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 ETIOLOGY 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