33. Esophageal cancer

Question 1

presentation/ prognosis

Answer 1

typically with 1. progressive dysphagia ( first solid , then liquids )
2. weight loss
POOR PROGNOSIS

Question 2

types and epidiology

Answer 2

Squamous –> more common worldwide

adenocarcinoma —> more comon in America

Question 3

Causes of SCC of esophagus

Answer 3

1. alcohol
2. hot liquids
   3 caustic strictures
3. smoking
4. achalasia
5. strictures

Question 4

Causes of adenocarcinoma of esophagus

Answer 4

1. chronic gastrointestinal reflux
2. barret esophagus
3. obesity
4. smoking
5. achalasia

Question 5

risk for both adenocarcinoma and SCC of esophagus

Answer 5

1. smoking

2. achalasia ( more common SCC)

Question 6

lymph nodes that cancer of esophagus can be spread

Answer 6

upper third –> cervical
middle third —> mediastinal or trachobronchial
lower third —> celiac and gastric

Question 7

• Name at least six risk factors associated with esophageal cancer.

Answer 7

Achalasia, Alcohol, Barrett esophagus, Cigarette smoking, Diverticula, Esophageal web, Familial, Fat, GERD, Hot liquids (AABCDEFFGH)

Question 8

• A Mexican woman with dysphagia of solids now has difficulty with liquids as well. She also smokes. Which part of her esophagus is affected?

Answer 8

Likely affects the upper two-thirds of the esophagus (this is squamous cell carcinoma)

Question 9

• Worldwide, which type of esophageal cancer is most common?

Answer 9

Esophageal squamous cell carcinoma

Question 10

• A patient (native of the United States) presents with esophageal cancer. Which part of the esophagus is it most likely to affect?

Answer 10

The lower third (this is esophageal adenocarcinoma, which is more common than squamous cell esophageal cancers in the United States)

Question 11

• A patient with a history of Barrett esophagus has dysphagia for solids and liquids and weight loss. What is the likely diagnosis?

Answer 11

Esophageal adenocarcinoma

Question 12

• An alcoholic with a Zenker diverticulum has dysphagia with hot liquids. What type of esophageal cancer is he at high risk for?

Answer 12

Esophageal squamous cell cancer

Question 13

• An obese patient with a very long history of GERD has started to have dysphagia to liquids. What finding is likely on esophageal biopsy?

Answer 13

Esophageal adenocarcinoma (long history of GERD is a risk factor for Barrett esophagus, which is followed by esophageal cancer

Question 14

• A smoker presents with progressive dysphagia and weight loss in the past few months. What is his likely diagnosis?

Answer 14

Esophageal squamous cell cancer or esophageal adenocarcinoma

Question 15

• A patient with Hirschsprung disease has progressive dysphagia and other symptoms of achalasia. What type of cancer is he at high risk for?

Answer 15

Esophageal cancer