Esophageal Cancer

(Gastroenterology 2005;128:1468-70. Am J Gastroenterol 1999;94:20-29)

DEFINITION:

EPIDEMIOLOGY:

Incidence <10/100,000
- However, the incidence of esophageal adenocarcinoma has increased sharply in U.S.
- The incidence of esophageal squamous cell cancer has decreased in U.S.

ETIOLOGIES:

Squamous cell cancer: smoking and alcohol; More common in African Americans
- World wide, squamous cell is the most common cancer of the esophagus and is related to tobacco/alcohol
Adenocarcinoma (AC): GERD, Barrett’s esophagus; More common in White Americans
- AC is the most common type of esophageal cancer in the U.S.; Incidence of cancer with BE is low (0.5% per patient year)
Obesity as an independent risk factor is quite possible
Diet: some research suggest that low intake of fresh fruits and vegetables may be risk; Fiber is protective
Tylosis: uncommon genetic disorder characterized by hyperkeratosis of the palms and soles; Autosomal dominant
- Predisposition to develop squamous esophageal cancer (prevalence can be >90% by age 65; death reported in young as 30 years)
- Surveillance endoscopy begins early; Swallowing symptoms should be evaluated promptly

CLINICAL MANIFESTATIONS/PHYSICAL EXAM:

Dysphagia 90% of patients; Odynophagia in 50% of patients
- Unfortunately, dysphagia associated with esophageal cancer usually signals an advanced stage, typically T3
Pseudoachalasia = achalasia-like symptoms produced by infiltrating cancer at the GE junction; Consider with ↓ symptom duration & weight loss

LABORATORY STUDIES:

DIAGNOSTIC STUDIES:

Aug 24, 2016 | Posted by drzezo in GASTROENTEROLOGY | Comments Off

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