Skip to main content
SpringerLink
Log in

Diagnostik und Therapie des Ösophaguskarzinoms

Diagnosis and treatment of esophageal cancer

  • CME Zertifizierte Fortbildung
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Die Prognose des Ösophaguskarzinoms ist im fortgeschrittenen Stadium schlecht. Das zunehmende Verständnis der Tumorbiologie des Plattenepithel- und Adenokarzinoms der Speiseröhre sowie die Kenntnis der entsprechenden Risikofaktoren eröffnen die Chance auf eine endoskopische Früherkennung und verbesserte Therapie. In der endoskopischen Diagnostik sind neue Techniken wie die (virtuelle) Chromoendoskopie, die Autofluoreszenz und die Endomikroskopie hilfreich. Die Therapie mukosaler Frühstadien von Plattenepithel- und Adenokarzinomen kann endoskopisch erfolgen; bei geringen Komplikationsraten sind die Heilungschancen exzellent.

Die chirurgische En-bloc-Resektion – unter Mitnahme der lokoregionären Lymphknotenstationen – ist das operative Vorgehen der Wahl zur Therapie des lokal fortgeschrittenen oder lymphogen metastasierten Karzinoms. Die minimal-invasiven Operationsverfahren sind in diesem Zusammenhang besonders patientenschonend. Die multimodale Therapie umfasst die neoadjuvante und adjuvante (Radio-)Chemotherapie und sollte stets zwischen allen beteiligten Fachabteilungen individuell abgestimmt werden (Tumorboard). Neue medikamentöse Optionen versprechen höhere Heilungsraten, bergen aber auch ein erhöhtes Komplikationsrisiko. Auch Patienten mit primär inoperablem Ösophaguskarzinom profitieren von einer multimodalen Vorgehensweise.

Abstract

The prognosis for patients with advanced esophageal cancer is poor. Proper risk assessment and knowledge of tumor biology may facilitate early diagnosis of adenocarcinomas and squamous cell cancer of the esophagus. New endoscopic techniques are available (e.g., (virtual) chromoendoscopy, autofluorescence, and endomicroscopy) for the early detection of cancer. Endoscopic therapy with complete resection of mucosal cancers offers long-term survival.

En bloc resection combined with the removal of locoregional lymph nodes is the surgical option of choice for locally advanced cancer. In this respect, minimally invasive surgery offers the patient numerous advantages. Multimodal therapy results in better outcome for defined cancer stages and includes surgery, chemotherapy and chemoradiation. Multimodal treatment should always be individualized and requires cooperation of all subspecialties (tumor board conference). New chemotherapeutic strategies may offer improved survival but may also include new side effects. Patients with inoperable esophageal cancer also benefit from multimodal treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Enzinger PC, Mayer RJ (2003) Esophageal cancer. N Engl J Med 349:2241–2252

    Google Scholar 

  2. Sharma P (2009) Clinical practice. Barrett’s esophagus. N Engl J Med 361:2548–2556

    Google Scholar 

  3. Messmann H, Ell C, Fein M et al (2005) Topic complex VI: barrett esophagus. Z Gastroenterol 43:184–190

    Google Scholar 

  4. Hvid-Jensen F, Pedersen L, Drewes AM et al (2011) Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 365:1375–1383

    Google Scholar 

  5. Edge SB, Byrd DR, Compton CC et al (Hrsg) (2010) American Joint Committee on Cancer Staging, Manual, 7. Aufl. Springer, New York, S 103

  6. Curvers W, Baak L, Kiesslich R et al (2008) Chromoendoscopy and narrow-band imaging compared with high-resolution magnification endoscopy in Barrett’s esophagus. Gastroenterology 134:670–679

    Article  PubMed  Google Scholar 

  7. Lopes AB, Fagundes RB (2012) Esophageal squamous cell carcinoma – precursor lesions and early diagnosis. World J Gastrointest Endosc 4:9–16

    Article  PubMed  Google Scholar 

  8. Curvers WL, Herrero LA, Wallace MB et al (2010) Endoscopic tri-modal imaging is more effective than standard endoscopy in identifying early-stage neoplasia in Barrett’s esophagus. Gastroenterology 139:1106–1114

    Article  PubMed  Google Scholar 

  9. Goetz M, Watson A, Kiesslich R (2011) Confocal laser endomicroscopy in gastrointestinal diseases. J Biophotonics 4:498–508

    Google Scholar 

  10. Polkowski M (2009) Endosonographic staging of upper intestinal malignancy. Best Pract Res Clin Gastroenterol 23:649–661

    Article  PubMed  CAS  Google Scholar 

  11. Young PE, Gentry AB, Acosta RD et al (2010) Endoscopic ultrasound does not accurately stage early adenocarcinoma or high-grade dysplasia of the esophagus. Clin Gastroenterol Hepatol 8:1037–1041

    Article  PubMed  Google Scholar 

  12. Omloo JM, Heijl M van, Hoekstra OS et al (2011) FDG-PET parameters as prognostic factor in esophageal cancer patients: a review. Ann Surg Oncol 18:3338–3352

    Article  PubMed  CAS  Google Scholar 

  13. Wallace MB, Nietert PJ, Earle C et al (2002) An analysis of multiple staging management strategies for carcinoma of the esophagus: computed tomography, endoscopic ultrasound, positron emission tomography, and thoracoscopy/laparoscopy. Ann Thorac Surg 74:1026–1032

    Article  PubMed  Google Scholar 

  14. Kaushik N, Khalid A, Brody D et al (2007) Endoscopic ultrasound compared with laparoscopy for staging esophageal cancer. Ann Thorac Surg 83:2000–2002

    Article  PubMed  Google Scholar 

  15. Pech O, Manner H, Ell C (2011) Endoscopic resection. Gastrointest Endosc Clin N Am 21:81–94

    Article  Google Scholar 

  16. Westerterp M, Koppert LB, Buskens CJ et al (2005) Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction. Virchows Arch 446:497–504

    Article  PubMed  Google Scholar 

  17. Ell C, May A, Gossner L et al (2000) Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett’s esophagus. Gastroenterology 118:670–677

    Article  PubMed  CAS  Google Scholar 

  18. Pech O, Ell C (2009) Editorial: resecting or burning: what should we do with the remaining barrett’s epithelium after successful ER of neoplasia? Am J Gastroenterol 104:2693–2694

    Article  PubMed  Google Scholar 

  19. Shaheen NJ, Sharma P, Overholt BF et al (2009) Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 360:2277–2288

    Google Scholar 

  20. Inoue H, Minami H, Kaga M et al (2010) Endoscopic mucosal resection and endoscopic submucosal dissection for esophageal dysplasia and carcinoma. Gastrointest Endosc Clin N Am 20:25–34

    Article  PubMed  Google Scholar 

  21. Birkmeyer JD, Stukel TA, Siewers AE et al (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349:2117–2127

    Google Scholar 

  22. Lewis I (1946) The surgical treatment of carcinoma of the esophagus with special reference to a new operation for growths of the middle third. Br J Surg 34:18–31

    Article  PubMed  CAS  Google Scholar 

  23. Schuhmacher C, Novotny A, Ott K et al (2007) Lymphadenectomy with tumors of the upper gastrointestinal tract. Chirurg 78:203–206, 208–212, 214–216

    Article  PubMed  CAS  Google Scholar 

  24. McKeown KC (1976) Total three-stage esophagectomy for cancer of the esophagus. Br J Surg 63:259–262

    Article  PubMed  CAS  Google Scholar 

  25. Orringer MB (1984) Transhiatal esophagectomy without thoracotomy for carcinoma of the thoracic esophagus. Ann Surg 200:282–288

    Article  PubMed  CAS  Google Scholar 

  26. Merendino KA, Dillard DH (1955) The concept of sphincter substitution by an interposed jejunal segment for anatomic and physiologic abnormalities at the esophagogastric junction; with special reference to reflux esophagitis, cardiospasm and esophageal varices. Ann Surg 142:486–506

    Article  PubMed  CAS  Google Scholar 

  27. Stein HJ, Feith M, Mueller J et al (2000) Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg 232:733–742

    Article  PubMed  CAS  Google Scholar 

  28. Luketich JD, Alvelo-Rivera M, Buenaventura PO et al (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238:486–494 (Diskussion: 494–495)

    Google Scholar 

  29. Palanivelu C, Prakash A, Senthilkumar R et al (2006) Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position-experience of 130 patients. J Am Coll Surg 203:7–16

    Google Scholar 

  30. Sgourakis G, Gockel I, Radtke A et al (2010) Minimally invasive versus open esophagectomy: meta-analysis of outcomes. Dig Dis Sci 55:3031–3040

    Article  PubMed  Google Scholar 

  31. Stahl M, Budach W, Meyer HJ et al (2010) Esophageal cancer: clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v46–49

    Article  PubMed  Google Scholar 

  32. Moehler M, Al-Batran SE, Andus T et al (2011) German S3-guideline „Diagnosis and treatment of esophagogastric cancer“. Z Gastroenterol 49:461–531

    Google Scholar 

  33. Lorenzen S, Schuster T, Porschen R et al (2009) Cetuximab plus cisplatin-5-fluorouracil versus cisplatin-5-fluorouracil alone in first-line metastatic squamous cell carcinoma of the esophagus: a randomized phase II study of the Arbeitsgemeinschaft Internistische Onkologie. Ann Oncol 20:1667–1673

    Article  PubMed  CAS  Google Scholar 

  34. Thallinger CM, Raderer M, Hejna M (2011) Esophageal cancer: a critical evaluation of systemic second-line therapy. J Clin Oncol 29:4709–4714

    Google Scholar 

  35. Thuss-Patience PC et al (2011) Survival advantage for irinotecan versus best supportive care as second-line chemotherapy in gastric cancer—a randomised phase III study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). Eur J Cancer 47:2306–2314

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland

    R. Kiesslich, M. Möhler & P.R. Galle

  2. Institut für Pathologie, Universitätsmedizin Mainz, Mainz, Deutschland

    T. Hansen

  3. Klinik für Allgemein- und Abdominalchirurgie, Universitätsmedizin Mainz, Mainz, Deutschland

    H. Lang & I. Gockel

Authors
  1. R. Kiesslich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Möhler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P.R. Galle
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. I. Gockel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Kiesslich.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kiesslich, R., Möhler, M., Hansen, T. et al. Diagnostik und Therapie des Ösophaguskarzinoms. Internist 53, 1315–1329 (2012). https://doi.org/10.1007/s00108-012-3128-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-012-3128-0

Schlüsselwörter

Keywords

Search

Navigation