 expressing compartment that is more resistant to bile and acids as the normal squamous epithelium and that is prone to both intestinal differentiation as well asoncogenic transformation. Following GERD this HOXA13-expressing compartment outcompetes the normal squamous compartment, leading to the intestinal aspect of the esophagus and increased propensity to the development of esophageal cancer.[28]
Having symptomatic GERD orbile reflux makes Barrett's esophagus more likely, which in turn raises the risk offurther changes that can ultimately lead to adenocarcinoma.[17] Bile reflux containing unconjugatedbile acids, includingdeoxycholic acid andchenodeoxycholic acid, appears to contribute to esophageal adenocarcinoma carcinogenesis by inducingoxidative stress andDNA damage.[29] The risk of developing adenocarcinoma in the presence of Barrett's esophagus is unclear, and may in the past have been overestimated.[2]
Being obese oroverweight is strongly associated with risk of developing esophageal adenocarcinoma, and may in fact be the strongest of any type ofobesity-related cancer, though the reasons for this remain unclear.[30][31]Abdominal obesity seems to be of particular relevance, given thecloseness of its association with this type of cancer, as well as with both GERD and Barrett's esophagus.[31] This type of obesity is characteristic of men.[31] Physiologically, it stimulates GERD and also has other chronicinflammatory effects.[27]
Helicobacter pylori infection (a common occurrence thought to have affected over half of the world's population) is not a risk factor for esophageal adenocarcinoma and actually appears to be protective. Despite being a cause of GERD and a risk factor forgastric cancer, the infection seems to be associated with a reduced risk of esophageal adenocarcinoma of as much as 50%.[32][33] The biological explanation for a protective effect is unclear.[33] One explanation is that some strains ofH. pylori reducestomach acid, thereby reducing damage by GERD.[34] Decreasing rates ofH. pylori infection in Western populations over recent decades, which have been linked to less overcrowding in households, could be a factor in the concurrent increase in esophageal adenocarcinoma.[32]
Female hormones may also have a protective effect, as EAC is not only much less common in women but develops later in life, by an average of 20 years. Although studies of many reproductive factors have not produced a clear picture, risk seems to decline for the mother in line with prolonged periods ofbreastfeeding.[32]
Tobacco smoking increases risk, but the effect in esophageal adenocarcinoma is slight compared to that in squamous cell carcinoma, and alcohol has not been demonstrated to be a cause.[32]
Although an occlusive tumor may be suspected on abarium swallow orbarium meal, the diagnosis is best made with an examination using anendoscope. This involves the passing of a flexible tube with a light and camera down the esophagus and examining the wall, and is called anesophagogastroduodenoscopy.Biopsies taken of suspicious lesions are then examinedhistologically for signs of malignancy.
Additional testing is needed to assess how much the cancer has spread (see§ Staging, below).Computed tomography (CT) of the chest, abdomen and pelvis can evaluate whether the cancer has spread to adjacent tissues or distant organs (especiallyliver andlymph nodes). The sensitivity of a CT scan is limited by its ability to detect masses (e.g. enlargedlymph nodes or involved organs) generally larger than 1 cm.[44][45]Positron emission tomography is also used to estimate the extent of the disease and is regarded as more precise than CT alone.[46] PET/MR as a novel modality has shown promising results in preoperative staging with fair feasibility and good correlation in comparison to PET/CT. It can enhance tissue differentiation with lowering the radiation dose to the patient.[47] Esophagealendoscopic ultrasound can provide staging information regarding the level of tumor invasion, and possible spread to regional lymph nodes.
The location of the tumor is generally measured by the distance from the teeth. The esophagus (25 cm or 10 in long) is commonly divided into three parts for purposes of determining the location. Adenocarcinomas tend to occur nearer the stomach and squamous cell carcinomas nearer the throat, but either may arise anywhere in the esophagus.
Esophageal cancers are typicallycarcinomas that arise from theepithelium, or surface lining, of the esophagus. Most esophageal cancers fall into one of two classes: esophageal squamous-cell carcinomas (ESCC), which are similar tohead and neck cancer in their appearance and association with tobacco and alcohol consumption—and esophageal adenocarcinomas (EAC), which are often associated with a history of GERD and Barrett's esophagus. A rule of thumb is that a cancer in the upper two-thirds is likely to be ESCC and one in the lower one-third EAC.
Rare histologic types of esophageal cancer include different variants of squamous-cell carcinoma, and non-epithelial tumors, such asleiomyosarcoma,malignant melanoma,rhabdomyosarcoma andlymphoma, among others.[48][49]
Staging is based on theTNM staging system, which classifies the amount of tumor invasion (T), involvement oflymph nodes (N), and distantmetastasis (M).[17] The currently preferred classification is the 2010AJCC staging system for cancer of the esophagus and theesophagogastric junction.[17] To help guide clinical decision making, this system also incorporates information on cell type (ESCC, EAC, etc.),grade (degree ofdifferentiation – an indication of the biological aggressiveness of thecancer cells), and tumor location (upper, middle, lower, or junctional[50]).[51]
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Prevention includes stopping smoking or chewing tobacco.[2] Overcoming addiction to areca chewing in Asia is another promising strategy for the prevention of esophageal squamous-cell carcinoma.[4] The risk can also be reduced by maintaining a normal body weight.[52] According to a 2022 umbrella review, calcium intake could be associated with lower risk.[53]
According to theNational Cancer Institute, "diets high in cruciferous (cabbage, broccoli/broccolini, cauliflower, Brussels sprouts) and green and yellow vegetables and fruits are associated with a decreased risk of esophageal cancer."[54]Dietary fiber is thought to be protective, especially against esophageal adenocarcinoma.[55] There is no evidence that vitamin supplements change the risk.[1]
People withBarrett's esophagus (an abnormality of the cells lining the lower esophagus) are at much higher risk,[56] and may receive regular endoscopic screening for the early signs of cancer.[57] Because the benefit of screening for adenocarcinoma in people without symptoms is unclear,[2] it is not recommended in the United States.[1]
The Nath Score is a history-based risk assessment model developed using machine learning and retrospective data. It evaluates clinical history and symptom patterns to estimate the likelihood of esophageal cancer and has been proposed as a screening tool, particularly in settings where access to endoscopic screening is limited. While retrospective studies support its ability to identify high-risk individuals, it has not yet been adopted into standard screening guidelines.[58]
Treatment is best managed by a multidisciplinary team covering the variousspecialties involved.[clarification needed][59][60] Adequatenutrition must be assured, and appropriate dental care is essential. Factors that influence treatment decisions include thestage and cellular type of cancer (EAC, ESCC, and other types), along with the person's general condition and anyother diseases that are present.[17]
In general, treatment with acurative intention is restricted to localized disease, without distantmetastasis: in such cases a combined approach that includes surgery may be considered. Disease that is widespread, metastatic or recurrent is managedpalliatively: in this case, chemotherapy may be used to lengthen survival, while treatments such asradiotherapy orstenting may be used to relieve symptoms and make it easier to swallow.[17]
If the cancer has been diagnosed while still in an early stage, surgical treatment with a curative intention may be possible. Some small tumors that only involve themucosa or lining of the esophagus may be removed byendoscopic mucosal resection (EMR).[61][62] Otherwise, curative surgery of early-stage lesions may entail removal of all or part of the esophagus (esophagectomy), although this is a difficult operation with a relatively high risk of mortality or post-operative difficulties. The benefits of surgery are less clear in early-stage ESCC than EAC. There are a number of surgical options, and the best choices for particular situations remain the subject of research and discussion.[59][63][64]
The likelyquality of life after treatment is a relevant factor when considering surgery.[65] Surgical outcomes are likely better in large centers where the procedures are frequently performed.[63] If the cancer has spread to other parts of the body, esophagectomy is nowadays not normally performed.[63][66]
Esophagectomy is the removal of a segment of the esophagus; as this shortens the length of the remaining esophagus, some other segment of the digestive tract is pulled up through the chest cavity and interposed. This is usually thestomach or part of thelarge intestine (colon) orjejunum. Reconnection of the stomach to a shortened esophagus is called an esophagogastricanastomosis.[63]
Esophagectomy can be performed using several methods. The choice of the surgical approach depends on the characteristics and location of the tumor, and the preference of the surgeon. Clear evidence from clinical trials for which approaches give the best outcomes in different circumstances is lacking.[63] A first decision, regarding the point of entry, is between atranshiatal and atransthoracic procedure. The more recent transhiatal approach avoids the need to open the chest; instead the surgeon enters the body through an incision in the lower abdomen and another in the neck. The lower part of the esophagus is freed from the surrounding tissues and cut away as necessary. The stomach is then pushed through theesophageal hiatus (the hole where the esophagus passes through thediaphragm) and is joined to the remaining upper part of the esophagus at the neck.[63]
The traditional transthoracic approach enters the body through the chest, and has a number of variations. The thoracoabdominal approach opens the abdominal and thoracic cavities together, the two-stage Ivor Lewis (also called Lewis–Tanner) approach involves an initiallaparotomy and construction of agastric tube, followed by a right thoracotomy to excise the tumor and create an esophagogastric anastomosis. The three-stage McKeown approach adds a third incision in the neck to complete the cervical anastomosis. Recent approaches by some surgeons use what is called extended esophagectomy, where more surrounding tissue, includinglymph nodes, is removeden bloc.[63]
If the person cannot swallow at all, anesophageal stent may be inserted to keep the esophagus open;stents may also assist in occluding fistulas. Anasogastric tube may be necessary to continue feeding while treatment for the tumor is given, and some patients require agastrostomy (feeding hole in the skin that gives direct access to the stomach). The latter two are especially important if the patient tends to aspirate food or saliva into the airways, predisposing foraspiration pneumonia.[citation needed]
Chemotherapy depends on the tumor type, but tends to becisplatin-based (orcarboplatin oroxaliplatin) every three weeks withfluorouracil (5-FU) orcapecitabine either continuously or every three weeks. In more studies, addition ofepirubicin was better than other three drug regimens in advanced nonresectable cancer.[67] However, a meta-analysis in 2017 failed to demonstrate thatanthracyclines such asepirubicin improved survival.[68] Therefore in metastatic cancer, a two drug combination is now standard. Most recently with the addition of immune checkpoint inhibitors such asnivolumab[69] orpembrolizumab[70] which prolongs disease-free survival after neoadjuvant chemoradiotherapy and surgery in patients with residual locally advanced esophageal squamous cell carcinoma, they are increasingly being incorporated into combined treatment strategies and are under investigation in both neoadjuvant and chemoradiation regimens.[71]
Chemotherapy may be given after surgery (adjuvant, i.e. to reduce risk of recurrence), before surgery (neoadjuvant) or if surgery is not possible.Cisplatin andfluorouracil were most commonly used a, however the REAL-2 trial confirmed thatoxaliplatin andcapecitabine were non-inferior and potentially more convenient.[72]
Radiotherapy is given before, during, or after chemotherapy or surgery, and sometimes on its own to control symptoms. In patients with localized disease but contraindications to surgery, "radical radiotherapy" may be used with curative intent.[medical citation needed]
Forms of endoscopic therapy have been used for stage 0 and I disease:endoscopic mucosal resection (EMR)[73] and mucosal ablation using radiofrequency ablation, photodynamic therapy, Nd-YAG laser, or argon plasma coagulation.
Laser therapy is the use of high-intensity light to destroy tumor cells while affecting only the treated area. This is typically done if the cancer cannot be removed by surgery. The relief of a blockage can help with pain and difficulty swallowing.Photodynamic therapy, a type of laser therapy, involves the use of drugs that are absorbed by cancer cells; when exposed to a special light, the drugs become active and destroy the cancer cells.
Patients are followed closely after a treatment regimen has been completed. Frequently, other treatments are used to improve symptoms and maximize nutrition.
In general, the prognosis of esophageal cancer is quite poor, because most patients present with advanced disease. By the time the first symptoms (such as difficulty swallowing) appear, the disease has already progressed. The overallfive-year survival rate (5YSR) in the United States is around 15%, and most people die within the first year of diagnosis.[74] The latest survival data for England and Wales (patients diagnosed during 2007) show that only one in ten people survives esophageal cancer for at least ten years.[75]
Individualized prognosis depends largely on stage. Those with cancer restricted entirely to the esophagealmucosa have about an 80% 5YSR, butsubmucosal involvement brings this down to less than 50%. Extension into themuscularis propria (muscle layer of the esophagus) suggests a 20% 5YSR, and extension to the structures adjacent to the esophagus predict a 7% 5YSR. Patients with distant metastases (who are not candidates for curative surgery) have a less than 3% 5YSR.[76]
_per_100.000_of_Incidence_Cases%2c_Both_sexes%2c_Worldwide_in_2022.svg)
Esophageal cancer is the eighth most frequently diagnosed cancer worldwide,[2] and because of its poor prognosis, it is the sixth most common cause of cancer-related deaths.[56] It caused about 400,000 deaths in 2012, accounting for about 5% of all cancer deaths (about 456,000 new cases were diagnosed, representing about 3% of all cancers).[2]
ESCC (esophageal squamous-cell carcinoma) comprises 60–70% of all cases of esophageal cancer worldwide, while EAC (esophageal adenocarcinoma) accounts for a further 20–30% (melanomas, leiomyosarcomas, carcinoids and lymphomas are less common types).[77] The incidence of the two main types of esophageal cancer varies greatly between different geographical areas.[78] In general, ESCC is more common in thedeveloping world, and EAC is more common in thedeveloped world.[2]
The worldwideincidence rate of ESCC in 2012 was 5.2 new cases per 100,000 person-years, with a male predominance (7.7 per 100,000 in men vs. 2.8 in women).[79] It was the common type in 90% of the countries studied.[79] ESCC is particularly frequent in the so-called "Asian esophageal cancer belt", an area that passes throughnorthern China, southernRussia, north-easternIran, northernAfghanistan and easternTurkey.[77] In 2012, about 80% of ESCC cases worldwide occurred in central and south-eastern Asia, and over half (53%) of all cases were in China.[79][verification needed] The countries with the highest estimated national incidence rates were (in Asia)Mongolia andTurkmenistan and (in Africa)Malawi,Kenya andUganda.[79] The problem of esophageal cancer has long been recognized in the eastern and southern parts ofSub-Saharan Africa, where ESCC appears to predominate.[80]
In Western countries, EAC has become the dominant form of the disease, following an increase in incidence over recent decades (in contrast to the incidence of ESCC, which has remained largely stable).[5][32] In 2012, the global incidence rate for EAC was 0.7 per 100,000 with a strong male predominance (1.1 per 100,000 in men vs. 0.3 in women). Areas with particularly high incidence rates include northern and western Europe, North America andOceania. The countries with highest recorded rates were theUK,Netherlands,Ireland,Iceland andNew Zealand.[79]
In the United States, esophageal cancer is the seventh-leading cause of cancer-related deaths among males (making up 4% of the total).[81] TheNational Cancer Institute estimated that there were about 18,000 new cases and more than 15,000 deaths from esophageal cancer in 2013; theAmerican Cancer Society estimated that during 2014, about 18,170 new esophageal cancer cases would be diagnosed, resulting in 15,450 deaths.[78][81]
The squamous-cell carcinoma type is more common amongAfrican American males with a history of heavy smoking or alcohol use. Until the 1970s, squamous-cell carcinoma accounted for the vast majority of esophageal cancers in the United States. In recent decades, incidence of adenocarcinoma of the esophagus (which is associated with Barrett's esophagus) steadily rose in the United States to the point that it has now surpassed squamous-cell carcinoma. In contrast to squamous-cell carcinoma, esophageal adenocarcinoma is more common inwhite American men (over the age of 60) than it is in African Americans. Multiple reports indicate esophageal adenocarcinoma incidence has increased during the past 20 years, especially in non-Hispanic white men. Esophageal adenocarcinoma age-adjusted incidence increased inNew Mexico from 1973 to 2002. This increase was found in non-Hispanic whites andHispanics and became predominant in non-Hispanic whites.[82] Esophageal cancer incidence and mortality rates for African Americans continue to be higher than the rate for Causasians. However, incidence and mortality of esophageal cancer has significantly decreased among African Americans since the early 1980s, whereas with whites it has continued to increase.[83] Between 1975 and 2004, incidence of the adenocarcinoma type increased among white American males by over 460% and among white American females by 335%.[78]
The incidence of esophageal adenocarcinoma has risen considerably in the UK in recent decades.[17] Overall, esophageal cancer is the thirteenth most common cancer in the UK (around 8,300 people were diagnosed with the disease in 2011), and it is the sixth most common cause of cancer death (around 7,700 people died in 2012).[84]
Humphrey Bogart, actor, died of esophageal cancer in 1957, aged 57.
Billy Strayhorn, Americanjazz composer, pianist,lyricist, andarranger, who collaborated with bandleader and composerDuke Ellington, died of esophageal cancer in 1967 at age 51.
ActorJohn Thaw died of esophageal cancer in 2002, at the age of 60.
Christopher Hitchens, author and journalist, died of esophageal cancer in 2011, aged 62.[85]
Morrissey in October 2015 stated he has the disease and has described his experience when he first heard he had it.[86]
Mako Iwamatsu, voice actor forAvatar: The Last Airbender as GeneralIroh andSamurai Jack as Aku, died of esophageal cancer in 2006, aged 72.
Robert Kardashian, attorney and businessman, died of esophageal cancer in 2003, aged 59.
Traci Braxton, singer and reality TV star, died of esophageal cancer in 2022, aged 50.
Andrew Bonar Law resigned asPrime Minister of the United Kingdom in 1923 and died of throat cancer shortly after aged 65.
Ed Sullivan, host of the prominent self-titled television programThe Ed Sullivan Show, died of esophageal cancer in 1974 at the age of 73.
Lynn Yamada Davis, chef YouTube star, died of esophageal cancer in 2024, aged 67.
The risk of esophageal squamous-cell carcinoma may be reduced in people usingaspirin or relatedNSAIDs,[87] but in the absence ofrandomized controlled trials the current evidence is inconclusive.[2][32]
The genomics of esophageal adenocarcinoma is being studied usingcancer genome sequencing. Esophageal adenocarcinoma is characterized by complex tumor genomes[88][89] with heterogeneity within the tumor micro-environment.[89]
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| National | |
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