Esophageal Cancer Signs and Symptoms | Diagnosis | Treatments
Two types of Esophageal Cancer
- Squamous Cell Carcinoma (SCC)
- Adenocarcinoma
Epidemiology
- More Likely to occur in males (3:1)
- Onset occurs later in life (55-60)
- Geographical differences in incidence of SCC and adenocarcinoma
- Very poor prognosis with low survival rates
Esophageal Cancer | Pathogenesis
Squamous Cell Carcinoma (SCC)
- Cancer of squamous cells
- Affects upper portion of esophagus
- Mid-portion commonly affected
- Often begins as plaques or small outgrowths
Adenocarcinoma
- Affects lower 1/3 of esophagus
- Many cases due to Barrett’s esophagus
- Metaplasia of esophageal squamous cells into to gastric glandular cells
Esophageal Cancer | Risk Factors
Squamous Cell Carcinoma
- Smoking and alcohol
- Human papillomavirus (HPV)
- Diet low in fruits and vegetables
- Drinking hot liquids
- Atrophic gastritis
- Poor oral hygiene
Adenocarcinoma
- Gastroesophageal reflux disease (GERD)
- Smoking and Alcohol
- Obesity
- pylori infection
- Cholecystectomy
Esophageal Cancer | Signs & Symptoms
- Progressive dysphagia
Solids > Solids and Liquids
- Pain with Swallowing (odynophagia)
- As disease progresses, pain becomes constant
- Regurgitation
- Aspiration
- Reflux (if concurrent GERD)
- Hematemesis
- Melena
- Anemia
Constitutional Symptoms
- Fatigue
- Night Sweats
- Weight Loss
Other Signs and Symptoms
- Dry cough
- May be caused by aspiration and/or aspiration pneumonia
- Hoarseness of voice
Esophageal Cancer | Diagnosis
- Barium swallow
- May show narrowing but generally not a good test
- Endoscopy with biopsy
- Endoscopic ultrasound
- Assess for metastases
- CT scan, bone scan, PET scan
Esophageal Cancer | Treatment
- Superficial, limited to mucosa
- Endoscopic resection
- Lesions that penetrate the submucosa
- Surgical resection (esophagectomy) with lymphadenectomy (negative lymph nodes)
- Lesions invading muscularis propria with affected lymph nodes
- Surgical resection with neoadjuvant chemotherapy
- Metastatic disease
- Palliative
- Esophageal stent
- Combination therapy better than surgery alone