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Updated: Dec 27 2021

Esophageal Carcinoma

  • 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
  • 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
  • Prognosis
    • Negative factors
      • increased grade and evidence of metastasis
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