Esophageal Cancer

Esophageal cancer-endoscopic– Squamous cell carcinomas, which account for 60% of esophageal cancer, arise from the surface epithelium, most commonly in the middle and lower esophagus. Adenocarcinomas, which constitute the remaining 35%, arise from the gastric fundus and develop in the lower third of the esophageal tract.

Causes and Incidence

The etiology is not well defined, but risk factors associated with chronic esophageal irritation include smoking and alcohol abuse. The incidence is low in the United States, but the disease is endemic in central China and Southeast Africa, with reports of 50 cases per 100,000. This cancer is most common in older adults, with blacks affected three times as often as whites and men three times as often as women.

Disease Process

A squamous cell carcinoma begins as a small mucosal patch that grows, ulcerates, and extends into the esophageal lumen and then the recurrent laryngeal nerve and tracheobronchial tree. Extension to the aorta and other adjacent structures also occurs. Metastasis to local and abdominal lymph nodes and to most body organs follows.

Symptoms

Dysphagia is the most common presenting symptom. Regurgitation and weight loss may also occur.

Potential Complications

The prognosis is poor, with less than 5% long-term survival. Complications of advanced disease include esophageal obstruction, hemorrhage, and perforation.

Diagnostic Tests

The tumor is diagnosed with visualization on esophageal x-ray followed by esophagoscopy with a brush biopsy.

Treatments

Surgery
Resection of tumor for palliation; esophagectomy with Dacron graft replacement; esophageal dilation to aid eating.

Drugs
Preoperative systemic, cisplatinbased chemotherapy.

General
Radiation for palliation and to control pain; head of bed propped up on 4-inch blocks to prevent reflux; treatment of esophagitis.