Hong Kong experience

Abstract

Esophageal cancer is the sixth most common cancer in the world [1]. There has been a divergence of histological cell type between the East and West. In western countries, adenocarcinoma has increased dramatically in incidence in the past 30 years, closely related to rising prevalence of obesity, gastroesophageal reflux disease, and Barrett’s esophagus. In Asia, esophageal squamous cell carcinoma (ESCC) remains the predominant cell type; more than 80 % of esophageal cancer is squamous cell in origin. There has not been a convincing rise in incidence of true adenocarcinoma of the esophagus (Siewert type I) in Asia. In Hong Kong, ESCC accounts for more than 90 % of all esophageal cancers. In 2010, the Cancer Registry of Hong Kong identified esophageal cancer as the eighth leading cause of cancer deaths. The overall 5-year survival rate was disappointing at around 20 % only [2]. There has been advancement of technology in diagnosis, staging, and treatment of this highly lethal disease in the last few decades. In Hong Kong, more than 70 % of esophageal cancer patients are diagnosed at stage III/IV. Diagnosis at an earlier stage can improve the outcome and prognosis. Accurate staging allows optimal stage-directed therapeutic strategy. Multimodality treatment methods such as neoadjuvant chemotherapy or chemoradiation with surgery have gained popularity and outcomes have improved compared with surgical resection alone. The authors will summarize the treatment strategies and experience at The University of Hong Kong.