Snapshot A 60-year-old man presents to the physician with a complaint of difficulty swallowing food and drinks. Initially, he only had issues with solid food, but now it has progressed to difficulty with swallowing liquids. He has smoked 2 packs of cigarettes per day for the past 35 years. An upper endoscopy is performed and shows the findings. Introduction Overview malignancy affecting the esophagus most cases of esophageal malignant tumors are due to squamous cell carcinoma and adenocarcinoma Epidemiology Incidence adenocarcinoma > squamous cell carcinoma in Western countries adenocarcinoma accounts for > 60% of all esophageal cancers in the United States squamous cell carcinoma is the predominant type of esophageal cancer worldwide Demographics most common > 50 years of age men > women Location distal esophagus adenocarcinoma middle esophagus squamous cell carcinoma Risk factors smoking associated with squamous cell carcinoma alcohol consumption associated with squamous cell carcinoma Barrett esophagus associated with adenocarcinoma gastroesophageal reflux disease associated with adenocarcinoma Presentation History patients often complain of difficulty swallowing solids that progresses to difficulty swallowing liquids Symptoms progressive dysphagia unintentional weight loss bleeding epigastric or retrosternal pain hoarseness persistent cough Physical exam typically normal exam unless the cancer has metastasized cervical or supraclavicular lymphadenopathy (indicating metastasis) Studies Upper gastrointestinal endoscopy allows for direct visualization and biopsies if a tumor is present Histology squamous cell carcinoma keratinocyte-like cells with intercellular bridges or keratinization adenocarcinoma well or moderately differentiated intestinal-type mucosa cells with well-formed tubular or papillary structures Treatment Medical chemoradiation indication stage I-III disease systemic chemotherapy with palliative care indication stage IV disease patients who are not candidates for surgery Surgical endoscopic mucosal resection indication stage I-III disease esophagectomy or esophagogastrectomy indication high-grade dysplasia in a patient with Barrett esophagus that cannot be adequately treated with endoscopic resection Complications Esophageal obstruction Metastasis distant metastasis typically to the liver, lungs, and adrenal glands Prognosis Negative factors increased grade of tumor metastasis to other areas of the body