Esophageal cancer

Source: Wikipedia, the free encyclopedia.
Esophageal cancer
Other namesOesophageal cancer
Five-year survival rates ~15%[1][6]
Frequency746,000 affected as of 2015[7]
Deaths509,000 (2018)[8]

Esophageal cancer is

hoarse voice, enlarged lymph nodes ("glands") around the collarbone, a dry cough, and possibly coughing up or vomiting blood.[1]

The two main

glandular cells present in the lower third of the esophagus, often where they have already transformed to intestinal cell type (a condition known as Barrett's esophagus).[2][11]

Causes of the squamous-cell type include tobacco, alcohol, very hot drinks, poor diet, and chewing

acid reflux.[3]

The disease is diagnosed by

fiberoptic camera).[5] Prevention includes stopping smoking and eating a healthy diet.[1][2] Treatment is based on the cancer's stage and location, together with the person's general condition and individual preferences.[5] Small localized squamous-cell cancers may be treated with surgery alone with the hope of a cure.[5] In most other cases, chemotherapy with or without radiation 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.

Five-year survival rates are around 13% to 18%.[1][6]

Signs and symptoms

Prominent symptoms usually do not appear until the cancer has infiltrated over 60% of the circumference of the esophageal tube, by which time the tumor is already in an advanced stage.[14] Onset of symptoms is usually caused by narrowing of the tube due to the physical presence of the tumor.[15]

The first and the most common symptom is usually

region around the stomach often feels like heartburn. 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 the recurrent laryngeal nerve
.

The presence of the tumor may disrupt the normal

Hypercalcemia (excess calcium in the blood) may occur.[14]

If the cancer has spread elsewhere, symptoms related to

dyspnea
(the feelings often associated with impaired breathing).

Causes

The two main types (i.e.

acid reflux.[19] Tobacco is a risk factor for both types.[16] Both types are more common in people over 60 years of age.[20]

Squamous-cell carcinoma

The two major risk factors for esophageal squamous-cell carcinoma are tobacco (smoking or

synergistic effect.[21] 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 its aldehyde metabolite and to mutations in certain related enzymes.[16] Such metabolic variants are relatively common in Asia.[2]

Other relevant risk factors include regular consumption of very hot drinks (over 65 °C or 149 °F)

nutritional deficiencies, low socioeconomic status, and poor oral hygiene.[16] Chewing betel nut (areca) is an important risk factor in Asia.[4]

Physical trauma may increase the risk.[24] This may include the drinking of very hot drinks.[3]

Adenocarcinoma

Esophageal cancer (lower part) as a result of Barrettʼs esophagus

Male predominance is particularly strong in this type of esophageal cancer, which occurs about 7 to 10 times more frequently in men.[25] This imbalance may be related to the characteristics and interactions of other known risk factors, including acid reflux and obesity.[25]

GERD or Gastroesophageal reflux disease

The long-term erosive effects of acid reflux (an extremely common condition, also known as

bile acids, including deoxycholic acid and chenodeoxycholic acid, appears to contribute to esophageal adenocarcinoma carcinogenesis by inducing oxidative stress and DNA damage[28].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 or overweight both appear to be associated with increased risk.[29] The association with obesity seems to be the strongest of any type of obesity-related cancer, though the reasons for this remain unclear.[30] Abdominal obesity seems to be of particular relevance, given the closeness of its association with this type of cancer, as well as with both GERD and Barrett's esophagus.[30] This type of obesity is characteristic of men.[30] Physiologically, it stimulates GERD and also has other chronic inflammatory effects.[26]

stomach acid, thereby reducing damage by GERD.[33] Decreasing rates of H. 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.[31]

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 of breastfeeding.[31]

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.[31]

Related conditions

  • Head and neck cancer is associated with second primary tumors in the region, including esophageal squamous-cell carcinomas, due to field cancerization (i.e. a regional reaction to long-term carcinogenic exposure).[34][35]
  • History of
    chest is a risk factor for esophageal adenocarcinoma.[16]
  • caustic substances is a risk factor for squamous cell carcinoma.[2]
  • familial disease with autosomal dominant inheritance that has been linked to a mutation in the RHBDF2 gene, present on chromosome 17: it involves thickening of the skin of the palms and soles and a high lifetime risk of squamous cell carcinoma.[2][36]
  • Achalasia (i.e. lack of the involuntary reflex in the esophagus after swallowing) appears to be a risk factor for both main types of esophageal cancer, at least in men, due to stagnation of trapped food and drink.[37]
  • Plummer–Vinson syndrome (a rare disease that involves esophageal webs) is also a risk factor.[2]
  • There is some evidence suggesting a possible causal association between
    human papillomavirus (HPV) and esophageal squamous-cell carcinoma.[38] The relationship is unclear.[39] Possible relevance of HPV could be greater in places that have a particularly high incidence of this form of the disease,[40] as in some Asian countries, including China.[41]
  • There is an association between
    celiac disease and esophageal cancer. People with untreated celiac disease have a higher risk, but this risk decreases with time after diagnosis, probably due to the adoption of a gluten-free diet, which seems to have a protective role against development of malignancy in people with celiac disease. However, the delay in diagnosis and initiation of a gluten-free diet seems to increase the risk of malignancy. Moreover, in some cases the detection of celiac disease is due to the development of cancer, whose early symptoms are similar to some that may appear in celiac disease.[42]

Diagnosis

Esophageal cancer as shown by a filling defect during an upper GI series

Clinical evaluation

Although an occlusive tumor may be suspected on a

barium meal, the diagnosis is best made with an examination using an endoscope. This involves the passing of a flexible tube with a light and camera down the esophagus and examining the wall, and is called an esophagogastroduodenoscopy. Biopsies taken of suspicious lesions are then examined histologically
for signs of malignancy.

Additional testing is needed to assess how much the cancer has spread (see

Computed tomography (CT) of the chest, abdomen and pelvis can evaluate whether the cancer has spread to adjacent tissues or distant organs (especially liver and lymph nodes). The sensitivity of a CT scan is limited by its ability to detect masses (e.g. enlarged lymph nodes or involved organs) generally larger than 1 cm.[43][44] Positron emission tomography is also used to estimate the extent of the disease and is regarded as more precise than CT alone.[45] 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.[46] Esophageal endoscopic 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.

  • Endoscopic image of Barrett esophagus – a frequent precursor of esophageal adenocarcinoma
    Endoscopic image of
    Barrett esophagus
    – a frequent precursor of esophageal adenocarcinoma
  • Endoscopy and radial endoscopic ultrasound images of a submucosal tumor in the central portion of the esophagus
    Endoscopy and radial endoscopic ultrasound images of a submucosal tumor in the central portion of the esophagus
  • Contrast CT scan showing an esophageal tumor (axial view)
    Contrast CT scan showing an esophageal tumor (axial view)
  • Contrast CT scan showing an esophageal tumor (coronal view)
    Contrast CT scan showing an esophageal tumor (coronal view)
  • Esophageal cancer
    Esophageal cancer
  • Micrograph showing histopathological appearance of an esophageal adenocarcinoma (dark blue – upper-left of image) and normal squamous epithelium (upper-right of image) at H&E staining
    histopathological appearance of an esophageal adenocarcinoma (dark blue – upper-left of image) and normal squamous epithelium (upper-right of image) at H&E staining

Types

Esophageal cancers are typically carcinomas that arise from the epithelium, or surface lining, of the esophagus. Most esophageal cancers fall into one of two classes: esophageal squamous-cell carcinomas (ESCC), which are similar to head 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 as leiomyosarcoma, malignant melanoma, rhabdomyosarcoma and lymphoma, among others.[47][48]

Staging

esophagogastric junction.[16] To help guide clinical decision making, this system also incorporates information on cell type (ESCC, EAC, etc.), grade (degree of differentiation – an indication of the biological aggressiveness of the cancer cells), and tumor location (upper, middle, lower, or junctional[49]).[50]

  • T1, T2, and T3 stages of esophageal cancer
    T1, T2, and T3 stages of esophageal cancer
  • Stage T4 esophageal cancer
    Stage T4 esophageal cancer
  • Esophageal cancer with spread to lymph nodes
    Esophageal cancer with spread to lymph nodes

Prevention

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.[51] According to a 2022 umbrella review, calcium intake could be associated with lower risk.[52]

According to the National 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."[53] Dietary fiber is thought to be protective, especially against esophageal adenocarcinoma.[54] There is no evidence that vitamin supplements change the risk.[1]

Screening

People with Barrett's esophagus (a change in the cells lining the lower esophagus) are at much higher risk,[55] and may receive regular endoscopic screening for the early signs of cancer.[56] Because the benefit of screening for adenocarcinoma in people without symptoms is unclear,[2] it is not recommended in the United States.[1] Some areas of the world with high rates of squamous-carcinoma have screening programs.[2]

Management

Esophageal stent for esophageal cancer
Esophageal stent for esophageal cancer
Before and after a total esophagectomy
Typical scar lines after the two main methods of surgery

Treatment is best managed by a multidisciplinary team covering the various

other diseases that are present.[16]

In general, treatment with a

radiotherapy or stenting may be used to relieve symptoms and make it easier to swallow.[16]

Surgery

Further information: Esophagectomy

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 the

mucosa or lining of the esophagus may be removed by endoscopic mucosal resection (EMR).[59][60] 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.[57][61][62]
As well as characteristics and location of the tumor, other factors include the patient's condition, and the type of operation with which the surgical team is most experienced.

The likely quality of life after treatment is a relevant factor when considering surgery.[63] Surgical outcomes are likely better in large centers where the procedures are frequently performed.[61] If the cancer has spread to other parts of the body, esophagectomy is nowadays not normally performed.[61][64]

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 the stomach or part of the large intestine (colon) or jejunum. Reconnection of the stomach to a shortened esophagus is called an esophagogastric anastomosis.[61]

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.[61] A first decision, regarding the point of entry, is between a transhiatial and a transthoracic procedure. The more recent transhiatial 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 the esophageal hiatus (the hole where the esophagus passes through the diaphragm) and is joined to the remaining upper part of the esophagus at the neck.[61]

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 initial

lymph nodes, is removed en bloc.[61]

If the person cannot swallow at all, an

nasogastric tube may be necessary to continue feeding while treatment for the tumor is given, and some patients require a gastrostomy (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 for aspiration pneumonia
.

Chemotherapy and radiotherapy

Chemotherapy depends on the tumor type, but tends to be cisplatin-based (or carboplatin or oxaliplatin) every three weeks with fluorouracil (5-FU) either continuously or every three weeks. In more recent studies, addition of epirubicin was better[clarification needed] than other comparable regimens in advanced nonresectable cancer.[65][medical citation needed] Chemotherapy may be given after surgery (adjuvant, i.e. to reduce risk of recurrence), before surgery (neoadjuvant) or if surgery is not possible; in this case, cisplatin and 5-FU are used. Ongoing trials compare various combinations of chemotherapy; the phase II/III REAL-2 trial – for example – compares four regimens containing epirubicin and either cisplatin or oxaliplatin, and either continuously infused fluorouracil or capecitabine.

Radiotherapy
is given before, during, or after chemotherapy or surgery, and sometimes on its own to control symptoms. In patients with localised disease but contraindications to surgery, "radical radiotherapy" may be used with curative intent.

Other approaches

Forms of endoscopic therapy have been used for stage 0 and I disease: endoscopic mucosal resection (EMR)[66] 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.

Follow-up

Patients are followed closely after a treatment regimen has been completed. Frequently, other treatments are used to improve symptoms and maximize nutrition.

Prognosis

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 overall five-year survival rate (5YSR) in the United States is around 15%, with most people dying within the first year of diagnosis.[67] 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.[68]

Individualized prognosis depends largely on stage. Those with cancer restricted entirely to the esophageal

muscularis 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.[69]

Epidemiology

Death from esophageal cancer per million persons in 2012
  0-4
  5-6
  7-10
  11-15
  16-26
  27-36
  37-45
  46-59
  60-75
  76-142

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.[55] 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).

developed world.[2]

The worldwide

northern China, southern Russia, north-eastern Iran, northern Afghanistan and eastern Turkey.[70] 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.[72] The countries with the highest estimated national incidence rates were (in Asia) Mongolia and Turkmenistan and (in Africa) Malawi, Kenya and Uganda.[72] The problem of esophageal cancer has long been recognized in the eastern and southern parts of Sub-Saharan Africa, where ESCC appears to predominate.[73]

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).

UK, Netherlands, Ireland, Iceland and New Zealand.[72]

United States

In the United States, esophageal cancer is the seventh-leading cause of cancer-related deaths among males (making up 4% of the total).[74] The National Cancer Institute estimated that there were about 18,000 new cases and more than 15,000 deaths from esophageal cancer in 2013; the American Cancer Society estimated that during 2014, about 18,170 new esophageal cancer cases would be diagnosed, resulting in 15,450 deaths.[71][74]

The squamous-cell carcinoma type is more common among

Hispanics and became predominant in non-Hispanic whites.[75] 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.[76] Between 1975 and 2004, incidence of the adenocarcinoma type increased among white American males by over 460% and among white American females by 335%.[71]

United Kingdom

The incidence of esophageal adenocarcinoma has risen considerably in the UK in recent decades.[16] 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).[77]

Society and culture

Notable cases

See also: Category:Deaths from esophageal cancer

Humphrey Bogart, actor, died of esophageal cancer in 1957, aged 57.

arranger, who collaborated with bandleader and composer Duke Ellington
, died of esophageal cancer in 1967 at age 51.

Actor John 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.[78]

Morrissey in October 2015 stated he has the disease and has described his experience when he first heard he had it.[79]

Mako Iwamatsu, voice actor for Avatar: The Last Airbender as General Iroh and Samurai 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 as Prime 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 program The Ed Sullivan Show, died of esophageal cancer in 1974 at the age of 73

Research directions

The risk of esophageal squamous-cell carcinoma may be reduced in people using

NSAIDs,[80] but in the absence of randomized controlled trials the current evidence is inconclusive.[2][31]

The genomics of esophageal adenocarcinoma is being studied using Cancer genome sequencing. Esophageal adenocarcinoma is characterized by complex tumor genomes [81][82] with heterogeneity within the tumor micro-environment.[82]

See also

References

  1. ^
    ISBN 978-0-323-08373-7. Archived
    from the original on 2015-09-19.
  2. ^
    ISBN 978-92-832-0429-9
    .
  3. ^
    PMID 22507220
    .
  4. ^
    S2CID 14356684
    .
  5. ^
    PMID 24078662
    .
  6. ^ a b "SEER Stat Fact Sheets: Esophageal Cancer". National Cancer Institute. Archived from the original on 6 July 2014. Retrieved 18 June 2014.
  7. PMID 27733282
    .
  8. ^ a b "Esophageal Cancer Factsheet" (PDF). Global Cancer Observatory. Retrieved 8 November 2019.
  9. ^ Even by those using the British English spelling "oesophagus"
  10. ISBN 978-0-7817-7617-2. Archived
    from the original on 2015-09-25.
  11. ISBN 978-0-19-974797-9. Archived
    from the original on 2015-10-31.
  12. S2CID 1541253
    .
  13. ^
    PMID 14657432. Archived from the original
    (PDF) on 2014-07-14.
  14. ^
    ISBN 978-0-07-174889-6
    .
  15. ISBN 978-0-19-983012-1
    .
  16. ^
    S2CID 13550805
    .
  17. ISBN 978-1-4443-5941-1. Archived
    from the original on 2015-09-20.
  18. ISBN 978-1-55009-101-4. Archived
    from the original on 2015-10-30.
  19. ^
    PMID 20347291
    .
  20. ISBN 978-1-118-71325-9
    .
  21. S2CID 205103765
    .
  22. PMID 27318851. Archived from the original
    (PDF) on 2016-10-05. Retrieved 2016-10-03.
  23. ^ "Q&A on Monographs Volume 116: Coffee, maté, and very hot beverages" (PDF). www.iarc.fr. IARC / WHO. Archived (PDF) from the original on 5 July 2016. Retrieved 3 October 2016.
  24. ISBN 978-1-935281-17-7. Archived
    from the original on 2017-09-10.
  25. ^
    PMID 21602001
    .
  26. ^
    PMID 24092861
    .
  27. PMID 34099670
    .
  28. PMID 35429253
    .
  29. PMID 22898040
    .
  30. ^
    S2CID 31598439
    .
  31. ^
    PMID 23818335
    .
  32. ^
    PMID 19500737. Archived
    (PDF) from the original on 2014-08-12.
  33. ISBN 978-0-7637-8047-0. Archived
    from the original on 2015-09-25.
  34. S2CID 207335139
    .
  35. S2CID 9504791
    .
  36. ^ "Tylosis with esophageal cancer". rarediseases.info.nih.gov. Genetic and Rare Diseases Information Center (GARD) – NIH. 18 January 2013. Archived from the original on 19 August 2014. Retrieved 16 August 2014.
  37. ISBN 978-0-19-531117-4. Archived
    from the original on 2015-10-25.
  38. PMID 23894436
    .
  39. PMID 22228147
    .
  40. S2CID 22862509
    .
  41. S2CID 21457534
    .
  42. PMID 26402826
    .
  43. PMID 26712189
    .
  44. PMID 19325056
    .
  45. PMID 18025508
    .
  46. S2CID 80059143
    .
  47. ISBN 978-0-7817-7982-1. Archived
    from the original on 2015-10-25.
  48. ISBN 978-0-7817-6369-1. Archived
    from the original on 2015-10-19.
  49. ^ Cancer arising at the junction between the esophagus and stomach is often classified as stomach cancer, as in ICD-10. See: "C16 - Malignant neoplasm of the stomach". ICD-10 Version: 2015. World Health Organization. Archived from the original on 2 November 2015. Retrieved 14 November 2014.
  50. PMID 20176201
    .
  51. PMID 27557308
    .
  52. PMID 36041184
    .
  53. S2CID 1546319. Archived
    from the original on 2008-04-30.
  54. PMID 23815145
    .
  55. ^
    PMID 24039351
    .
  56. PMID 24867396
    .
  57. ^
    ISBN 978-1-118-71325-9
    .
  58. ^ Berry 2014, p. S292
  59. PMID 24671864
    .
  60. PMID 24885614
    .
  61. ^
    ISBN 978-1-4511-0545-2
    . Online edition, with updates to 2014
  62. PMID 24876933
    .
  63. S2CID 19933001
    .
  64. ^ Berry 2014, p. S293
  65. PMID 11956258
    .
  66. PMID 20703112
    .
  67. S2CID 6539230
    .
  68. ^ "Oesophageal cancer survival statistics". Cancer Research UK. 2015-05-15. Archived from the original on 2014-10-08.
  69. ^ "Esophageal Cancer Treatment | How We Treat Esophageal Cancer | KAIZEN Hospital". www.kaizenhospital.com. Archived from the original on 2021-01-21. Retrieved 2021-01-17.
  70. ^
    PMID 22615011. Archived
    from the original on 2013-05-17.
  71. ^
    PMID 24834141
    .
  72. ^
    PMID 25320104
    .
  73. PMID 21977849
    .
  74. ^ a b "Cancer Facts and Figures 2014" (PDF). American Cancer Society. Archived (PDF) from the original on 29 April 2014. Retrieved 28 April 2014.
  75. PMID 19688596
    .
  76. ^ "Incidence and Mortality Rate Trends" (PDF). A Snapshot of Esophageal Cancer. National Cancer Institute. September 2006. Archived from the original (PDF) on 2007-03-16. Retrieved 2007-03-21.
  77. ^ "Oesophageal cancer statistics". Cancer Research UK. 2015-05-14. Archived from the original on 6 October 2014. Retrieved 3 October 2014.
  78. ^ "Christopher Hitchens' widow on his death: "God never came up"". CBS News. 7 September 2012. Archived from the original on 30 October 2015. Retrieved 11 November 2015.
  79. ^ "Morrissey Talks Trump, Cancer Diagnosis, TSA Groping With Larry King". Rolling Stone. 2015-08-19. Archived from the original on 9 December 2015. Retrieved 11 November 2015.
  80. PMID 21539676
    .
  81. PMID 30718927
    .
  82. ^
    PMID 37258531
    .

External links

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