• 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
• 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
• 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
• Weight loss and weakness
• Difficulty swallowing solid foods initially followed by both solids and liquids
• Pain that may be related to swallowing
• Regurgitation and aspiration
• Coughing related to swallowing
• Hoarseness most often reflects spread to the recurrent laryngeal nerves
• Chest film: A column of air or air-fluid level in the esophageal lumen
• Barium swallow
• 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
• 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
• Benign strictures
• Benign papillomas, polyps, or granular cell tumors
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