ESOPHAGEAL CARCINOMA

Question 1

Squamous cell carcinoma (5)

Answer 1

1- More common worldwide
2- Upper and middle thirds of the esophagus
3- Risk factors: smoking, alcohol, high dietary intake of nitrosamines (salted fish), achalasia, history of caustic injury to esophagus, China/Asia/Iran
4- Progressive dysphagia, weight loss, chest pain (local infiltration/food impaction), usually age >50
5- Usually present with more advanced disease, greater weight loss, and history of smoking and alcohol (overall survival of patients is 20% in 5 years)

Question 2

Adenocarcinoma (5)

Answer 2

1- More common in US
2- Lower third of esophagus
3- Risk factors: mainly Barrett’s esophagus after GERD
4- Progressive dysphagia, weight loss, chest pain (local infiltration/food impaction), usually age >50
5- Usually present healthier with less advanced disease (especially if undergoing follow-up for Barrett’s)

Question 3

Diagnosis (4)

Answer 3

1- Barium swallow (typically demonstrates a stricture with irregular filling defect)
2- CT scan: detecting metastasis (mostly to liver and lungs). PET scan more sensitive than CT to detect metastasis
3- Endoscopy: mandatory for histologic confirmation of cancer. Endoscopic ultrasound defining the depth of tumor, localizing adjacent LN’s for FNA, only if no evidence of distance mets (local staging)
4- Bronchoscopy: to rule out tracheobronchial involvement, laparoscopy (occult peritoneal disease)

Question 4

Management (3)

Answer 4

1- If tumor confined within esophageal wall: surgical resection with neoadjuvant chemotherapy with/without radiation therapy —> best chance of cure
2- Locally advanced w/out mets: chemotherapy and radiation therapy
3- If metastasis: survival is dismal, so management is usually palliative by:
- Dilation using dilators and balloon expansions
- Laser and photodynamic therapy

Question 5

Other rare cancers of the esophagus (3)

Answer 5

• GIST, carcinoid, and small cell carcinoma