In Germany, approximately 23,000 patients are diagnosed with esophageal carcinoma or carcinoma of the stomach every year. Due to lack of early symptoms, a great majority of these diseases is discovered at an advanced stage.
Tumors of the esophagus are differentiated as squamous cell carcinoma, which is usually located in the upper two thirds of the esophagus, and adenocarcinoma, which arises in the lower third of the esophagus or at its junction to the stomach (gastroesophageal junction). Risk factors for esophageal cancer include alcohol consumption and smoking, possibly with concomitant nutritional deficits, especially vitamin deficiencies. Reflux disease plays an important role in tumors of the gastroesophageal junction.
Besides nutrition factors (low fruit and vegetable consumption, excessive consumption of cured and smoked foods), smoking, and excessive alcohol consumption, the bacterium Helicobacter pylori is known to be a mediator of secondary inflammation with secondary malignant transformation into stomach cancer. At a localized stage, surgical excision of the esophagus/stomach is the treatment of choice. At a locally advanced stage, a neoadjuvant (preoperative) chemotherapy/radiation therapy (irradiation and chemotherapy) is recommended. If surgery cannot be performed due to the extent of the tumor or because of accompanying diseases, for example, of the heart or lungs, then definitive radiochemotherapy (concurrent irradiation and chemotherapy) of the tumor is performed.
In metastastic disease, i. e., when metastasis to distant lymph nodes or organs has already occurred, the therapy of choice consists of tumor-specific system therapy. In addition to classical chemotherapy, immunotherapy or targeted therapy are increasingly used.