Esophageal cancer Classification and external resources
Endoscopic image of patient with esophageal adenocarcinoma seen at gastro-esophageal junction. The cardia (also known as Z-line or esophagogastric junction or gastroesophageal junction) is the anatomical term for the junction orifice of
ICD-10	C15.
ICD-9	150
MeSH	D004938

Esophageal cancer is malignancy of the esophagus. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in There are various subtypes. Esophageal tumors usually lead to dysphagia (difficulty swallowing), pain and other symptoms, and are diagnosed with biopsy. Dysphagia should not be confused with the similarly pronounced Dysphasia, a language disorder Swallowing, known scientifically as deglutition is the process in the human or animal body that makes something pass from the Mouth, to the Pharynx, into A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues Small and localized tumors are treated surgically with curative intent. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Larger tumors tend not to be operable and hence cannot be cured; their growth can still be delayed with chemotherapy, radiotherapy or a combination of the two. Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant In some cases chemo- and radiotherapy can render a larger tumor operable. Prognosis depends on the extent of the disease and other medical problems, but is fairly poor. ^[1]

Signs and symptoms

Dysphagia (difficulty swallowing) is the first symptom in most patients. Odynophagia (painful swallowing) may be present. Odynophagia is Painful Swallowing, in the mouth ( Oropharynx) or Esophagus. Fluids and soft foods are usually tolerated, while hard or bulky substances (such as bread or meat) cause much more difficulty. Bread is a Staple food prepared by Baking a Dough of Flour and Water. In modern English usage meat most often refers to Animal tissue used as food mostly Skeletal muscle and associated Fat, but it may also refer Substantial weight loss is characteristic as a result of poor nutrition and the active cancer. Weight loss, in the context of Medicine or Health or Physical fitness, is a reduction of the total Body weight, due to a mean loss of fluid Pain, often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character. Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm An early sign may be an unusually husky or raspy voice.

The presence of the tumor may disrupt normal peristalsis (the organised swallowing reflex), leading to nausea and vomiting, regurgitation of food, coughing and an increased risk of aspiration pneumonia. In the Esophagus After food is chewed into a bolus it is swallowed to move it into the esophagus Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the In Medicine, a cough ( Latin: tussis) is a sudden and often repetitively occurring defence Reflex which helps to clear the large breathing passages Aspiration pneumonia is Bronchopneumonia that develops due to the entrance of foreign materials that enter the bronchial tree usually oral or gastric contents (including food The tumor surface may be fragile and bleed, causing hematemesis (vomiting up blood). Bleeding, technically known as hemorrhaging / haemorrhaging (see American and British spelling differences) is the loss of Blood from Hematemesis or haematemesis (see American and British spelling differences) is the Vomiting of Blood. Compression of local structures occurs in advanced disease, leading to such problems as superior vena cava syndrome. Superior vena cava syndrome ( SVCS) or superior vena cava obstruction ( SVCO) is a result of obstruction of the superior vena cava Fistulas may develop between the esophagus and the trachea, increasing the pneumonia risk; this symptom is usually heralded by cough, fever or aspiration. In medicine a fistula (pl fistulas or fistulae is an abnormal connection or passageway between two Epithelium -lined organs or vessels that normally do not connect The traceartes, or windpipe, is a tube that has an inner diameter of about 20-25 mm and a length of about 10-16 cm in humans In Medicine, a cough ( Latin: tussis) is a sudden and often repetitively occurring defence Reflex which helps to clear the large breathing passages Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris ^[1]

If the disease has spread elsewhere, this may lead to symptoms related to this: liver metastasis could cause jaundice and ascites, lung metastasis could cause shortness of breath, pleural effusions, etc. Metastasis ( Greek: displacement μετά=next + στάσις=placement, plural metastases) sometimes abbreviated mets, The liver is a vital organ in the human body and is present in Vertebrates and some other animals Jaundice, also known as icterus (attributive adjective "icteric" is yellowish discoloration of the Skin, sclerae (whites of the eyes In Medicine ( Gastroenterology) ascites (also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive Dyspnea or dyspnoea (pronounced disp-nee-ah, IPA /dɪsp'niə/ from Latin dyspnoea, from Greek dyspnoia from Pleural effusion is excess fluid that accumulates in the Pleural cavity, the fluid-filled space that surrounds the Lungs Excessive amounts of such fluid can impair

Causes and risk factors

Increased risk

Barrett's esophagus is considered to be a risk factor for esophageal adenocarcinoma

There are a number of risk factors for esophageal cancer. Barrett's esophagus (UK Oesophagus (sometimes called Barrett's syndrome, CELLO, columnar epithelium lined lower oesophagus or colloquially as Barrett's ^[1] Some subtypes of cancer are linked to particular risk factors:

• Age. Most patients are over 60, and the median in US patients is 67. ^[1]
• Gender. It is more common in men.
• Heredity. It is more likely in people who have close relatives with cancer.
• Tobacco smoking and heavy alcohol use increase the risk, and together appear to increase the risk more than these two individually. Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette.
• Gastroesophageal reflux disease (GERD) and its resultant Barrett's esophagus increase esophageal cancer risk due to the chronic irritation of the mucosal lining (adenocarcinoma is more common in this condition, while all other risk factors predispose more for squamous cell carcinoma). Gastroesophageal reflux disease ( American English and Canadian English) or Gastro-oesophageal reflux disease ( British English, Hiberno-English Barrett's esophagus (UK Oesophagus (sometimes called Barrett's syndrome, CELLO, columnar epithelium lined lower oesophagus or colloquially as Barrett's Adenocarcinoma is a cancer that originates in Glandular tissue ^[2]
• Human papillomavirus (HPV)^[3]
• Swallowing lye or other caustic substances. Lye is a Corrosive alkaline substance commonly Sodium hydroxide (NaOH
• Particular dietary substances, such as nitrosamine. Nitrosamines are Chemical compounds of the Chemical structure R1N(-R2-N=O some of which are carcinogenic.
• A medical history of other head and neck cancers increases the chance of developing a second cancer in the head and neck area, including esophageal cancer. The term head and neck cancer refers to a group of biologically similar cancers originating from the upper aerodigestive tract including the Lip, Oral cavity (
• Plummer-Vinson syndrome (anemia and esophageal webbing)
• Tylosis and Howel-Evans syndrome (hereditary thickening of the skin of the palms and soles). Plummer-Vinson syndrome ( PVS) also called Paterson-Brown-Kelly syndrome or sideropenic dysphagia is a disorder linked to severe long-term Iron Howel-Evans syndrome is an extremely rare condition in which the skin of the palms of the hands and soles of the feet are affected ( Hyperkeratosis) Howel-Evans syndrome is an extremely rare condition in which the skin of the palms of the hands and soles of the feet are affected ( Hyperkeratosis)
• Radiation therapy for other conditions in the mediastinum. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant The mediastinum is a non-delineated group of structures in the Thorax (chest surrounded by Loose connective tissue. ^[1]
• Celiac disease predisposes towards squamous cell carcinoma. Coeliac ^[4]
• Obesity increases the risk of adenocarcinoma fourfold. Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected ^[5] It is suspected that increased risk of reflux may be behind this association. ^[2][6]

Decreased risk

• Risk appears to be less in patients using aspirin or related drugs (NSAIDs). Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher ^[7]
• The role of Helicobacter pylori in progression to esophageal adenocarcinoma is still uncertain, but, on the basis of population data, it may carry a protective effect. Helicobacter pylori ( is a Gram-negative, microaerophilic Bacterium that inhabits various areas of the stomach and Duodenum. ^[8][9] It is postulated that H. pylori prevents chronic gastritis, which is a risk factor for reflux, which in turn is a risk factor for esophageal adenocarcinoma. Helicobacter pylori ( is a Gram-negative, microaerophilic Bacterium that inhabits various areas of the stomach and Duodenum. Gastritis is an inflammation of the lining of the stomach There are many possible causes Gastroesophageal reflux disease ( American English and Canadian English) or Gastro-oesophageal reflux disease ( British English, Hiberno-English ^[10]
• According to the National Cancer Institute, "diets high in cruciferous (cabbage, broccoli, cauliflower) and green and yellow vegetables and fruits are associated with a decreased risk of esophageal cancer. The National Cancer Institute (NCI is part of the United States Federal government's National Institutes of Health. "^[11]
• Moderate coffee consumption is associated with a decreased risk. CoFFEE is an Open source Software for computer supported collaborative learning (CSCL in a digital classroom ^[12]
• According to one Italian study of "diet surveys completed by 5,500 Italians" — a study which has raised debates questioning its claims among cancer researchers cited in news reports about it — eating pizza more than once a week appears "to be a favorable indicator of risk for digestive tract neoplasms in this population. Pizza (ˈpiːtsə, in Italian:) is a popular dish made with an Oven -baked flat generally round Bread that is covered with tomatoes or a tomato-based "^[13]

Diagnosis

Endoscopy and radial endoscopic ultrasound images of submucosal tumour in mid-esophagus. Endoscopic ultrasound is a medical procedure in which an endoscopically directed Ultrasound is used to obtain images of the internal organs in the The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in

Clinical evaluation

Although an occlusive tumor may be suspected on a barium swallow or barium meal, the diagnosis is best made with esophagogastroduodenoscopy (EGD, endoscopy); this involves the passing of a flexible tube down the esophagus and visualising the wall. A barium swallow is a Medical imaging procedure used to examine the upper GI (gastrointestinal tract which includes the esophagus and to a lesser extent the stomach A barium meal, also known as an upper gastrointestinal series is a procedure in which radiographs of the Esophagus, Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope. Biopsies taken of suspicious lesions are then examined histologically for signs of malignancy. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues Histology (from the Greek = 'tissue' is the study of the microscopic anatomy of cells and tissues of Plants and

Additional testing is usually performed to estimate the tumor stage. 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). Computed tomography (CT is a Medical imaging method employing Tomography. The liver is a vital organ in the human body and is present in Vertebrates and some other animals A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system. The sensitivity of CT scan is limited by its ability to detect masses (e. g. enlarged lymph nodes or involved organs) generally larger than 1 cm. FDG-PET (positron emission tomography) scan is also being used to estimate whether enlarged masses are metabolically active, indicating faster-growing cells that might be expected in cancer. Positron emission tomography ( PET) is a Nuclear medicine imaging technique which produces a three-dimensional image or map of functional processes in the Esophageal endoscopic ultrasound (EUS) can provide staging information regarding the level of tumor invasion, and possible spread to regional lymph nodes. Endoscopic ultrasound is a medical procedure in which an endoscopically directed Ultrasound is used to obtain images of the internal organs in the

The location of the tumor is generally measured by the distance from the teeth. The esophagus (25 cm or 10 inches long) is commonly divided into three parts for purposes of determining the location. Adenocarcinomas tend to occur distally and squamous cell carcinomas proximally, but the converse may also be the case.

Histopathology

Most tumors of the esophagus are malignant. A very small proportion (under 10%) is leiomyoma (smooth muscle tumor) or gastrointestinal stromal tumor (GIST). A leiomyoma (plural is 'leiomyomata' is a Benign Smooth muscle Neoplasm that is not Premalignant. A gastrointestinal stromal tumor ( GIST) is a rare Tumor of the Gastrointestinal tract (1-3% of all gastrointestinal malignancies Malignant tumors are generally adenocarcinomas, squamous cell carcinomas, and occasionally small-cell carcinomas. Adenocarcinoma is a cancer that originates in Glandular tissue In Medicine, squamous cell carcinoma (SCC is a form of Cancer of the Carcinoma type that may occur in many different organs including the Skin The latter share many properties with small-cell lung cancer, and are relatively sensitive to chemotherapy compared to the other types. Lung cancer is a Disease of uncontrolled Cell growth in tissues of the Lung.

Classification

Esophageal cancers are typically carcinomas which arise from the epithelium, or surface lining, of the esophagus. A carcinoma is any Malignant Cancer that arises from epithelial cells. In biology and medicine epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body Most esophageal cancers fall into one of two classes: squamous cell carcinomas, which are similar to head and neck cancer in their appearance and association with tobacco and alcohol consumption, and adenocarcinomas, which are often associated with a history of gastroesophageal reflux disease and Barrett's esophagus. In Medicine, squamous cell carcinoma (SCC is a form of Cancer of the Carcinoma type that may occur in many different organs including the Skin The term head and neck cancer refers to a group of biologically similar cancers originating from the upper aerodigestive tract including the Lip, Oral cavity ( Tobacco is an Agricultural product recognized as an addictive drug processed from the fresh Leaves of plants in the genus Nicotiana. In Chemistry, an alcohol is any Organic compound in which a Hydroxyl group ( - O[[hydrogen H]]) is bound to a Carbon Adenocarcinoma is a cancer that originates in Glandular tissue Gastroesophageal reflux disease ( American English and Canadian English) or Gastro-oesophageal reflux disease ( British English, Hiberno-English Barrett's esophagus (UK Oesophagus (sometimes called Barrett's syndrome, CELLO, columnar epithelium lined lower oesophagus or colloquially as Barrett's

Treatment

General approaches

Self-expandable metallic stents are used for the palliation of esophageal cancer

Esophageal cancer affecting the lower esophageus. A self-expandable metallic stent (or SEMS) is a metallic tube or Stent, used in order to hold open a structure in the Gastrointestinal tract in order Palliative care (from Latin palliare to cloak is any form of medical care or treatment that concentrates on reducing the severity of Disease Symptoms Insets show the tumor in more detail both before and after placement of a stent.

The treatment is determined by the cellular type of cancer (adenocarcinoma or squamous cell carcinoma vs other types), the stage of the disease, the general condition of the patient and other diseases present. On the whole, adequate nutrition needs to be assured, and adequate dental care is vital. Nutrition (also called nourishment or aliment) is the provision to cells and Organisms of the materials necessary (in the form of food to support

If the patient cannot swallow at all, a stent may be inserted to keep the esophagus patent; stents may also assist in occluding fistulas. In Medicine, a stent is a tube that is inserted into a natural conduit of the body to prevent or counteract a disease-induced localized flow constriction A 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). Nasogastric intubation is a medical process involving the insertion of a plastic tube ( nasogastric tube NG tube) through the Nose, past the Throat Gastrostomy refers to a surgical opening into the stomach Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression The latter two are especially important if the patient tends to aspirate food or saliva into the airways, predisposing for aspiration pneumonia. Aspiration pneumonia is Bronchopneumonia that develops due to the entrance of foreign materials that enter the bronchial tree usually oral or gastric contents (including food

Tumor treatments

Surgery is possible if the disease is localised, which is the case in 20-30% of all patients. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental If the tumor is larger but localised, chemotherapy and/or radiotherapy may occasionally shrink the tumor to the extent that it becomes "operable"; however, this combination of treatments (referred to as neoadjuvant chemoradiation) is still somewhat controversial in most medical circles. Esophagectomy is the removal of a segment of the esophagus; as this shortens the distance between the throat and the stomach, some other segment of the digestive tract (typically the stomach or part of the colon) is placed in the chest cavity and interposed. Esophagectomy or Oesophagectomy (regional variation in spelling is the surgical removal of all or part of the Esophagus (also spelt 'oesophagus' In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following The colon is a storage tube for solid wastes The main function of the colon appears to be extraction of Water and salts from Feces. ^[14] If the tumor is metastatic, surgical resection is not considered worthwhile, but palliative surgery may offer some benefit.

Laser therapy is the use of high-intensity light to destroy tumor cells; it affects only the treated area. A laser is a device that emits Light ( Electromagnetic radiation) through a process called Stimulated emission. This is typically done if the cancer cannot be removed by surgery. The relief of a blockage can help to reduce dysphagia and pain. Photodynamic therapy (PDT), 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. Photodynamic therapy (PDT matured as a feasible medical technology in the 1980s at several institutions throughout the world is a third-level treatment for Cancer involving

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. Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. Cisplatin, cisplatinum or cis -diamminedichloridoplatinum(II (CDDP is a Platinum -based Chemotherapy drug used to treat CARBOplatin is a Chemotherapy drug used against some forms of Cancer (mainly ovarian carcinoma lung head and neck cancers Oxaliplatin is a Platinum -based Chemotherapy drug in the same family as Cisplatin and Carboplatin. Fluorouracil (5-FU or f5U is a Pyrimidine analog, which is used as a drug in the treatment of Cancer. In more recent studies, addition of epirubicin (ECF) was better than other comparable regimens in advanced nonresectable cancer. Epirubicin is an Anthracycline drug used for Chemotherapy. It is marketed by Pfizer under the trade name Ellence in the US and ^[15] 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. Epirubicin is an Anthracycline drug used for Chemotherapy. It is marketed by Pfizer under the trade name Ellence in the US and Cisplatin, cisplatinum or cis -diamminedichloridoplatinum(II (CDDP is a Platinum -based Chemotherapy drug used to treat Oxaliplatin is a Platinum -based Chemotherapy drug in the same family as Cisplatin and Carboplatin. Capecitabine ( INN) (keɪpˈsaɪtəbiːn is an orally-administered chemotherapeutic agent used in the treatment of Metastatic breast and Colorectal

Radiotherapy is given before, during or after chemotherapy or surgery, and sometimes on its own to control symptoms. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant In patients with localised disease but contraindications to surgery, "radical radiotherapy" may be used with curative intent.

Follow-up

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

Prognosis

In general, the prognosis of esophageal cancer is quite poor, because so many patients present with advanced disease: The overall five-year survival rate (5YSR) is less than 5%. The five-year Survival rate is a term used in medicine for estimating the Prognosis of a particular disease Individualized prognosis depends largely on stage. Those with cancer restricted entirely to the esophageal mucosa have about an 80% 5YSR, but submucosal involvement brings this down to less than 50%. The mucous membranes (or mucosae; singular mucosa) are linings of mostly endodermal origin covered in Epithelium, which are involved in In the Gastrointestinal tract, the submucosa is the layer of Loose connective tissue that supports the Mucosa, as well as joins the mucosa to the bulk Extension into the muscularis propria (muscular layer of the esophageus) has meant a 20% 5YSR and extension to the structures adjacent to the esophagus results in a 7% 5YSR. Patients with distant metastases (who are not candidates for curative surgery) have a less than 3% 5YSR. Of all patients undergoing surgery with curative intent, the 5YSR is only about 25%.

Epidemiology

Esophageal cancer is a relatively rare form of cancer, but some world areas have a markedly higher incidence than others: China, India and Japan, as well as the United Kingdom, appear to have a higher incidence, as well as the region around the Caspian Sea. China ( Wade-Giles ( Mandarin) Chung¹kuo² is a cultural region, an ancient Civilization, and depending on perspective a National India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country For a topic outline on this subject see List of basic Japan topics. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located The Caspian Sea is the largest enclosed body of water on Earth by area variously classed as the world's largest lake or a full-fledged Sea. ^[16]

The American Cancer Society estimates that during 2007, approximately 15,560 new esophageal cancer cases will be diagnosed in the United States. ^[17]

The esophageal cancer incidence and mortality rates for people of African-Americans have been higher than the rate for Caucasians. African Americans or Black Americans are citizens or residents of the United States who have origins in any of the black populations of Africa The Caucasian race, sometimes the Caucasoid race, is a term of Racial classification, coined around 1800 by Johann Friedrich Blumenbach for the " ^[18] According to the NCI, incidence of adenocarcinoma of the esophagus, which is associated with Barrett's esophagus, is rising in the United States. This type is more common in Caucasian men over the age of 60.

Multiple reports indicate that esophageal adenocarcinoma incidence has increased during the past 20 yr, especially in non-Hispanic white men. Esophageal adenocarcinoma age-adjusted incidence increased in New Mexico from 1973 to 1997. This increase was found in non-Hispanic whites and Hispanics and became predominant in non-Hispanic whites. Hispanic (hispano hispánico hispânico Hispānus adjective from ''Hispānia'', the Roman name for the Iberian Peninsula) is a term that historically ^[19]

References

External links

• Mayo Clinic Esophageal Cancer Information
• The Johns Hopkins Esophageal Cancer Web page
• Information at Cathy's EC Cafe
• Esophageal Cancer Awareness Association
• "Learn More about Esophageal Cancer"
• MedlinePlus: Esophageal Cancer
• NCI Esophageal Cancer Home Page
• Oesophageal Cancer at Cancer Research UK
• Oesophageal Cancer Facts/ Resources (BBC) (Last updated: 30 January 2004)
• Tea and Cancer Prevention Fact Sheet (NCI Fact Sheet)
• The UCLA Center for Esophageal Disorders