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  • • Progressive dysphagia, initially during ingestion of solid foods and later of liquids

    • Progressive weight loss and inanition

    • Classic radiographic outlines: Irregular mucosal pattern with narrowing, with shelf-like upper border or concentrically narrowed esophageal lumen

    • Definitive diagnosis established by endoscopic biopsy or cytologic studies

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Epidemiology

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  • • 1% of all malignant lesions and 6% of GI tract cancers

    • More common among men

    • Associated with alcohol and tobacco use

    • Some adenocarcinomas are an upward extension of a gastric tumor but most are related to Barrett epithelium, which has been increasing in frequency

    • Squamous cell lesions predominate in the mid esophagus; adenocarcinomas are more common in the lower third

    • Direct intramural extension from the gross margin as great as 9 cm in 10% of cases

    • -In 15% of patients, there are additional islands of tumor within 5 cm of the gross margin of the lesion

    • Metastases to lymph nodes are present at the time of diagnosis in 80% of cases

    • Extramural extension is common

    • Lung, bone, liver, and adrenal glands are frequent sites of distant metastases

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Symptoms and Signs

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  • • Dysphagia

    • Weight loss and weakness

    • Difficulty swallowing solid foods initially followed by both solids and liquids

    • Pain that may be related to swallowing

    • -If pain is constant, the tumor has probably invaded somatic structures

    • Regurgitation and aspiration

    • Coughing related to swallowing

    • Hoarseness most often reflects spread to the recurrent laryngeal nerves

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Laboratory Findings

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  • • Anemia

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Imaging Findings

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  • Chest film: A column of air or air-fluid level in the esophageal lumen

    Barium swallow

    • -Narrowing of the lumen at the site of the lesion and dilation proximally

      -Tumor appears as an irregular mass

    Esophagoscopy with biopsy: Provides a tissue diagnosis in 95% of cases

    Endoscopic US: Wall penetration and mediastinal invasion

    CT scans: Distant mediastinal and celiac axis nodal metastases

    Bronchoscopy: Distortion of the bronchial lumen, blunting of the carina, or intrabronchial tumor

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  • • Angulation of the axis of the esophagus above and below the tumor may be seen on barium swallow, a finding that strongly suggests spread of the lesion to extraesophageal sites

    • Because lesions of the upper and mid esophagus may invade the tracheobronchial tree, bronchoscopy is always indicated in the assessment of growths at these levels

    • Premalignant states

    • -Chronic iron deficiency

      -Esophageal stasis

      -Barrett esophagus

      -Reflux esophagitis

      -Congenital tylosis of the esophagus

    • Benign strictures

    • Benign papillomas, polyps, or granular cell tumors

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  • • Barium swallow

    • Esophagoscopy with biopsy

    • Endoscopic US

    • CT scan

    • Bronchoscopy

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When to Admit

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  • • Severe pain or dysphagia

    • Inability to maintain adequate enteral nutrition

    • Severe pain

    • Respiratory distress

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  • • Preoperative radiation may convert an unresectable growth to a ...

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