Cancer of the esophagus is more common in males than females and in blacks than whites. It usually appears after age 50 and is associated with lower socioeconomic status. The most common symptoms are progressive dysphagia and weight loss. By the time symptoms appear, it is usually incurable since over 60% of the esophagus is usually infiltrated. Diagnosis involves endoscopy and biopsy to visualize and confirm tumors. Treatment options include surgery, radiation, chemotherapy, or a combination, but the prognosis is generally poor with less than 5% surviving more than 5 years.

1. Cancer of the Esophagus

2. is an uncommon but extremely lethal malignancy.
more common in blacks than whites and in males
than females
appears mostly after age 50 and seems to be
associated with a lower socioeconomic status.

4. Clinical Features
10% of esophageal cancers occur in the upper third
of the esophagus (cervical esophagus)
35% in the middle third
55% in the lower third.
Progressive dysphagia and weight loss of short
duration are the initial presentation
Dysphagia initially occurs with solid foods and
gradually progresses to include semisolids and
liquids

5. By the time symptoms develop, it is usually
incurable, since difficulty in swallowing occur
when >60% of the esophageal circumference is
infiltrated with cancer
Dysphagia may be associated with: odynophagia,
pain radiating to the chest and/or back,
regurgitation or vomiting, and aspiration
pneumonia
most commonly spreads to supraclavicular lymph
nodes, liver, lungs, pleura and bone
Tracheoesophageal fistulas may develop as the
disease advances
Hypercalcemia occur in the absence of osseous
metastases, probably from parathormone-related
peptide secreted by tumor cells

6. Diagnosis
ndoscopic & cytologic screening for CA in pts with
Barrett's esophagus
Routine contrast xray : identify esophageal lesions
Esophageal carcinomas: ragged, ulcerating changes in
the mucosa with deeper infiltration, producing a
picture resembling achalasia
Smaller, resectable tumors are often poorly visualized
despite technically adequate esophagograms, therefore
esophagoscopy: to visualize the tumor & obtain
histopathologic confirmation of the diagnosis
persons at risk for SCC of esophagus has a high rate of
cancers of the lung & head and neck region 
endoscopic inspection of the larynx, trachea, and
bronchi should be done

7. Diagnosis
Exam of fundus of stomach by retroflexing the
endoscope is also needed
Endoscopic biopsies of esophagus CA fail to recover
malignant tissue in 1/3 of cases bec. biopsy forceps
cannot penetrate deeply through normal mucosa
pushed in front of the carcinoma.
 taking multiple biopsies increases the yield.
Cytologic exam of tumor brushings complements
standard biopsies and should be performed routinely.
CT scans of chest & abdo and EUS to check extent of
tumor spread to the mediastinum and para-aortic
lymph nodes
Positron emission tomography: assessment of
resectability, offering accurate information regarding
spread to mediastinal lymph nodes.

8. Treatment
Prognosis for esophageal carcinoma is poor
< 5% survive 5 years after the diagnosis
Surgical resection of all gross tumor is feasible in
only 45% of cases, with residual tumor cells
frequently present at the resection margins.
Esophagectomies is associated with a postoperative
mortality rate of 5% due to anastomotic fistulas,
subphrenic abscesses, and respiratory
complications
20% of patients who survive a total resection live 5
years.

9. Efficacy of primary radiation therapy for SCC is
similar to radical surgery, sparing patients
perioperative morbidity but resulting in less
satisfactory palliation of obstructive symptoms.
reductions in size of tumor: 15–25% of patients
given single-agent treatment and 30–60% of
patients treated with drug combinations that
include cisplatin

10. Combination chemo and radiation tx as initial
therapy either alone or ff by an attempt at
operative resection, seems to be beneficial
 When administered with radiation therapy,
chemotherapy produces a better survival outcome
than radiation therapy alone.
 The use of preoperative chemo & radio ff by
esophageal resection appears to prolong survival as
compared with controls and reports said no
additional benefit accrues when surgery is added if
significant shrinkage of tumor has been achieved by
the chemoradiation

11. Incurable, surgically unresectable esophageal
cancer: dysphagia, malnutrition, and mngt of
tracheoesophageal fistulas are major issues
Palliative mngt: repeated endoscopic dilatation,
surgical placement of a gastrostomy or
jejunostomy for hydration and feeding and
endoscopic placement of an expansive metal stent
to bypass the tumor
Endoscopic fulguration of the obstructing tumor
with lasers is the most promising of these
techniques.

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