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Snapshot
  • A 56-year-old man presents to the emergency department for difficulty with eating. Initially he had difficulty keeping down solid foods and now liquids. He has noticed a 25-pound unintentional weight loss. Medical history is notable for Barrett esophagus. An upper endoscopy demonstrates a distal esophageal mass, where a tissue biopsy is performed, and is notable for adenocarcinoma.
Introduction
  • Overview
    • malignancy affecting the esophagus
      • most cases of esophageal malignant tumors are due to squamous cell carcinoma and adenocarcinoma 
  • Epidemiology
    • demophraphics
      • > 50 years of age
      • men > women
    • risk factors
      • smoking and alcohol
        • associated with squamous cell carcinoma
          • typically affects the middle esophagus
      • Barrett esophagus and gastroesophageal reflux disease
        • associated with adenocarcinoma
          • typiclaly affects the distal esophagus
  • Associated conditions
    • Barrett esophagus
    • Bloom syndrome
    • Fanconi anemia
  • Prognosis
    • negative factors
      • increased grade and evidence of metastasis
Presentation
  • Symptoms
    • progressive dysphagia
  • Physical exam
    • weight loss
Imaging
  • Upper gastrointenstional endoscopy with biopsy
    • indication
      • initial study of choice in obtaining a histologic confirmation of malignancy
Differential
  • Acid reflux
    • differentiating factor
      • absence of malignancy on esophageal biopsy
Treatment
  • Treatment is dependent on the tumor's pathology, location, and evidence of metastasis
Complications
  • Esophageal obstruction
  • Dysphagia and subsequent malnourishment
  • Tracheoesophageal fistula

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