Esophageal Cancer

Question 1

What is the incidence of esophageal cancer?

Answer 1

◦patients > 50 years old
•adenocarcinoma tends to present in patients aged 50-60 years
•squamous cell cancer tends to present in patients aged 60-70 years

◦male to female ratio 3:1

Question 2

What is the etiology of esophageal cancer?

Answer 2

◦likely due to repeated exposure to numerous irritants (for example smoking, alcohol, chronic gastroesophageal reflux disease [GERD]) in combination with genetic predisposition.

Question 3

Subjective symptoms of esophageal cancer?

Answer 3

◦usually asymptomatic until advanced stage III or stage IV
◦symptoms may include
•progressive difficulty swallowing
•painful swallowing
•new-onset dyspepsia after age 55
•weight loss > 10% of normal weight in < 6 months
•substernal chest pain
•hiccups with sudden onset, suggesting transmural involvement in mediastinum or diaphragm

Question 4

What is objective data related to esophageal cancer?

Nutritional:

Answer 4

◦cachexia (dramatic weight loss and atrophy)
◦assess nutritional status at presentation and prior to surgery to identify or rule out malnutrition, defined as ≥ 1 of
•unintentional weight loss > 10% body weight within prior 3-6 months
•body mass index (BMI) < 20 kg/m2 and unintentional weight loss > 5% within prior 3-6 months
•BMI < 18.5 kg/m2

Question 5

What is objective data related to esophageal cancer?

HEENT?

Answer 5

HEENT: 
◦signs suggesting advanced disease
•ipsilateral Horner's syndrome (miosis, ptosis, absence of sweating on ipsilateral face and neck)
•supraclavicular adenopathy
•hoarseness 
•halitosis 
Extremities: 
◦clubbing is later sign

Question 6

What is objective data related to esophageal cancer?

Abdomen?

Answer 6

Abdomen:

◦check for epigastric swelling or mass

Question 7

What is objective data related to esophageal cancer?

Extremities

Answer 7

Extremities:

◦clubbing is later sign

Question 8

How do you diagnose esophageal cancer?

Answer 8

◦suspect esophageal cancer in
•patients aged > 55 years with new-onset dyspepsia
•patients of any age with dyspepsia and alarm symptoms of
◦gastrointestinal bleeding
◦dysphagia (pain or difficulty with swallowing)
◦unintentional weight loss
◦epigastric mass
◦persistent vomiting

Question 9

Referral if esophageal Cancer suspected:

Answer 9

◦refer patients with suspected esophageal cancer for rapid access endoscopy and biopsy
◦endoscopic biopsy necessary for diagnosis of esophageal cancer

Question 10

Follow up recommendations for esophageal cancer.

Answer 10

◦address symptoms, nutrition, and psycho-social problems