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Updated: Dec 26 2021

Esophageal Cancer

  • 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
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