Talk:Esophageal cancer

ESMO guideline

doi:10.1093/annonc/mdt342 - fairly concise and authoritative. JFW | T@lk 19:10, 29 April 2014 (UTC)

Initial review by CRUK

This is a write-up of the notes made in an initial review by a CRUK specialist. The idea is to sort these points out in the article before sending the article for review by other outside specialists. Epidemiology & the missing research section were not covered - will be done with other people. By no means all points made are written up - many ticks etc, but also other points.. I'm hoping this gives the medical editing community enough to go on to start serious work on the article, but I realize it may not. Wiki CRUK John (talk) 10:26, 27 June 2014 (UTC)

Best recent papers

(I have p/os):

• (already used in article)free online; Stahl, M; Mariette, C; Haustermans, K; Cervantes, A; Arnold, D; ESMO Guidelines Working, Group (2013 Oct). "Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up". Annals of oncology : official journal of the European Society for Medical Oncology / ESMO. 24 Suppl 6: vi51-6. PMID 24078662. {{cite journal}}: |first6= has generic name (help); Check date values in: |date= (help)
• Berry, MF (2014 May). "Esophageal cancer: staging system and guidelines for staging and treatment". Journal of thoracic disease. 6 (Suppl 3): S289-97. PMID 24876933. {{cite journal}}: Check date values in: |date= (help)
• Free online, D'Journo, XB; Thomas, PA; Nakamura, FY; Andrín, G; Weston, M (2014 May). "Current management of esophageal cancer". Journal of thoracic disease. 6 (Suppl 2): S253-64. PMID 24868443. {{cite journal}}: Check date values in: |date= (help)
• free online, Kyle J Napier, Mary Scheerer, and Subhasis Misra, "Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities, World J Gastrointest Oncol. May 15, 2014; 6(5): 112–120., Published online May 15, 2014. doi:10.4251/wjgo.v6.i5.112, PMC 4021327
• Free online Fitzgerald, RC; di Pietro, M; Ragunath, K; Ang, Y; Kang, JY; Watson, P; Trudgill, N; Patel, P; Kaye, PV; Sanders, S; O'Donovan, M; Bird-Lieberman, E; Bhandari, P; Jankowski, JA; Attwood, S; Parsons, SL; Loft, D; Lagergren, J; Moayyedi, P; Lyratzopoulos, G; de Caestecker, J; British Society of, Gastroenterology (2014 Jan). "British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus". Gut. 63 (1): 7–42. PMID 24165758. {{cite journal}}: Check date values in: |date= (help)

• Not in CRUK list for some reason. Free online, here or here Allum, WH; Blazeby, JM; Griffin, SM; Cunningham, D; Jankowski, JA; Wong, R; Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, the British Society of Gastroenterology and the British Association of Surgical, Oncology (2011 Nov). "Guidelines for the management of oesophageal and gastric cancer". Gut. 60 (11): 1449–72. PMID 21705456. {{cite journal}}: Check date values in: |date= (help)

Review comments

• O/Esophagus is an unfamiliar term to most of the population, even without spelling diffs. "Gullet" is also not too familiar. CRUK decided to use "foodpipe" at the start. Y[1]
• Relative to article length, too much on Endoscopic resection and EMR in particular, which is only likely to be used in a small % of cases - move off to own article?
• "some repetition and jumps about a bit"
• "Other approaches" section - chemo/radio should get their own section, not be in here.
• Comments on the mix and timing of chemo/radio
• "It is around three times more common in men than women.[1]" ref WCRep 2014. UK figure 2:1.
• Screening - should mention Barrett's patients should be getting v regular endoscopy Y [2]
• Other small/detailed points I'll probably do myself
• Yes, the lead pic is horrible (see now archived talk too)
• Stats & detailed surgical procedures left for others.
• Nothing on research.

Wiki CRUK John (talk) 12:00, 27 June 2014 (UTC)

Swollen glands

There are glands other than LNs. Thus enlarged lymph nodes is more specific. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:33, 27 June 2014 (UTC)

Yep, of course. Just trying to find ways to help general comprehension. (Perhaps like this.) 86.128.169.211 (talk) 16:56, 27 June 2014 (UTC)

Epidemiology section update

Wheeler JB, Reed CE. Epidemiology of esophageal cancer. Surg Clin North Am. 2012 PMID 23026270 might also be useful here. Unfortunately it's behind a paywall. 109.156.204.159 (talk) 18:50, 30 June 2014 (UTC); [previously 86.128.169.211]

We have the 2014 World Cancer Report. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:44, 30 June 2014 (UTC)

That's good to know. Unfortunately I don't have it. I think that review paper might be worth a look anyway. 109.156.204.159 (talk) 09:18, 1 July 2014 (UTC)

Email me. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:05, 1 July 2014 (UTC)

Cheers. It would certainly be good to incorporate the 2014 WHO report, perhaps in preference to some of the less specific sources I've been using. However, I'm reasonably confident that the update so far is basically reliable. One advantage of using the WHO is that it should help provide a balanced world view. 109.156.204.159 (talk) 10:11, 1 July 2014 (UTC)

There's also this page, mostly UK but not all. The references are listed at the bottom WP-style. I notice they are not yet using the 2014 WCR (which I also have) though. They have these pages on all the major types. Wiki CRUK John (talk) 11:02, 1 July 2014 (UTC)

That's good (though obviously we shouldn't be giving excessive weight to possibly artefactual figures such as the lowest recorded incidence worldwide being in western Africa). What's the plan on how we're going to go about incorporating 2014 WCR sourcing? 109.156.204.159 (talk) 11:24, 1 July 2014 (UTC)

I'm planning on taking all the epidemiology sections of the articles I'm working on to the internal specialists here (who produce those pages). I can write it up from WCR first, though they take squamous cell cancer and adenocarcinoma separately. Wiki CRUK John (talk) 11:42, 1 July 2014 (UTC)

Ok, I'll back off then :) 109.156.204.159 (talk) 12:42, 1 July 2014 (UTC)

Signs and symptoms section

I've just made a modest start here with some preliminary clean-up. More than a substantial "update", I suspect this is a section that can benefit from more general editorial improvements in presentation and sourcing. 109.156.204.159 (talk) 15:26, 2 July 2014 (UTC)

I've been trying to deploy more lay-friendly language. The downside of this seems to me to be rather a lot of blue ink strewn across the page. 86.134.200.29 (talk) 09:10, 1 September 2014 (UTC)

Following a very useful chat with RexxS I've made some rapid tweaks to the wording in this section [3] and the lead. Any thoughts about how about our approach to symptoms of metastasis, per Anthonyhcole's edit-summary query here (something I've also been wondering about)? 86.164.164.123 (talk) 10:03, 23 September 2014 (UTC) (previously 86.134.200.29 etc)

I'm fine with those changes - thanks Rexx! In general I think we should be pretty sparing in covering symptoms of metastasis, & I agree with Anthony they won't normally belong in the lead. The whole subject gets too complicated, and alarming for the hypochondriac community, no doubt one of our key readership groups. But in cases where metastatic symptoms may be the first to be noticed, it is appropriate to cover them briefly. I think what is there now is (when properly refed) about right. On a rather different point, our coverage in these sections always very much covers presenting symptoms that aid diagnosis. We have nothing much, here as elsewhere, on the unpleasant topic of the "symptoms" experienced as the disease develops and is treated - a link to Anthony's cancer pain should probably be de rigeur in these articles. Wiki CRUK John (talk) 11:23, 23 September 2014 (UTC)

Causes

This section obviously needs to be improved and restructured. Cancer Research UK has kindly offered support for the ongoing rewrite, through Wiki CRUK John. 86.157.144.73 (talk) 19:18, 10 August 2014 (UTC) (previously 109.156...)

The section makes the common mistake of conflating causes and associations. It can probably be redone with only 2-3 good MEDRS sources. JFW | T@lk 22:40, 10 August 2014 (UTC)

Jacob, could you be more specific? Are you referring to HPV? If so, I certainly agree this is a tricky one to weight. The 2014 World Cancer Report does not seem to mention it, despite ongoing interest in its possible relevance for prevention in countries where incidence of the squamous cell carcinoma is high. As regards causality, the biological plausibility of HPV as a putative risk factor has been discussed for some time now [4], though no mechanism has been demonstrated [5]. As currently noted in the ongoing revision, results from meta-analyses of the epidemiological studies of association are somewhat conflicting, though more than one suggests relevant geographical variations. I'm very conscious of the intrinsic difficulties in avoiding hidden bias in the systematic review and meta-analysis of observational studies, and have tried to hedge accordingly.

The section as a whole does need a lot of work - so far, I've just made a small start (in agreement with John and the team at CRUK), based mainly on some potentially "ideal" medrs. 86.157.144.73 (talk) 00:01, 11 August 2014 (UTC)

I've now tried to reweight the HPV topic [6] by moving the entry to the bottom of the pre-existing list of bullet points. I agree that sourcing to a general review of the recent systematic reviews would be preferable (if one could be found). 86.157.144.73 (talk) 00:47, 11 August 2014 (UTC)

I have removed a couple of "causes" that were simply not supported by the references. For instance, the "alcohol flush reaction" claim was based on modelling and speculation. I do not disagree with the decision to provide a bit more depth about HPV, but perhaps the remainder of the causes should be sourced to 2-3 general reviews or textbooks.

There are still a few causes that are not referenced to a secondary source at all. JFW | T@lk 09:52, 11 August 2014 (UTC)

Getting there... I prefer to take one thing at a time...
As regards celiac disease (one of the items recently removed from the longstanding rag-bag list), I agree this is another tricky one to weight. The esophageal cancer chapter in the 2014 WCR does mention it in a list of "other circumstances mediating increased risk". I suspect this may be rather speculative. According to the Textbook of Cancer Epidemiology (2008) [7], "Celiac disease has also been associated with an increased risk of esophageal cancer although properly designed epidemiologic studies are lacking." Even though this publication falls just outside our current MEDDATE, I believe this statement remains reasonably valid from a MEDRS perspective at least, and I feel it could be a suitable source to reassure any of our readers with celiac disease who may come looking for information here. 86.157.144.73 (talk) 12:52, 11 August 2014 (UTC)

I've tentatively reinserted a heavily hedged mention of celiac disease in the working draft. 86.157.144.73 (talk) 16:51, 11 August 2014 (UTC)

Apropos of associations, I don't think leukoplakia with tylosis and esophageal carcinoma deserves a mention; please see this merge proposal. 86.157.144.73 (talk) 17:44, 16 August 2014 (UTC)

Paywalled articles

For convenience only, I'm starting a list of potentially relevant recent medrs that are behind paywalls (please feel free to add to it).

• de Jonge PJ, van Blankenstein M, Grady WM, Kuipers EJ (2014). "Barrett's oesophagus: epidemiology, cancer risk and implications for management". Gut. 63 (1): 191–202. doi:10.1136/gutjnl-2013-305490. PMID 24092861. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

I get free full text on this (at home, normal a/c) Johnbod (talk) 20:49, 16 August 2014 (UTC)

Ah, thanks! 86.157.144.73 (talk) 21:04, 16 August 2014 (UTC)

• Denlinger, CE; Thompson, RK (2012). "Molecular basis of esophageal cancer development and progression". The Surgical Clinics of North America. 92 (5): 1089–103. doi:10.1016/j.suc.2012.07.002. PMID 23026271. {{cite journal}}: Unknown parameter |month= ignored (help)
• Hardefeldt, HA; Cox, MR; Eslick, GD (2014). "Association between human papillomavirus (HPV) and oesophageal squamous cell carcinoma: a meta-analysis". Epidemiology and Infection. 142 (6): 1119–37. doi:10.1017/S0950268814000016. PMID 24721187. {{cite journal}}: Unknown parameter |month= ignored (help)
• Prabhu, A; Obi, KO; Rubenstein, JH (2014). "The synergistic effects of alcohol and tobacco consumption on the risk of esophageal squamous cell carcinoma: a meta-analysis". The American Journal of Gastroenterology. 109 (6): 822–7. doi:10.1038/ajg.2014.71. PMID 24751582. {{cite journal}}: Unknown parameter |month= ignored (help)
• Priante AV, Castilho EC, Kowalski LP (2011). "Second primary tumors in patients with head and neck cancer". Current Oncology Reports. 13 (2): 132–7. doi:10.1007/s11912-010-0147-7. PMID 21234721. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Robertson, EV; Jankowski, JA (2008). "Genetics of gastroesophageal cancer: paradigms, paradoxes, and prognostic utility". The American Journal of Gastroenterology. 103 (2): 443–9. doi:10.1111/j.1572-0241.2007.01574.x. PMID 17925001. {{cite journal}}: Unknown parameter |month= ignored (help)
• Syrjänen, K (2013). "Geographic origin is a significant determinant of human papillomavirus prevalence in oesophageal squamous cell carcinoma: systematic review and meta-analysis". Scandinavian Journal of Infectious Diseases. 45 (1): 1–18. doi:10.3109/00365548.2012.702281. PMID 22830571. {{cite journal}}: Unknown parameter |month= ignored (help)

86.157.144.73 (talk) 19:31, 10 August 2014 (UTC)

Arbitrary break

• Akhtar, S (2013). "Areca nut chewing and esophageal squamous-cell carcinoma risk in Asians: a meta-analysis of case-control studies". Cancer Causes & Control. 24 (2): 257–65. doi:10.1007/s10552-012-0113-9. PMID 23224324. {{cite journal}}: Unknown parameter |month= ignored (help)
• Alexandre L, Broughton T, Loke Y, Beales IL (2012). "Meta-analysis: risk of esophageal adenocarcinoma with medications which relax the lower esophageal sphincter". Diseases of the Esophagus. 25 (6): 535–44. doi:10.1111/j.1442-2050.2011.01285.x. PMID 22129441. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Lao-Sirieix, P; Caldas, C; Fitzgerald, RC (2010). "Genetic predisposition to gastro-oesophageal cancer". Current Opinion in Genetics & Development. 20 (3): 210–7. doi:10.1016/j.gde.2010.03.002. PMID 20347291. {{cite journal}}: Unknown parameter |month= ignored (help)

86.157.144.73 (talk) 14:10, 20 August 2014 (UTC)

Arbitrary break

• Ryan AM, Duong M, Healy L, Ryan SA, Parekh N, Reynolds JV, Power DG (2011). "Obesity, metabolic syndrome and esophageal adenocarcinoma: epidemiology, etiology and new targets". Cancer Epidemiology. 35 (4): 309–19. doi:10.1016/j.canep.2011.03.001. PMID 21470937. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

109.153.156.71 (talk) 13:44, 8 October 2014 (UTC)

• And one from me: Cowie, A; Noble, F; Underwood, T (2014 Jun). "Strategies to improve outcomes in esophageal adenocarcinoma". Expert review of anticancer therapy. 14 (6): 677–87. PMID 24621143. {{cite journal}}: Check date values in: |date= (help). Wiki CRUK John (talk) 17:36, 27 October 2014 (UTC)

• Useful perhaps: Hoppo T, Jobe BA (2013). "Personalizing therapy for esophageal cancer patients". Thoracic Surgery Clinics. 23 (4): 471–8. doi:10.1016/j.thorsurg.2013.07.001. PMID 24199697. {{cite journal}}: Unknown parameter |month= ignored (help) This paper is one of a series on the theme of "Evolving Therapies in Esophageal Carcinoma" [8], which I feel could be useful. 109.157.83.50 (talk) 14:43, 11 November 2014 (UTC)

• For a history section: Annals of Surgery: March 2009 - Volume 249 - Issue 3 - pp 535-540, doi:10.1097/01.sla.0000345936.63500.aa, Surgical Retrospection: "The Origins of an Operation: A Brief History of Transhiatal Esophagectomy" pubmed/19247045, and this

• For surgery sources: Esophagectomy: Modern surgical approaches, and TIME trial

Gallery layout

I think Keilana deserves thanks for adding in images from Cancer Research UK that are intended mainly for the non-medical subset of our general readership. I note that Keilana chose to use a gallery layout, which I feel is especially appropriate, given that not all our readers are likely to be interested in consulting or examining the detail of every image on the page. Some of these can frankly turn the stomach (as in GERD!), and some are not really illustrating the text they're positioned alongside (eg endoscopic view of Barrett esophagus in Causes, CT scans in Prevntion, histology in Management). Would greater use of the gallery format perhaps help address some of these issues here? —86.157.144.73 (talk) 12:48, 19 August 2014 (UTC)

In my art history articles I make lots of use of the one row "mini-gallery" mid-article, which Keilana has done here, and I agree it is highly suitable, especially where we have a series of T stage images (eg Endometrial cancer) or to reduce the impact of the grisly tumour shots. By the way, anyone who says this style is not accepted in Featured articles is dead wrong - that minor battle was won years ago. Ask me if you need examples. A format giving slightly larger images can be seen at eg Sculpture#Ancient_Near_East. I'm extremely grateful to Keilana for all her work adding the CRUK images, all done very nicely. Wiki CRUK John (talk) 13:34, 19 August 2014 (UTC)

Aww, thanks guys! I'm glad you like it! I'm a big fan of galleries for when there's a large series of images of tumors. :) I think I'm almost done with the CRUK images, John, and you should definitely let me know when there's another batch up. Best, Keilana|^{Parlez ici} 23:58, 19 August 2014 (UTC)

They've put up everything they have in the way of diagrams, but as more get created the plan is to upload them too, but this will be a gradual, long-term thing. Other types of images, such as infographics, will follow soonish. Wiki CRUK John (talk) 15:06, 23 August 2014 (UTC)

Arbitrary break

• I've now replaced the astonishingly grisly image in the infobox with one of the CRUK diagrams, and have used galleries to tone down unwanted effects of other photos. I'm convinced that this sort of consideration is highly relevant to our broad general readership. To give just a small personal example, I'd like to email a link to my cousin who is curious to know what I'm doing here. However, I really can't as long as it's illustrated like this. Imo, we need to remember that not all our readers have been desensitized to such stimuli by years of study. Please excuse the friendly rant. I feel it's relevant. 86.157.144.73 (talk) 15:42, 20 August 2014 (UTC)

Update

"86" and I had another good meeting at CRUK on the 22nd. The causes section is nearly done, after a lot of work by 86, and we looked at others. More soon, with some ticklish issues on which comments will be invited. We have a specialist lined up to help with the research section. I will start work on "Treatment", firstly by hiving off the over-long section on endoscopic resection to its own article. Wiki CRUK John (talk) 15:03, 23 August 2014 (UTC)

Yes, following our meeting I've now added more information to the Causes section about male predominance and obesity in EAC. We also talked about how much detail this section should go into, especially as regards risk factors for which there's only limited evidence (eg possible occupational ones, anticholinergics, etc). Personally, I feel it's long enough as it is and that this sort of information might eventually be included on a potential subpage, along with any estimates of relative risks etc. For example, I'd be quite willing to remove celiac disease, per JFW above. And it might be worth moving this and HPV [NB strain info still to be inserted] to the Research section? 86.134.200.29 (talk) 17:40, 28 August 2014 (UTC)

My intuition would be that we don't need more information on causes. A lot of publications insufficiently address confounding, and the "causation" is association at most. JFW | T@lk 19:26, 28 August 2014 (UTC)

In effect, that's an intrinsic drawback of having these sections titled "Causes" when we often, almost inevitably, need to discuss associations. If you spot any particular problems with the current wording, I'll happily do my best to address them. 86.134.200.29 (talk) 21:26, 28 August 2014 (UTC)

Adding UK stats

I'm from Cancer Research UK and going to add some UK stats to the epidemiology section complied from ONS, ISD Scotland, Welsh Cancer Intelligence and Surveillance Unit and the Northern Ireland Cancer Registry as summarized on the Cancer Research UK website. Howardstats (talk) 15:25, 3 October 2014 (UTC)

Worldwide view

I think this recent paper may help provide a worldwide view (see also discussion at WT:MED#Health statistics: US vs global). 109.153.156.71 (talk) 18:40, 16 October 2014 (UTC)

Protective factors

I'm genuinely uncertain about the wisdom of reframing the "Causes" section [9] as "Causes and protective factors" [10]. While I agree that H. Pyloris is a relevant and interesting topic, I tend to feel it was better placed under "Causes#Related conditions" [11],[12]. 109.153.156.71 (talk) 18:36, 27 October 2014 (UTC)

OT paragraph

I'm moving the following paragraph here because, as currently framed, it regards management of Barrett's esophagus /dysplasia rather than esophageal cancer as such:

Radiofrequency ablation is a new treatment modality for the treatment of Barrett's esophagus and dysplasia, and has been the subject of numerous published clinical trials. The findings demonstrate radiofrequency ablation has an efficacy of 80–90% or greater with respect to complete clearance of Barrett's esophagus and dysplasia with durability up to five years and a favorable safety profile. Recent clinical trials have shown that endoscopic resection of esophageal mucosal irregularities and nodules which contain dysplasia or carcinoma combined with subsequent radiofrequency ablation of the remaining flat Barrett's esophagus and dysplasia can effectively and safely eradicate the disease. Further, a recent multicenter randomized control trial found that in patients with Barrett's esophagus containing nodules or mucosal irregularities which contained high grade dysplasia or cancer, subsequent radiofrequency ablation resulted not only in eradication of Barrett's esophagus and dysplasia, but also had significantly less esophageal stricture versus patients who had circumferential endoscopic mucosal resection for their disease.

109.157.83.50 (talk) 14:40, 7 November 2014 (UTC) [previously 109.153.156.71 etc]

I think this sort of content, when supported by suitable MEDRS, could perhaps be reframed/refocused for the "Prevention" section (re secondary prevention). 109.157.83.50 (talk) 13:45, 8 November 2014 (UTC)

Perspective

For reasons of flow at the start of the Management section I've temporarily removed a sentence which I see was inserted by Wiki CRUK John:

A number of types and combinations of surgery, chemotherapy and radiotherapy, as well as other therapies, have been used over recent decades, but there has been no transformative improvement in outlook for patients equivalent to that seen in some other cancers.

I agree that this sort of background may be useful to many of our readers, but I'm not sure quite where this (historical) perspective about the poor overall prognosis should go. Perhaps in the lead? 109.157.83.50 (talk) 10:05, 12 November 2014 (UTC)

I would say in the prognosis / outcome section. Doc James (talk · contribs · email) 19:39, 15 November 2014 (UTC)

NEJM review

Just when you need it most: doi:10.1056/NEJMra1314530 JFW | T@lk 14:01, 25 December 2014 (UTC)

"Foodpipe" in intro?

Do we really need to describe the esophagus as the "foodpipe" in the intro? I'd rather call it a tubular structure or tube if we must. Anyone agree? BakerStMD T|C 19:01, 3 January 2015 (UTC)

After doing a little more research, i guess people actually do call it that. Painful. BakerStMD T|C 19:05, 3 January 2015 (UTC)

But comprehensible to the general reader, which is more important. That is not what most readers would find "painful" about the terminology in WP medical articles - that would be the undiluted Latinate medical jargon that flourishes despite WP:MEDMOS. Wiki CRUK John/ Johnbod (talk) 22:30, 3 January 2015 (UTC)

Hot drinks - how hot is hot?

RE [13]: Regardless of the (unfortunate imo) wording used in the 2014 WCR report, the distinction between "very hot drinks" and "hot drinks" as a whole is of obvious relevance from a public health / prevention perspective - the evidence-based aim being not to discourage people from drinking hot drinks as such, but encouraging consumption at a sensible temperature. Cheers :-) 81.153.161.114 (talk) 14:53, 3 October 2016 (UTC)

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Lancet

doi:10.1016/S0140-6736(17)31462-9 JFW | T@lk 11:10, 24 November 2017 (UTC)