How Has the Treatment of Esophageal Cancer Changed Since Its Discovery?

The history of surgery to treat esophageal cancer goes back to the sixth century A.D. Treatment for esophageal cancer improved significantly during the 20th century. Unfortunately, despite past and recent progress, the prognosis for this disease is often poor; the five-year mortality rate is over 85 percent. Further research is necessary to find a truly effective treatment for esophageal cancer.

Early Treatments

• Cancer was first recognized as a disease in ancient times; the term originated with the Greek physician Hippocrates in the 5th century B.C. In their search for treatments, however, Greek and Roman physicians' limited understanding of biology hampered their efforts. Surgeries for many conditions were difficult or impossible in the pre-anesthesia age. It wasn't until anesthesia became available in 1846 that surgery to treat esophageal cancer became practical. Surgical techniques advanced rapidly in the late 19th and early 20th centuries, and by the mid-20th century, surgery was a standard approach to treating many cancers--esophageal cancer among them. Today surgery is not only the oldest but also the most common treatment for this disease.

Chemotherapy

• After an accidental release of chemical warfare agents in 1943, during the Second World War, doctors noticed that some of the patients exposed to the chemicals had greatly reduced white blood cell counts--suggesting a possible method to treat some cancers. From that point forward, chemotherapy, or the use of cancer-killing drugs, grew rapidly. A drug called fluorouracil (5-FU), developed in 1957, has become a standard treatment for esophageal cancer, often in combination with a drug called cisplatin that was developed in 1965. Physicians have studied or tested various combinations of other newer drugs like paclitaxel and irinotecan, but cisplatin/5-FU remains a very common treatment for metastatic esophageal cancer.

Radiotherapy

• Radiation was first used for cancer treatment in the first decade of the 20th century, although for some time after its discovery, physicians were unaware radiation could not only treat cancer but cause it as well. Over the course of the century, doctors and researchers have discovered increasingly sophisticated techniques to maximize the dose of radiation delivered to the tumor while minimizing the dose to surrounding tissues. Today physicians can seal radioactive substances in needles, seeds or catheters and place them near the tumor when treating esophageal cancer.

Targeted Therapies

• A more recent advance is the development of "targeted therapies." Although most traditional chemotherapy drugs kill rapidly dividing cells--which include not only cancer cells but many other cells in the body as well--targeted drugs are designed to act on processes that control cell growth and could thus avoid some of the side effects associated with older chemotherapy drugs. Currently there are ongoing clinical trials for a number of monoclonal antibodies (a type of targeted therapy agent) designed to treat esophageal cancer.

Earlier Detection

• Cancers detected in the early stages are much easier to treat than those that have already spread to surrounding tissues. In other words, early diagnosis often means a better prognosis. The tools available to detect esophageal cancer in the early stages improved dramatically over the past four or five decades. Physicians now often use a medical imaging procedure called a barium swallow to reveal cancerous lesions of the esophagus. During this procedure, the patient swallows some barium sulfate (a contrast agent that absorbs x-rays) in suspension to help produce a clearer x-ray image of the upper digestive tract.