Esophageal malignancy: a growing concern

Abstract

Esophageal cancer is mainly found in Asia and east Africa and is one of the deadliest cancers in the world. However, it has not garnered much attention in the Western world due to its low incidence rate. An increasing amount of data indicate that esophageal cancer, particularly esophageal adenocarcinoma, has been rising by 6-fold annually and is now becoming the fastest growing cancer in the United States. This rise has been associated with the increase of the obese population, as abdominal fat puts extra pressure on the stomach and causes gastroesophageal reflux disease (GERD). Long standing GERD can induce esophagitis and metaplasia and, ultimately, leads to adenocarcinoma. Acid suppression has been the main strategy to treat GERD; however, it has not been proven to control esophageal malignancy effectively. In fact, its side effects have triggered multiple warnings from regulatory agencies. The high mortality and fast growth of esophageal cancer demand more vigorous efforts to look into its deeper mechanisms and come up with better therapeutic options.

Keywords: Esophageal cancer; Gastroesophageal reflux disease; Obesity.

Figures

Figure 1

Top 10 leading causes of death worldwide. Cancer is the second highest one. Data extracted from World Health Organization documents. AIDS: Acquired immune deficiency syndrome.

Figure 2

Top 10 of the most common cancers in men (up) and women (below) worldwide. Esophageal cancer is No. 7 in men. Data extracted from World Health Organization documents.

Figure 3

Geographic distribution of esophageal cancer. China is a hot spot. Data from World Health Organization documents.

Figure 4

Gastroesophageal reflux disease-induced esophagitis in human and rat (hematoxylin and eosin staining). Gastroesophageal reflux disease rats were created by surgically anastomosing the duodenum to the gastroesophageal junction. These rats can develop esophageal adenocarcinoma within a year, in a pathological sequence similar to human esophageal malignancy.

Figure 5

National Institute of Health expenditure on cancer-related studies in 2011. Esophageal cancer barely shows on the pie chart. Data from National Institute of Health documents.