The changing face of esophageal cancer

Abstract

The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction.

Figure 1

Mortality trends for esophageal cancer in selected countries with highest incidence, age-standardized rates (world). (A) males; (B) females. (From the WHO mortality database, International Agency for Research on Cancer.)

Figure 2

Mortality trends from esophageal cancer for the Central Asian Republics, age-standardized rates (world). (A) males; (B) females. (From the WHO mortality database, International Agency for Research on Cancer).

Figure 3

Mortality from esophageal cancer in westernized nations experiencing increased incidence, age-standardized rates (world). (From the WHO mortality database, International Agency for Research on Cancer).