Snapshot A 62-year-old man presents to the physician with complaint of fatigue and weight loss. His wife noted that he has looked thinner in the past few months, at which point he weighed himself and noted that he had unintentionally lost 10 pounds in the past few months. He has also had increased difficulty swallowing his food with occasionally choking. He has a history of alcohol use disorder and has smoked 1 pack of cigarettes daily for the past 40 years. An upper endoscopy is performed and demonstrates the finding seen in the image. Introduction Overview malignancy affecting the esophagus most cases of esophageal malignant tumors are due to squamous cell carcinoma and adenocarcinoma Epidemiology incidence adenocarcinoma > squamous cell carcinoma in Western countries adenocarcinoma accounts for > 60% of all esophageal cancers in the United States squamous cell carcinoma is the predominant type of esophageal cancer worldwide demographics most common > 50 years of age men > women location distal esophagus adenocarcinoma middle esophagus squamous cell carcinoma risk factors smoking associated with squamous cell carcinoma alcohol consumption associated with squamous cell carcinoma Barrett esophagus associated with adenocarcinoma gastroesophageal reflux disease associated with adenocarcinoma Plummer-Vinson syndrome associated with squamous cell carcinoma Prognosis negative factors increased grade of tumor metastasis to other areas of the body Presentation History patients often complain of difficulty swallowing solids that progresses to difficulty swallowing liquids Symptoms progressive dysphagia unintentional weight loss bleeding epigastric or retrosternal pain hoarseness persistent cough Physical exam typically normal exam unless the cancer has metastasized cervical or supraclavicular lymphadenopathy (indicating metastasis) Studies Upper gastrointestinal endoscopy allows for direct visualization and biopsies if a tumor is present Histology squamous cell carcinoma keratinocyte-like cells with intercellular bridges or keratinization adenocarcinoma well or moderately differentiated intestinal-type mucosa cells with well-formed tubular or papillary structures Differential Gastroesophageal reflux disease (GERD) differentiating factor absence of malignancy on esophageal biopsy Treatment Medical chemoradiation indication stage I-III disease systemic chemotherapy with palliative care indication stage IV disease patients who are not candidates for surgery Surgical endoscopic mucosal resection indication stage I-III disease esophagectomy or esophagogastrectomy indication high-grade dysplasia in a patient with Barrett esophagus that cannot be adequately treated with endoscopic resection Complications Esophageal obstruction Metastasis distant metastasis typically to the liver, lungs, and adrenal glands
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.ON.13.31) A 45-year-old African American male presents to his primary care physician complaining of difficulty swallowing that was initially limited to solids but has now progressed to liquids. Biopsy of the esophagus reveals dysplastic cells, but does not show evidence of glands or increased mucin. Which of the following patient behaviors most contributed to his condition? Tested Concept QID: 101088 Type & Select Correct Answer 1 Obesity 0% (0/12) 2 Smoking 75% (9/12) 3 Drinking extremely hot beverages 0% (0/12) 4 Gastroesophageal reflux disease 25% (3/12) 5 Radiation exposure in the past 6 months 0% (0/12) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept