**1. Introduction**

Esophageal cancer is one of the most fatal cancers worldwide as it was ranked ninth for cancer incidence and sixth for cancer death in 2013. In 2013, there were 442,000 new cases of esopha‐ geal cancer and 440,000 deaths [1]. There are two main histologic subtypes of esophageal cancer: squamous cell carcinoma and adenocarcinoma, each one of them is related to several risk factors. Among them, modifiable lifestyle factors, such as alcohol consumption, tobacco use, and nutrition should be considered as key points in order to prevent esophageal cancer.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Excess alcohol consumption and consumption of hot food and beverages increase the risk of esophageal squamous cell carcinoma, whereas many components of Western type diet, such as red and processed meat increase the risk of esophageal adenocarcinoma [2–4]. Moreover, obesity, especially central type, and gastroesophageal reflux disease are risk factors toward developing esophageal adenocarcinoma [5, 6]. On the other hand, healthy dietary habits could be a shield against some types of esophageal cancer [7], while nutritional support could be beneficial for the management of these patients after cancer diagnosis.

Esophageal cancer is commonly associated with malnutrition and impaired nutritional intake. Nutritional management of these patients may differ according to the type of therapy and stage of disease, in order to alleviate symptoms, ameliorate nutritional status, and improve quality of life. Furthermore, cancer cachexia affects a great percentage of esophageal can‐ cer patients emerging as a significant factor the multidisciplinary team should deal with [8]. Regarding the perioperative care, the proper type of feeding (i.e. enteral/parenteral nutrition (EN/PN), immunonutrition, oral supplements, etc.) as well as the right time of feeding is a matter of controversy due to lack of consistent evidence for patients undergoing esophagec‐ tomy [9]. Special nutritional needs in the long run are also of great significance for patients with both resectable and unresectble disease, bearing in mind that the majority of these patients strive to meet their caloric and protein needs. Considering the treatment approach, nutritional screening and assessment leads to early detection of malnourished patients in need of nutritional support. Taking into account patient's specific needs helps to choose the most suitable routes of delivering nutritional support (nutritional counseling and artificial nutrition). Personalized nutritional support could modify poor nutritional status resulting in reduced postoperative complications and improved survival. Moreover, the implementation of nutritional protocols could reduce toxicity of treatment regimens and in conjunction with nutritional monitoring could have impact on patients' daily living [10]. Therefore, nutritional therapy should be an essential part of a multidisciplinary approach in the clinical setting, in order to improve short‐ and long‐term outcomes.

The aim of the current review is to focus on the etiology of malnutrition, review the various methods of nutritional assessment, and analyze the aspects of nutritional management of esophageal cancer patients as a fundamental part of multimodality therapy.
